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

Björk, Jonas; Bäck, Sten Erik; Ebert, Natalie; Evans, Marie; Grubb, Anders; Hansson, Magnus; Jones, Ian; Lamb, Edmund J.; Martus, Peter; Schaeffner, Elke; Sjöström, Per; Nyman, Ulf

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

Mark

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. (2018) In Clinical Chemistry and Laboratory Medicine 56(3). p.422-435

Abstract: Although recommended by the Kidney Disease Improving Global Outcomes, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI_CR) creatinine equation was not targeted to estimate glomerular filtration rate (eGFR) among older adults. The Berlin Initiative Study (BIS1_CR) equation was specifically developed in older adults, and the Lund-Malmö revised (LMR_CR) and the Full Age Spectrum (FAS_CR) 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-EPI_CR) creatinine equation was not targeted to estimate glomerular filtration rate (eGFR) among older adults. The Berlin Initiative Study (BIS1_CR) equation was specifically developed in older adults, and the Lund-Malmö revised (LMR_CR) and the Full Age Spectrum (FAS_CR) 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 BIS1_CR/CKD-EPI_CR/FAS_CR/LMR_CR 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. LMR_CR had the most stable performance across mGFR subgroups. Only LMR_CR and FAS_CR 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 BIS2_CR+CYS/CKD-EPI_CR+CYS/FAS_CR+CYS/MEAN_LMR+CAPA. LMR_CR and FAS_CR seem to be attractive alternatives to CKD-EPI_CR 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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Please use this url to cite or link to this publication: https://lup.lub.lu.se/record/5cf4358a-809b-48f6-8218-8f07e53f7ad6

author

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. (More)

Björk, Jonas ^LU ; Bäck, Sten Erik ^LU ; Ebert, Natalie ; Evans, Marie ; Grubb, Anders ^LU

; Hansson, Magnus ; Jones, Ian ; Lamb, Edmund J. ; Martus, Peter ; Schaeffner, Elke ; Sjöström, Per and Nyman, Ulf ^LU (Less)

organization

publishing date

2018

type

Contribution to journal

publication status

published

subject

Clinical Laboratory Medicine

keywords

chronic kidney disease, creatinine, cystatin C, glomerular filtration rate, kidney function tests, renal failure

in

Clinical Chemistry and Laboratory Medicine

volume

56

issue

3

pages

422 - 435

publisher

De Gruyter

external identifiers

pmid:28985182
scopus:85037683717

ISSN

1437-4331

DOI

10.1515/cclm-2017-0563

language

English

LU publication?

yes

id

5cf4358a-809b-48f6-8218-8f07e53f7ad6

date added to LUP

2018-01-11 13:09:45

date last changed

2024-06-11 07:44:50

@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}},
  keywords     = {{chronic kidney disease; creatinine; cystatin C; glomerular filtration rate; kidney function tests; renal failure}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{422--435}},
  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}},
  doi          = {{10.1515/cclm-2017-0563}},
  volume       = {{56}},
  year         = {{2018}},
}

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