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Extending the Lund-Malmö creatinine-based GFR equation to cystatin C–validation results from the European Kidney Function Consortium (EKFC) cohort of children and adults

Björk, Jonas LU orcid ; Nyman, Ulf LU ; Berg, Ulla ; Bökenkamp, Arend ; Cavalier, Etienne ; Ebert, Natalie ; Eriksen, Björn O. ; Derain Dubourg, Laurence ; Goffin, Karolien and Grubb, Anders LU orcid , et al. (2024) In Scandinavian Journal of Clinical and Laboratory Investigation 84(7-8). p.577-583
Abstract

The aim of the present study was to extend the creatinine-based Lund-Malmö GFR equation for use with rescaled cystatin C (r-LMRCys) and validate it against measured GFR (mGFR) in the EKFC cystatin C cohort of children (n = 2,293) and adults (n = 7,727). Rescaling was obtained by dividing each biomarker by a Q-value, representing the population-specific median biomarker level among healthy individuals. Validation included median bias/precision/accuracy (percent estimates within ±30% of mGFR, P30). Performance was compared with the EKFC-equation (EKFCCys), the CAPA cystatin C equation, the corresponding equations based on rescaled creatinine (r-LMRCr and EKFCCr) and the arithmetic... (More)

The aim of the present study was to extend the creatinine-based Lund-Malmö GFR equation for use with rescaled cystatin C (r-LMRCys) and validate it against measured GFR (mGFR) in the EKFC cystatin C cohort of children (n = 2,293) and adults (n = 7,727). Rescaling was obtained by dividing each biomarker by a Q-value, representing the population-specific median biomarker level among healthy individuals. Validation included median bias/precision/accuracy (percent estimates within ±30% of mGFR, P30). Performance was compared with the EKFC-equation (EKFCCys), the CAPA cystatin C equation, the corresponding equations based on rescaled creatinine (r-LMRCr and EKFCCr) and the arithmetic mean of r-LMRCr and CAPA (r-LMRCr+CAPA), r-LMRCr and r-LMRCys (r-LMRMean), and EKFCCr and EKFCCys (EKFCMean). The overall P30 of r-LMRCys in adults was 86.2% (95% CI 85.4%-86.9%), which was 6.6 percentage points (pp; 95% CI 5.8–7.4 pp) higher than for CAPA and similar to r-LMRCr (P30 87.4%, 95% CI 86.6%−88.1%). r-LMRCys and EKFCCys exhibited similar performance both overall and across subgroups of age, sex, GFR and BMI and in children. All three arithmetic mean equations had similar P30-accuracy and generally performed better than the corresponding single-marker equations. Our results show that the Lund-Malmö GFR equation can be adapted for use with rescaled cystatin C with performance that is similar to the best-performing equations based on rescaled creatinine. The generality of the applied biomarker rescaling principle implies that the future demand for population- and biomarker-specific GFR estimating equations can be expected to decrease substantially.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
chronic kidney disease, creatinine, cystatin C, Glomerular filtration rate, kidney function tests
in
Scandinavian Journal of Clinical and Laboratory Investigation
volume
84
issue
7-8
pages
7 pages
publisher
Informa Healthcare
external identifiers
  • scopus:85214379900
  • pmid:39773180
ISSN
0036-5513
DOI
10.1080/00365513.2024.2441280
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
id
142dd043-f22f-4f1d-a218-88a4c5ae619a
date added to LUP
2025-03-27 12:33:49
date last changed
2025-07-03 19:32:11
@article{142dd043-f22f-4f1d-a218-88a4c5ae619a,
  abstract     = {{<p>The aim of the present study was to extend the creatinine-based Lund-Malmö GFR equation for use with rescaled cystatin C (r-LMR<sub>Cys</sub>) and validate it against measured GFR (mGFR) in the EKFC cystatin C cohort of children (n = 2,293) and adults (n = 7,727). Rescaling was obtained by dividing each biomarker by a Q-value, representing the population-specific median biomarker level among healthy individuals. Validation included median bias/precision/accuracy (percent estimates within ±30% of mGFR, P<sub>30</sub>). Performance was compared with the EKFC-equation (EKFC<sub>Cys</sub>), the CAPA cystatin C equation, the corresponding equations based on rescaled creatinine (r-LMR<sub>Cr</sub> and EKFC<sub>Cr</sub>) and the arithmetic mean of r-LMR<sub>Cr</sub> and CAPA (r-LMR<sub>Cr</sub>+CAPA), r-LMR<sub>Cr</sub> and r-LMR<sub>Cys</sub> (r-LMR<sub>Mean</sub>), and EKFC<sub>Cr</sub> and EKFC<sub>Cys</sub> (EKFC<sub>Mean</sub>). The overall P<sub>30</sub> of r-LMR<sub>Cys</sub> in adults was 86.2% (95% CI 85.4%-86.9%), which was 6.6 percentage points (pp; 95% CI 5.8–7.4 pp) higher than for CAPA and similar to r-LMR<sub>Cr</sub> (P<sub>30</sub> 87.4%, 95% CI 86.6%−88.1%). r-LMR<sub>Cys</sub> and EKFC<sub>Cys</sub> exhibited similar performance both overall and across subgroups of age, sex, GFR and BMI and in children. All three arithmetic mean equations had similar P<sub>30</sub>-accuracy and generally performed better than the corresponding single-marker equations. Our results show that the Lund-Malmö GFR equation can be adapted for use with rescaled cystatin C with performance that is similar to the best-performing equations based on rescaled creatinine. The generality of the applied biomarker rescaling principle implies that the future demand for population- and biomarker-specific GFR estimating equations can be expected to decrease substantially.</p>}},
  author       = {{Björk, Jonas and Nyman, Ulf and Berg, Ulla and Bökenkamp, Arend and Cavalier, Etienne and Ebert, Natalie and Eriksen, Björn O. and Derain Dubourg, Laurence and Goffin, Karolien and Grubb, Anders and Hansson, Magnus and Lemoine, Sandrine and Littmann, Karin and Mariat, Christophe and Melsom, Toralf and Schaeffner, Elke and Sundin, Per Ola and Åsling-Monemi, Kajsa and Delanaye, Pierre and Pottel, Hans and Larsson, Anders}},
  issn         = {{0036-5513}},
  keywords     = {{chronic kidney disease; creatinine; cystatin C; Glomerular filtration rate; kidney function tests}},
  language     = {{eng}},
  number       = {{7-8}},
  pages        = {{577--583}},
  publisher    = {{Informa Healthcare}},
  series       = {{Scandinavian Journal of Clinical and Laboratory Investigation}},
  title        = {{Extending the Lund-Malmö creatinine-based GFR equation to cystatin C–validation results from the European Kidney Function Consortium (EKFC) cohort of children and adults}},
  url          = {{http://dx.doi.org/10.1080/00365513.2024.2441280}},
  doi          = {{10.1080/00365513.2024.2441280}},
  volume       = {{84}},
  year         = {{2024}},
}