Comparison of methods for determination of glomerular filtration rate in hypertensive subjects with normal serum creatinine

BACKGROUND: Glomerular filtration rate (GFR) measured through technetium-99m diethyl triamine penta-acetic acid (Tc(99m)DTPA) renal scintigraphy (rsGFR) was compared with that estimated (eGFR) from 24-h creatinine clearance (CrCl) and, using both the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulas, in a population of hypertensive subjects (HTs) with normal serum creatinine (SCr) levels. PATIENTS AND METHODS: In 200 normoalbuminuric (<30 mg/24 h) HTs 55-75 years old, without diabetes and history of coronary and cerebrovascular diseases, Pearson's correlation assess the relationship between rsGFR and eGFR. The Bland-Altman method was used to assess the agreement between rsGFR and eGFR, separately in subjects with low (<60 ml/min/1.73 m(2)) and normal (≥60 ml/min/1.73 m(2)) rsGFR. The span between -1.96 and +1.96 standard deviations of mean difference (bias) was calculated and used for this purpose. RESULTS: In 76 subjects, an unknown low renal function was found by Tc(99m)DTPA renal scintigraphy. In subjects with normal rsGFR the Bland-Altman analysis showed that the smallest span between rsGFR and eGFR was evident for ClCr values (26.0 ml/min/1.73 m(2)), whereas higher values were detected with the CG and MDRD formulas (41.0 and 40.4 ml/min/1.73 m(2), respectively). The same results were observed for low rsGFR, where a smaller span was found for ClCr (21.2 ml/min/1.73 m(2)), whereas CG and MDRD methods gave greater results (30.4 and 31.8 ml/min/1.73 m(2) respectively); no differences were found between genders. The degree of agreement for eGFR estimated with the CG and MDRD formulas was wider than that derived from ClCr, reflecting a greater between-methods variability and a considerable discrepancy of rsGFR values in the former than in the latter. CONCLUSIONS: In HTs with normal SCr values, Tc(99m)DTPA renal scintigraphy discovered un known renal organ damage in 38% of cases. If this methodology is not available, ClCr measurement should be preferred to estimate GFR whereas CG and MDRD formulas are of limited efficacy.