The Center for Medicaid and Medicare Services (CMS) has recently revised their end-stage renal disease (ESRD) Medical Evidence Report, Medicare Entitlement, and Patient Registration CMS 2728 Form. The modified algorithm calls for the use of formulae to estimate-glomerular filtration rate (GFR). The new criterion is defined as estimated GFR of less than 20 ml/min per 1.73 m2. GFR is either estimated by Schwartz formula (CSCH) in children or Modification of Diet in Renal Disease formula (CMDRD) in adults. The purpose of this communication is to test the validity of the new CMS GFR algorithm in detecting children who need renal replacement therapy. We evaluated two cohorts of children. Group I included single-center data from 626 125I-iothalamate clearance studies (CIO) that were compared with the simultaneous estimation of GFR by CSCH. Group II included data on 659 children from the patient incidence registry obtained from the ESRD Network of Texas between February 1996 and October 2003. In group I there were 76 children (76 CIO) with CSCH less than 20 ml/min per 1.73 m2 of whom 50 (67%) had CIO less than 15 ml/min per 1.73 m2. Of children with CIO less than 15 ml/min per 1.73 m2, 62% had a CSCH less than 20 ml/min per 1.73 m2. The ability of CSCH greater than 20 ml/min per 1.73m2 to predict CIO greater than 15 ml/min per 1.73 m2 (negative predictive value) is 0.95. The number of children who were started on dialysis in Texas within the study period was 659 (group II). The mean CSCH±SD was 10.8±7.7 ml/min per 1.73 m2. Of the patients who were initiated on dialysis, 94% had CSCH less than 20 ml/min per 1.73 m2. The results were sustained when race, gender, age range, and type of diagnosis were considered. The new CMS algorithm provides a good negative predictive estimate of GFR less than 15 ml/min per 1.73 m2.
- Glomerural filtration rate
- Schwartz formula
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health