Comparison of Creatinine Clearance Estimates with Routine Measured Clearance in Adult Jordanians

Ayman M. Wahbeh, Mohamed H. Ewais, Mohamad E. Elsharif


Aims: To determine the correlation between endogenous creatinine clearance, the Modification of Diet
in Renal Disease and Cockcroft–Gault equations, and to examine agreement between these methods.
Material and Method: Creatinine clearance measured by 24-hour urine creatinine in patients with
chronic kidney disease was compared with estimated clearance using the Cockcroft–Gault and
Modification of Diet in Renal Disease equations. Correlation, regression analysis, limits of agreement
and concordance analysis were used.
Results: There was a positive correlation between both the Cockroft-Gault (r=0.931, p<0.001) and the
Modification of Diet in Renal Disease (r=0.741, p<0.001) equations with creatinine clearance; the
former being statistically superior (P = 0.0073) comparing the correlation coefficients. Using Bland-
Altman method, there was better agreement with the Cockcroft–Gault formula where the limits of
agreement were (-10.1 to +11.2) compared with (-22.8 to +18.5) for the Modification of Diet in Renal
Disease. Concordance analysis showed a concordance correlation coefficient of 0.938 (95% CI, 0.89-
0.97) for Cockroft-Gault and 0.713 (95% CI, 0.55-0.82) for Modification of Diet in Renal Disease.
Pearson р coefficient (precision) and bias correlation factor Cb (accuracy) of Cockcroft–Gault were
0.939, 0.998 and of Modification of Diet in Renal Disease they were 0.713 and 0.947, respectively.
Conclusions: In Jordanian patients, the Cockcroft–Gault equation had a superior performance in the
estimate of creatinine clearance compared to the Modification of Diet in Renal Disease equation. Further
studies to evaluate these formulae with larger number of patients and using a gold standard method are
needed. In the meantime, we suggest using the Cockcroft–Gault equation in patients with a moderate-tosevere
chronic renal failure.


Creatinine, Clearance, Cokroft-Gault, MDRD, Jordan.

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