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The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula was first published in May 2009. It was developed in an effort to create a formula more accurate than the MDRD formula, especially when actual GFR is greater than 60 mL/min per 1.73 m 2. This is the formula currently recommended by NICE in the UK. [27]
The normal range of GFR, adjusted for body surface area, is 100–130 average 125 (mL/min)/(1.73 m 2) in men and 90–120 (mL/min)/(1.73 m 2) in women younger than the age of 40. In children, GFR measured by inulin clearance is 110 (mL/min)/(1.73 m 2 ) until 2 years of age in both sexes, and then it progressively decreases.
Other studies have found that in patients with an impaired renal function, women have lower and blacks have higher cystatin C levels for the same GFR. [89] For example, the cut-off values of cystatin C for CKD for a 60-year-old white women would be 1.12 mg/L and 1.27 mg/L in a black man (a 13% increase).
In renal physiology, the filtration fraction is the ratio of the glomerular filtration rate (GFR) over the renal plasma flow (RPF). Filtration Fraction, FF = GFR/RPF, or =. The filtration fraction, therefore, represents the proportion of the fluid reaching the kidneys that passes into the renal tubules. It is normally about 20%.
Algorithms to estimate GFR from creatinine concentration and other parameters are discussed in the renal function article. Unfortunately, the MDRD Study equation was developed in people with chronic kidney disease, and its major limitations are imprecision and systematic underestimation of measured GFR (bias) at higher/normal values. [20]
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Diagram showing the basic physiologic mechanisms of the kidney. The kidney's ability to perform many of its functions depends on the three fundamental functions of filtration, reabsorption, and secretion, whose sum is called renal clearance or renal excretion.