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Comparison of glomerular filtration rate estimating equations derived from creatinine and cystatin C : Validation in the Age, Gene/Environment Susceptibility-Reykjavik elderly cohort

Björk, Jonas LU ; Grubb, Anders LU ; Gudnason, Vilmundur; Indridason, Olafur S.; Levey, Andrew S.; Palsson, Runolfur and Nyman, Ulf LU (2018) In Nephrology Dialysis Transplantation 33(8). p.1380-1388
Abstract

Background. Validation studies comparing glomerular filtration rate (GFR) equations based on standardized creatinine and cystatin C assays in the elderly are needed. The Icelandic Age, Gene/Environment Susceptibility-Kidney cohort was used to compare two pairs of recently developed GFR equations, the revised Lund-Malmö creatinine equation (LMRCr) and the arithmetic mean of the LMRCr and Caucasian, Asian, Paediatric and Adult cystatin C equations (MEANLMRþCAPA), as well as the Full Age Spectrum creatinine equation (FASCr) and its combination with cystatin C (FASCrþCys), with the corresponding pair of Chronic Kidney Disease Epidemiology Collaboration equations... (More)

Background. Validation studies comparing glomerular filtration rate (GFR) equations based on standardized creatinine and cystatin C assays in the elderly are needed. The Icelandic Age, Gene/Environment Susceptibility-Kidney cohort was used to compare two pairs of recently developed GFR equations, the revised Lund-Malmö creatinine equation (LMRCr) and the arithmetic mean of the LMRCr and Caucasian, Asian, Paediatric and Adult cystatin C equations (MEANLMRþCAPA), as well as the Full Age Spectrum creatinine equation (FASCr) and its combination with cystatin C (FASCrþCys), with the corresponding pair of Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPICr and CKD-EPICrþCys). Methods. A total of 805 individuals, 74-93 years of age, underwent measurement of GFR (mGFR) using plasma clearance of iohexol. Four metrics were used to compare the performance of the GFR equations: bias, precision, accuracy [including the percentage of participants with estimated GFR (eGFR) within 30% of mGFR (P30)] and the ability to detect mGFR <60 mL/min/1.73 m2. Results. All equations had a P30 >90%. LMRCr and FASCr yielded significantly higher precision and P30 than CKD-EPICr, while bias was significantly worse. LMRCr, FASCr and CKD-EPICr showed similar ability to detect mGFR <60 mL/min/1.73 m2 based on the area under the receiver operating characteristic curves. MEANLMRþCAPA, FASCrþCys and CKD-EPICrþCys all exhibited consistent improvements compared with the corresponding creatinine-based equations. Conclusion. None of the creatinine-based equations was clearly superior overall in this community-dwelling elderly cohort. The addition of cystatin C improved all of the creatinine-based equations.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Chronic kidney disease, Elderly, Glomerular filtration rate, Kidney function tests, Renal failure
in
Nephrology Dialysis Transplantation
volume
33
issue
8
pages
9 pages
publisher
Oxford University Press
external identifiers
  • scopus:85055350958
ISSN
0931-0509
DOI
10.1093/ndt/gfx272
language
English
LU publication?
yes
id
609da5e0-13fc-434e-837a-b9105a1dd5d7
date added to LUP
2018-11-20 11:47:03
date last changed
2019-02-03 05:36:57
@article{609da5e0-13fc-434e-837a-b9105a1dd5d7,
  abstract     = {<p>Background. Validation studies comparing glomerular filtration rate (GFR) equations based on standardized creatinine and cystatin C assays in the elderly are needed. The Icelandic Age, Gene/Environment Susceptibility-Kidney cohort was used to compare two pairs of recently developed GFR equations, the revised Lund-Malmö creatinine equation (LMR<sub>Cr</sub>) and the arithmetic mean of the LMR<sub>Cr</sub> and Caucasian, Asian, Paediatric and Adult cystatin C equations (MEAN<sub>LMR</sub>þ<sub>CAPA</sub>), as well as the Full Age Spectrum creatinine equation (FAS<sub>Cr</sub>) and its combination with cystatin C (FAS<sub>Cr</sub>þ<sub>Cys</sub>), with the corresponding pair of Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI<sub>Cr</sub> and CKD-EPI<sub>Cr</sub>þ<sub>Cys</sub>). Methods. A total of 805 individuals, 74-93 years of age, underwent measurement of GFR (mGFR) using plasma clearance of iohexol. Four metrics were used to compare the performance of the GFR equations: bias, precision, accuracy [including the percentage of participants with estimated GFR (eGFR) within 30% of mGFR (P<sub>30</sub>)] and the ability to detect mGFR &lt;60 mL/min/1.73 m<sup>2</sup>. Results. All equations had a P<sub>30</sub> &gt;90%. LMR<sub>Cr</sub> and FAS<sub>Cr</sub> yielded significantly higher precision and P<sub>30</sub> than CKD-EPI<sub>Cr</sub>, while bias was significantly worse. LMR<sub>Cr</sub>, FAS<sub>Cr</sub> and CKD-EPI<sub>Cr</sub> showed similar ability to detect mGFR &lt;60 mL/min/1.73 m<sup>2</sup> based on the area under the receiver operating characteristic curves. MEAN<sub>LMR</sub>þCAPA, FAS<sub>Cr</sub>þ<sub>Cys</sub> and CKD-EPI<sub>Cr</sub>þ<sub>Cys</sub> all exhibited consistent improvements compared with the corresponding creatinine-based equations. Conclusion. None of the creatinine-based equations was clearly superior overall in this community-dwelling elderly cohort. The addition of cystatin C improved all of the creatinine-based equations.</p>},
  author       = {Björk, Jonas and Grubb, Anders and Gudnason, Vilmundur and Indridason, Olafur S. and Levey, Andrew S. and Palsson, Runolfur and Nyman, Ulf},
  issn         = {0931-0509},
  keyword      = {Chronic kidney disease,Elderly,Glomerular filtration rate,Kidney function tests,Renal failure},
  language     = {eng},
  number       = {8},
  pages        = {1380--1388},
  publisher    = {Oxford University Press},
  series       = {Nephrology Dialysis Transplantation},
  title        = {Comparison of glomerular filtration rate estimating equations derived from creatinine and cystatin C : Validation in the Age, Gene/Environment Susceptibility-Reykjavik elderly cohort},
  url          = {http://dx.doi.org/10.1093/ndt/gfx272},
  volume       = {33},
  year         = {2018},
}