BMI, eGFR, CrCl....outdated calculations?

BMI, eGFR, CrCl....all measurements used to analyze and categorize a patient's health in order to fit them into a specific treatment or dosing algorithm. Despite their longstanding use within the medical community, there have been countless claims stating that these calculations are not only inaccurate, but, at times, a false representation of a patient's health status. So why are they still being used?

The body max index math or BMI was first coined in 1972 by a scientist named Ancel Keys who wanted to aid the government in developing a centralized method to monitor health risks among Americans. Today, it is still being used as a major indicator among medical professionals as well as a tool among the federal government to track obesity rates within the United States. According to the CDC, approximately 42.4% of Americans aged 20 years and older are considered obese, a statistic that has steadily risen over several decades. As more studies have been conducted regarding the relevance and accuracy of BMI in healthcare practice, it has become more and more evident that it has several flaws and imperfections. The biggest reason why BMI has been under scrutiny is because it doesn't distinguish between muscle and fat. From a visual perspective, a healthcare professional would be able to assess whether or not a patient's BMI is accurate but nevertheless, it doesn't accurately predict when a patient's weight could lead to several comorbidities. Another discrepancy with using BMI is that there are racial groups that are misrepresented when using this health status indicator. For example, the Asian and African American population is known to have with rather larger BMI measurements than their white counterparts. 

 The Cockcroft Gault and MDRD equations are formulas used to estimate renal function in order to determine appropriate medication dosing for a patient. Both equations came to be in the late 1900s (1970s-1999s) but according to a 2016 study conducted by the Saudi Journal of Kidney Diseases and Transplantations, the MDRD equation was 48.8% accurate, the CG equation was 41.5% accurate, and the CKD-EPI equation was 78.2% accurate.  Despite the higher accuracy with the MDRD equation, the Cockcroft-Gault equation is more widely used than the latter. The biggest risk that presents from using Cockcroft-Gault over the MDRD equation is the misclassification of patient's renal function or renal disease which could lead to several downstream health risks and complications.  Another issue with the Cockcroft Gault equation is the fact that it was developed using white people as their subject matter yet this equation is being adopted across all populations. African Americans are known to have higher body masses and creatinine generation and despite efforts to try and adjust for this difference (using the ethnic factor of 1.21), the medical community has thought to consider race if a new equation were to be created. 

Overall, these three health indicators have several inconsistencies despite their wide use in today's medical practice but if these inconsistencies were taught in professional schools and reinforced within health system's, there could be a newfound awareness that could positively impact healthcare outcomes. 


Idrees, MuhammadKhalid, et al. “Accuracy of GFR Estimation Formula in Determination of Glomerular Filtration Rate in Kidney Donors: Comparison with 24 h Urine Creatinine Clearance.” Saudi Journal of Kidney Diseases and Transplantation, vol. 27, no. 2, 2016, p. 320., doi:10.4103/1319-2442.178551.

Lemond, Angela, et al. “BMI Flaws, History, and Other Ways to Measure Body Weight and Fat: Everyday Health.” EverydayHealth.com, www.everydayhealth.com/diet-nutrition/bmi/bmi-flaws-history-other-ways-measure-body-weight/.

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