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Development and Validation of a Modified Full Age Spectrum Creatinine-Based Equation to Estimate Glomerular Filtration Rate : A Cross-sectional Analysis of Pooled Data

Pottel, Hans ; Björk, Jonas LU ; Courbebaisse, Marie ; Couzi, Lionel ; Ebert, Natalie ; Eriksen, Björn O. ; Dalton, R. Neil ; Dubourg, Laurence ; Gaillard, François and Garrouste, Cyril , et al. (2021) In Annals of Internal Medicine 174(2). p.183-191
Abstract

BACKGROUND: The Chronic Kidney Disease in Children Study (CKiD) equation for children and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for adults are recommended serum creatinine (SCr)-based calculations for estimating glomerular filtration rate (GFR). However, these equations, as well as their combination, have limitations, notably the problem of implausible changes in GFR during the transition from adolescence to adulthood and overestimation of GFR in young adults. The full age spectrum (FAS) equation addresses these issues but overestimates GFR when SCr levels are low. OBJECTIVE: To develop and validate a modified FAS SCr-based equation combining design features of the FAS and CKD-EPI equations. DESIGN:... (More)

BACKGROUND: The Chronic Kidney Disease in Children Study (CKiD) equation for children and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for adults are recommended serum creatinine (SCr)-based calculations for estimating glomerular filtration rate (GFR). However, these equations, as well as their combination, have limitations, notably the problem of implausible changes in GFR during the transition from adolescence to adulthood and overestimation of GFR in young adults. The full age spectrum (FAS) equation addresses these issues but overestimates GFR when SCr levels are low. OBJECTIVE: To develop and validate a modified FAS SCr-based equation combining design features of the FAS and CKD-EPI equations. DESIGN: Cross-sectional analysis with separate pooled data sets for development and validation. SETTING: Research and clinical studies (n = 13) with measured GFR available. PATIENTS: 11 251 participants in 7 studies (development and internal validation data sets) and 8378 participants in 6 studies (external validation data set). MEASUREMENTS: Clearance of an exogenous marker (reference method), SCr level, age, sex, and height were used to develop a new equation to estimate GFR. RESULTS: The new European Kidney Function Consortium (EKFC) equation is a FAS equation with low bias (-1.2 mL/min/1.73 m2 [95% CI, -2.7 to 0.0 mL/min/1.73 m2] in children and -0.9 mL/min/1.73 m2 [CI, -1.2 to -0.5 mL/min/1.73 m2] in adults) across the FAS (2 to 90 years) and SCr range (40 to 490 µmol/L [0.45 to 5.54 mg/dL]) and with fewer estimation errors exceeding 30% (6.5% [CI, 3.8% to 9.1%] in children and 3.1% [CI, 2.5% to 3.6%] in adults) compared with the CKiD and CKD-EPI equations. LIMITATION: No Black patients were included. CONCLUSION: The new EKFC equation shows improved accuracy and precision compared with commonly used equations for estimating GFR from SCr levels. PRIMARY FUNDING SOURCE: Swedish Research Council (Vetenskapsrådet).

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type
Contribution to journal
publication status
published
subject
in
Annals of Internal Medicine
volume
174
issue
2
pages
9 pages
publisher
American College of Physicians
external identifiers
  • scopus:85102153377
  • pmid:33166224
ISSN
0003-4819
DOI
10.7326/M20-4366
language
English
LU publication?
yes
id
0e419044-d593-4a3e-9671-bbdd53b4de81
date added to LUP
2021-03-18 09:11:35
date last changed
2021-06-20 05:37:29
@article{0e419044-d593-4a3e-9671-bbdd53b4de81,
  abstract     = {<p>BACKGROUND: The Chronic Kidney Disease in Children Study (CKiD) equation for children and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for adults are recommended serum creatinine (SCr)-based calculations for estimating glomerular filtration rate (GFR). However, these equations, as well as their combination, have limitations, notably the problem of implausible changes in GFR during the transition from adolescence to adulthood and overestimation of GFR in young adults. The full age spectrum (FAS) equation addresses these issues but overestimates GFR when SCr levels are low. OBJECTIVE: To develop and validate a modified FAS SCr-based equation combining design features of the FAS and CKD-EPI equations. DESIGN: Cross-sectional analysis with separate pooled data sets for development and validation. SETTING: Research and clinical studies (n = 13) with measured GFR available. PATIENTS: 11 251 participants in 7 studies (development and internal validation data sets) and 8378 participants in 6 studies (external validation data set). MEASUREMENTS: Clearance of an exogenous marker (reference method), SCr level, age, sex, and height were used to develop a new equation to estimate GFR. RESULTS: The new European Kidney Function Consortium (EKFC) equation is a FAS equation with low bias (-1.2 mL/min/1.73 m2 [95% CI, -2.7 to 0.0 mL/min/1.73 m2] in children and -0.9 mL/min/1.73 m2 [CI, -1.2 to -0.5 mL/min/1.73 m2] in adults) across the FAS (2 to 90 years) and SCr range (40 to 490 µmol/L [0.45 to 5.54 mg/dL]) and with fewer estimation errors exceeding 30% (6.5% [CI, 3.8% to 9.1%] in children and 3.1% [CI, 2.5% to 3.6%] in adults) compared with the CKiD and CKD-EPI equations. LIMITATION: No Black patients were included. CONCLUSION: The new EKFC equation shows improved accuracy and precision compared with commonly used equations for estimating GFR from SCr levels. PRIMARY FUNDING SOURCE: Swedish Research Council (Vetenskapsrådet).</p>},
  author       = {Pottel, Hans and Björk, Jonas and Courbebaisse, Marie and Couzi, Lionel and Ebert, Natalie and Eriksen, Björn O. and Dalton, R. Neil and Dubourg, Laurence and Gaillard, François and Garrouste, Cyril and Grubb, Anders and Jacquemont, Lola and Hansson, Magnus and Kamar, Nassim and Lamb, Edmund J. and Legendre, Christophe and Littmann, Karin and Mariat, Christophe and Melsom, Toralf and Rostaing, Lionel and Rule, Andrew D. and Schaeffner, Elke and Sundin, Per Ola and Turner, Stephen and Bökenkamp, Arend and Berg, Ulla and Åsling-Monemi, Kajsa and Selistre, Luciano and Åkesson, Anna and Larsson, Anders and Nyman, Ulf and Delanaye, Pierre},
  issn         = {0003-4819},
  language     = {eng},
  number       = {2},
  pages        = {183--191},
  publisher    = {American College of Physicians},
  series       = {Annals of Internal Medicine},
  title        = {Development and Validation of a Modified Full Age Spectrum Creatinine-Based Equation to Estimate Glomerular Filtration Rate : A Cross-sectional Analysis of Pooled Data},
  url          = {http://dx.doi.org/10.7326/M20-4366},
  doi          = {10.7326/M20-4366},
  volume       = {174},
  year         = {2021},
}