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Accuracy of GFR estimating equations based on creatinine, cystatin C or both in routine care

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Title: Accuracy of GFR estimating equations based on creatinine, cystatin C or both in routine care
Authors: Fu, Edouard L, Levey, Andrew S, Coresh, Josef, Grams, Morgan E, Faucon, Anne-Laure, Elinder, Carl-Gustaf, Dekker, Friedo W, Delanaye, Pierre, Inker, Lesley A, Carrero, Juan-Jesus
Contributors: Swedish Research Council, DKF - Dutch Kidney Foundation, NWO - Netherlands Organisation for Scientific Research, KI - Karolinska Institute, HAL UVSQ, Équipe, Brigham and Women's Hospital Boston, Harvard Medical School Boston (HMS), Karolinska Institute, Leiden University Medical Center (LUMC), Universiteit Leiden = Leiden University, Tufts Medical Center Boston, Johns Hopkins Bloomberg School of Public Health Baltimore, Johns Hopkins University (JHU), New York University School of Medicine (NYU Grossman School of Medicine), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Karolinska University Hospital Stockholm, Université de Liège = University of Liège = Universiteit van Luik = Universität Lüttich (ULiège), Centre Hospitalier Universitaire Sart Tilman (CHU Sart Tilman), Université de Liège = University of Liège = Universiteit van Luik = Universität Lüttich (ULiège)-Centre Hospitalier Universitaire de Liège (CHU-Liège), Hôpital Universitaire Carémeau Nîmes (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Danderyds sjukhus = Danderyd University Hospital, Vetenskapsrådet, Karolinska Institutet, Nederlandse Organisatie voor Wetenschappelijk Onderzoek, Nierstichting
Source: Nephrology Dialysis Transplantation. 39:694-706
Publisher Information: Oxford University Press (OUP), 2023.
Publication Year: 2023
Subject Terms: Adult, Male, [SDV]Life Sciences [q-bio], CKD-EPI, Urologie & néphrologie, Sciences de la santé humaine, cystatin C, Neoplasms, Humans, Urology & nephrology, Human health sciences, Cystatin C, Renal Insufficiency, Chronic, Child, Renal Insufficiency, Chronic/epidemiology, EKFC, glomerular filtration rate, Transplantation, Liver Diseases, creatinine, Middle Aged, 3. Good health, [SDV] Life Sciences [q-bio], Cross-Sectional Studies, Nephrology, Creatinine, Female, Glomerular Filtration Rate
Description: Background New equations to estimate glomerular filtration rate based on creatinine (eGFRcr), cystatin C (eGFRcys) or both (eGFRcr-cys) have been developed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and the European Kidney Function Consortium (EKFC). There is a need to evaluate the performance of these equations in diverse European settings to inform implementation decisions, especially among people with key comorbid conditions. Methods We performed a cross-sectional study including 6174 adults referred for single-point plasma clearance of iohexol in Stockholm, Sweden, with 9579 concurrent measurements of creatinine and cystatin C. We assessed the performance of the CKD-EPI 2009/2012/2021, EKFC 2021/2023, revised Lund-Malmö (RLM) 2011 and Caucasian, Asian, Pediatric and Adult (CAPA) 2014 equations against measured GFR (mGFR). Results Mean age was 56 years, median mGFR was 62 mL/min/1.73 m2 and 40% were female. Comorbid conditions were common: cardiovascular disease (30%), liver disease (28%), diabetes (26%) and cancer (26%). All eGFRcr-cys equations had small bias and P30 (the percentage of estimated values within 30% of mGFR) close to 90%, and performed better than eGFRcr or eGFRcys equations. Among eGFRcr equations, CKD-EPI 2009 and CKD-EPI 2021 showed larger bias and lower P30 than EKFC 2021 and RLM. There were no meaningful differences in performance across eGFRcys equations. Findings were consistent across comorbid conditions, and eGFRcr-cys equations showed good performance in patients with liver disease, cancer and heart failure. Conclusions In conclusion, eGFRcr-cys equations performed best, with minimal variation among equations in this Swedish cohort. The lower performance of CKD-EPI eGFRcr equations compared with EKFC and RLM may reflect differences in population characteristics and mGFR methods. Implementing eGFRcr equations will require a trade-off between accuracy and uniformity across regions.
Document Type: Article
File Description: application/pdf
Language: English
ISSN: 1460-2385
0931-0509
DOI: 10.1093/ndt/gfad219
Access URL: https://pubmed.ncbi.nlm.nih.gov/37813817
https://hdl.handle.net/1887/3720805
Rights: OUP Standard Publication Reuse
Accession Number: edsair.doi.dedup.....79d60cf9757ce5f9c26f8cb0eac7ff61
Database: OpenAIRE
Description
Abstract:Background New equations to estimate glomerular filtration rate based on creatinine (eGFRcr), cystatin C (eGFRcys) or both (eGFRcr-cys) have been developed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and the European Kidney Function Consortium (EKFC). There is a need to evaluate the performance of these equations in diverse European settings to inform implementation decisions, especially among people with key comorbid conditions. Methods We performed a cross-sectional study including 6174 adults referred for single-point plasma clearance of iohexol in Stockholm, Sweden, with 9579 concurrent measurements of creatinine and cystatin C. We assessed the performance of the CKD-EPI 2009/2012/2021, EKFC 2021/2023, revised Lund-Malmö (RLM) 2011 and Caucasian, Asian, Pediatric and Adult (CAPA) 2014 equations against measured GFR (mGFR). Results Mean age was 56 years, median mGFR was 62 mL/min/1.73 m2 and 40% were female. Comorbid conditions were common: cardiovascular disease (30%), liver disease (28%), diabetes (26%) and cancer (26%). All eGFRcr-cys equations had small bias and P30 (the percentage of estimated values within 30% of mGFR) close to 90%, and performed better than eGFRcr or eGFRcys equations. Among eGFRcr equations, CKD-EPI 2009 and CKD-EPI 2021 showed larger bias and lower P30 than EKFC 2021 and RLM. There were no meaningful differences in performance across eGFRcys equations. Findings were consistent across comorbid conditions, and eGFRcr-cys equations showed good performance in patients with liver disease, cancer and heart failure. Conclusions In conclusion, eGFRcr-cys equations performed best, with minimal variation among equations in this Swedish cohort. The lower performance of CKD-EPI eGFRcr equations compared with EKFC and RLM may reflect differences in population characteristics and mGFR methods. Implementing eGFRcr equations will require a trade-off between accuracy and uniformity across regions.
ISSN:14602385
09310509
DOI:10.1093/ndt/gfad219