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Clinical Chemistry and Laboratory Medicine (CCLM)

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Volume 52, Issue 6


The revised Lund-Malmö GFR estimating equation outperforms MDRD and CKD-EPI across GFR, age and BMI intervals in a large Swedish population

Ulf Nyman
  • Corresponding author
  • Department of Diagnostic Radiology, Lund University, Lasarettet Trelleborg, 231 52 Trelleborg, Sweden
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Anders Grubb / Anders Larsson / Lars-Olof Hansson / Mats Flodin / Gunnar Nordin / Veronica Lindström / Jonas Björk
  • R&D Centre Skåne, Skåne University Hospital, Lund, Sweden
  • Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2013-12-12 | DOI: https://doi.org/10.1515/cclm-2013-0741


Background: The performance of creatinine-based glomerular filtration rate (GFR) estimating equations may vary in subgroups defined by GFR, age and body mass index (BMI). This study compares the performance of the Modification of Diet in Renal Disease (MDRD) study and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations with the revised Lund-Malmö equation (LM Revised), a new equation that can be expected to handle changes in GFR across the life span more accurately.

Methods: The study included 3495 examinations in 2847 adult Swedish patients referred for measurement of GFR (mGFR) 2008–2010 by plasma clearance of iohexol (median 52 mL/min/1.73 m2). Bias, precision [interquartile range (IQR)] and accuracy [percentage of estimates ±10% (P10) and ±30% (P30) of mGFR] were compared.

Results: The overall results of LM Revised/MDRD/CKD-EPI were: median bias 2%/8%/11%, IQR 12/14/14 mL/min/1.73 m2, P10 40%/35%/35% and P30 84%/75%/76%. LM Revised was the most stable equation in terms of bias, precision and accuracy across mGFR, age and BMI intervals irrespective of gender. MDRD and CKD-EPI overestimated mGFR in patients with decreased kidney function, young adults and elderly. All three equations overestimated mGFR and had low accuracy in patients with BMI <20 kg/m2, most pronounced among men.

Conclusions: In settings similar to the investigated cohort LM Revised should be preferred to MDRD and CKD-EPI due to its higher accuracy and more stable performance across GFR, age and BMI intervals.

This article offers supplementary material which is provided at the end of the article.

Keywords: creatinine; glomerular filtration rate; kidney disease; kidney function tests; renal insufficiency


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About the article

Corresponding author: Ulf Nyman, MD, PhD, Department of Diagnostic Radiology, Lund University, Lasarettet Trelleborg, 231 52 Trelleborg, Sweden, Phone: +46 76 8871133/+46 733 842244, Fax: +46 410 15983, E-mail:

Received: 2013-09-05

Accepted: 2013-11-18

Published Online: 2013-12-12

Published in Print: 2014-06-01

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 52, Issue 6, Pages 815–824, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2013-0741.

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