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CKD-EPI and EKFC GFR Estimating Equations: Performance and Other Considerations for Selecting Equations for Implementation in Adults

Inker, Lesley A. ; Tighiouart, Hocine ; Adingwupu, Ogechi ; Shlipak, Michael G. ; Doria, Alessandro ; Estrella, Michelle M ; Froissart, Marc ; Gudnason, Vilmundur ; Grubb, Anders LU orcid and Kalil, Roberto , et al. (2023) In Journal of the American Society of Nephrology 34(12). p.1953-1964
Abstract
Background: New CKD-EPI and EKFC estimated GFR (eGFR) equations using
creatinine (eGFRcr), cystatin C (eGFRcys) and both (eGFRcr-cys) have sufficient
accuracy for use in clinical practice. A better understanding of the equations, including
their performance in race, sex and age subgroups, is important for selection of eGFR
equations for global implementation.
Methods: We evaluated performance (bias and P30) of equations and methods used
for equation development in an independent study population comprising 4050
participants pooled from 12 studies. The mean (SD) mGFR was 76.4 (29.6)
ml/min/1.73 m2, age 57.0 (17.4) years, with 1557 (38%) women and 579 (14%) Black
participants.
Results: Coefficients for... (More)
Background: New CKD-EPI and EKFC estimated GFR (eGFR) equations using
creatinine (eGFRcr), cystatin C (eGFRcys) and both (eGFRcr-cys) have sufficient
accuracy for use in clinical practice. A better understanding of the equations, including
their performance in race, sex and age subgroups, is important for selection of eGFR
equations for global implementation.
Methods: We evaluated performance (bias and P30) of equations and methods used
for equation development in an independent study population comprising 4050
participants pooled from 12 studies. The mean (SD) mGFR was 76.4 (29.6)
ml/min/1.73 m2, age 57.0 (17.4) years, with 1557 (38%) women and 579 (14%) Black
participants.
Results: Coefficients for creatinine, cystatin C, age and sex in the CKD-EPI and EKFC
equations are similar. Performance of the eGFRcr-cys equations in the overall
population (bias 90%) was better than the eGFRcr or
eGFRcys equations, with fewer differences among race, sex and age subgroups.
Differences in performance across subgroups reflected differences in diversity of
source populations and use of variables for race and sex for equation development.
Larger differences among eGFRcr equations reflected regional population differences
in non-GFR determinants of creatinine.
Conclusion: CKD-EPI and EKFC equations are approaching convergence. It is not
possible to maximize both accuracy and uniformity in selecting one of the currently
available eGFRcr equations for implementation across regions. Decisions should
consider methods for equation development in addition to performance. Wider use of
cystatin C with creatinine could maximize both accuracy and uniformity of GFR
estimation using currently available equations. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of the American Society of Nephrology
volume
34
issue
12
pages
1953 - 1964
publisher
American Society of Nephrology
external identifiers
  • pmid:37796982
  • scopus:85178652052
ISSN
1046-6673
DOI
10.1681/ASN.0000000000000227
language
English
LU publication?
yes
id
814f92be-fbb8-410b-b5fb-21e5c66a2cdb
date added to LUP
2023-10-26 18:10:19
date last changed
2024-01-09 15:45:22
@article{814f92be-fbb8-410b-b5fb-21e5c66a2cdb,
  abstract     = {{Background: New CKD-EPI and EKFC estimated GFR (eGFR) equations using<br/>creatinine (eGFRcr), cystatin C (eGFRcys) and both (eGFRcr-cys) have sufficient<br/>accuracy for use in clinical practice. A better understanding of the equations, including<br/>their performance in race, sex and age subgroups, is important for selection of eGFR<br/>equations for global implementation.<br/>Methods: We evaluated performance (bias and P30) of equations and methods used<br/>for equation development in an independent study population comprising 4050<br/>participants pooled from 12 studies. The mean (SD) mGFR was 76.4 (29.6)<br/>ml/min/1.73 m2, age 57.0 (17.4) years, with 1557 (38%) women and 579 (14%) Black<br/>participants.<br/>Results: Coefficients for creatinine, cystatin C, age and sex in the CKD-EPI and EKFC<br/>equations are similar. Performance of the eGFRcr-cys equations in the overall<br/>population (bias 90%) was better than the eGFRcr or<br/>eGFRcys equations, with fewer differences among race, sex and age subgroups.<br/>Differences in performance across subgroups reflected differences in diversity of<br/>source populations and use of variables for race and sex for equation development.<br/>Larger differences among eGFRcr equations reflected regional population differences<br/>in non-GFR determinants of creatinine.<br/>Conclusion: CKD-EPI and EKFC equations are approaching convergence. It is not<br/>possible to maximize both accuracy and uniformity in selecting one of the currently<br/>available eGFRcr equations for implementation across regions. Decisions should<br/>consider methods for equation development in addition to performance. Wider use of<br/>cystatin C with creatinine could maximize both accuracy and uniformity of GFR<br/>estimation using currently available equations.}},
  author       = {{Inker, Lesley A. and Tighiouart, Hocine and Adingwupu, Ogechi and Shlipak, Michael G. and Doria, Alessandro and Estrella, Michelle M and Froissart, Marc and Gudnason, Vilmundur and Grubb, Anders and Kalil, Roberto and Mauer, Michael and Rossing, Peter and Seegmiller, Jesse C and Coresh, Josef and Levey, Andrew S.}},
  issn         = {{1046-6673}},
  language     = {{eng}},
  month        = {{10}},
  number       = {{12}},
  pages        = {{1953--1964}},
  publisher    = {{American Society of Nephrology}},
  series       = {{Journal of the American Society of Nephrology}},
  title        = {{CKD-EPI and EKFC GFR Estimating Equations: Performance and Other Considerations for Selecting Equations for Implementation in Adults}},
  url          = {{http://dx.doi.org/10.1681/ASN.0000000000000227}},
  doi          = {{10.1681/ASN.0000000000000227}},
  volume       = {{34}},
  year         = {{2023}},
}