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GFR estimation based on standardized creatinine and cystatin C : A European multicenter analysis in older adults

Björk, Jonas LU ; Bäck, Sten Erik LU ; Ebert, Natalie; Evans, Marie; Grubb, Anders LU ; Hansson, Magnus; Jones, Ian; Lamb, Edmund J.; Martus, Peter and Schaeffner, Elke, et al. (2017) In Clinical Chemistry and Laboratory Medicine
Abstract

Although recommended by the Kidney Disease Improving Global Outcomes, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICR) creatinine equation was not targeted to estimate glomerular filtration rate (eGFR) among older adults. The Berlin Initiative Study (BIS1CR) equation was specifically developed in older adults, and the Lund-Malmö revised (LMRCR) and the Full Age Spectrum (FASCR) equations have shown promising results in older adults. Our aim was to validate these four creatinine equations, including addition of cystatin C in a large multicenter cohort of Europeans ≥70 years. A total of 3226 individuals (2638 with cystatin C) underwent GFR measurement (mGFR; median, 44... (More)

Although recommended by the Kidney Disease Improving Global Outcomes, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICR) creatinine equation was not targeted to estimate glomerular filtration rate (eGFR) among older adults. The Berlin Initiative Study (BIS1CR) equation was specifically developed in older adults, and the Lund-Malmö revised (LMRCR) and the Full Age Spectrum (FASCR) equations have shown promising results in older adults. Our aim was to validate these four creatinine equations, including addition of cystatin C in a large multicenter cohort of Europeans ≥70 years. A total of 3226 individuals (2638 with cystatin C) underwent GFR measurement (mGFR; median, 44 mL/min/1.73 m2) using plasma iohexol clearance. Bias, precision (interquartile range [IQR]), accuracy (percent of estimates ±30% of mGFR, P30), eGFR accuracy diagrams and probability diagrams to classify mGFR<45 mL/min/1.73 m2 were compared. The overall results of BIS1CR/CKD-EPICR/FASCR/LMRCR were as follows: median bias, 1.7/3.6/0.6/-0.7 mL/min/1.73 m2; IQR, 11.6/12.3/11.1/10.5 mL/min/1.73 m2; and P30, 77.5%/76.4%/80.9%/83.5% (significantly higher for LMR, p<0.001). Substandard P30 (<75%) was noted for all equations at mGFR<30 mL/min/1.73 m2, and at body mass index values <20 and ≥35 kg/m2. LMRCR had the most stable performance across mGFR subgroups. Only LMRCR and FASCR had a relatively constant small bias across eGFR levels. Probability diagrams exhibited wide eGFR intervals for all equations where mGFR<45 could not be confidently ruled in or out. Adding cystatin C improved P30 accuracy to 85.7/86.8/85.7/88.7 for BIS2CR+CYS/CKD-EPICR+CYS/FASCR+CYS/MEANLMR+CAPA. LMRCR and FASCR seem to be attractive alternatives to CKD-EPICR in estimating GFR by creatinine-based equations in older Europeans. Addition of cystatin C leads to important improvement in estimation performance.

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epub
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keywords
chronic kidney disease, creatinine, cystatin C, glomerular filtration rate, kidney function tests, renal failure
in
Clinical Chemistry and Laboratory Medicine
publisher
De Gruyter
external identifiers
  • scopus:85037683717
ISSN
1437-4331
DOI
10.1515/cclm-2017-0563
language
English
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yes
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5cf4358a-809b-48f6-8218-8f07e53f7ad6
date added to LUP
2018-01-11 13:09:45
date last changed
2018-01-12 03:00:02
@article{5cf4358a-809b-48f6-8218-8f07e53f7ad6,
  abstract     = {<p>Although recommended by the Kidney Disease Improving Global Outcomes, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI<sub>CR</sub>) creatinine equation was not targeted to estimate glomerular filtration rate (eGFR) among older adults. The Berlin Initiative Study (BIS1<sub>CR</sub>) equation was specifically developed in older adults, and the Lund-Malmö revised (LMR<sub>CR</sub>) and the Full Age Spectrum (FAS<sub>CR</sub>) equations have shown promising results in older adults. Our aim was to validate these four creatinine equations, including addition of cystatin C in a large multicenter cohort of Europeans ≥70 years. A total of 3226 individuals (2638 with cystatin C) underwent GFR measurement (mGFR; median, 44 mL/min/1.73 m<sup>2</sup>) using plasma iohexol clearance. Bias, precision (interquartile range [IQR]), accuracy (percent of estimates ±30% of mGFR, P<sub>30</sub>), eGFR accuracy diagrams and probability diagrams to classify mGFR&lt;45 mL/min/1.73 m<sup>2</sup> were compared. The overall results of BIS1<sub>CR</sub>/CKD-EPI<sub>CR</sub>/FAS<sub>CR</sub>/LMR<sub>CR</sub> were as follows: median bias, 1.7/3.6/0.6/-0.7 mL/min/1.73 m<sup>2</sup>; IQR, 11.6/12.3/11.1/10.5 mL/min/1.73 m<sup>2</sup>; and P<sub>30</sub>, 77.5%/76.4%/80.9%/83.5% (significantly higher for LMR, p&lt;0.001). Substandard P<sub>30</sub> (&lt;75%) was noted for all equations at mGFR&lt;30 mL/min/1.73 m<sup>2</sup>, and at body mass index values &lt;20 and ≥35 kg/m<sup>2</sup>. LMR<sub>CR</sub> had the most stable performance across mGFR subgroups. Only LMR<sub>CR</sub> and FAS<sub>CR</sub> had a relatively constant small bias across eGFR levels. Probability diagrams exhibited wide eGFR intervals for all equations where mGFR&lt;45 could not be confidently ruled in or out. Adding cystatin C improved P<sub>30</sub> accuracy to 85.7/86.8/85.7/88.7 for BIS2<sub>CR+CYS</sub>/CKD-EPI<sub>CR+CYS</sub>/FAS<sub>CR+CYS</sub>/MEAN<sub>LMR+CAPA</sub>. LMR<sub>CR</sub> and FAS<sub>CR</sub> seem to be attractive alternatives to CKD-EPI<sub>CR</sub> in estimating GFR by creatinine-based equations in older Europeans. Addition of cystatin C leads to important improvement in estimation performance.</p>},
  author       = {Björk, Jonas and Bäck, Sten Erik and Ebert, Natalie and Evans, Marie and Grubb, Anders and Hansson, Magnus and Jones, Ian and Lamb, Edmund J. and Martus, Peter and Schaeffner, Elke and Sjöström, Per and Nyman, Ulf},
  issn         = {1437-4331},
  keyword      = {chronic kidney disease,creatinine,cystatin C,glomerular filtration rate,kidney function tests,renal failure},
  language     = {eng},
  publisher    = {De Gruyter},
  series       = {Clinical Chemistry and Laboratory Medicine},
  title        = {GFR estimation based on standardized creatinine and cystatin C : A European multicenter analysis in older adults},
  url          = {http://dx.doi.org/10.1515/cclm-2017-0563},
  year         = {2017},
}