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Prospects for improved glomerular filtration rate estimation based on creatinine—results from a transnational multicentre study

Björk, Jonas LU ; Nyman, Ulf LU ; Courbebaisse, Marie ; Couzi, Lionel ; Dalton, R Neil ; Dubourg, Laurence ; Ebert, Natalie ; Eriksen, Bjørn Odvar ; Gaillard, Francois and Garrouste, Cyril , et al. (2020) In Clinical Kidney Journal 13(4). p.674-683
Abstract
Background
The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation is routinely used to assess renal function but exhibits varying accuracy depending on patient characteristics and clinical presentation. The overall aim of the present study was to assess if and to what extent glomerular filtration rate (GFR) estimation based on creatinine can be improved.MethodsIn a cross-sectional analysis covering the years 2003–17, CKD-EPI was validated against measured GFR (mGFR; using various tracer methods) in patients with high likelihood of chronic kidney disease (CKD; five CKD cohorts, n = 8365) and in patients with low likelihood of CKD (six community cohorts, n = 6759). Comparisons were made with the Lund–Malmö... (More)
Background
The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation is routinely used to assess renal function but exhibits varying accuracy depending on patient characteristics and clinical presentation. The overall aim of the present study was to assess if and to what extent glomerular filtration rate (GFR) estimation based on creatinine can be improved.MethodsIn a cross-sectional analysis covering the years 2003–17, CKD-EPI was validated against measured GFR (mGFR; using various tracer methods) in patients with high likelihood of chronic kidney disease (CKD; five CKD cohorts, n = 8365) and in patients with low likelihood of CKD (six community cohorts, n = 6759). Comparisons were made with the Lund–Malmö revised equation (LMR) and the Full Age Spectrum equation.Results7In patients aged 18–39 years old, CKD-EPI overestimated GFR with 5.0–16 mL/min/1.73 m2 in median in both cohort types at mGFR levels <120 mL/min/1.73 m2. LMR had greater accuracy than CKD-EPI in the CKD cohorts (P30, the percentage of estimated GFR within 30% of mGFR, 83.5% versus 76.6%). CKD-EPI was generally the most accurate equation in the community cohorts, but all three equations reached P30 above the Kidney Disease Outcomes Quality Initiative benchmark of 90%.ConclusionsNone of the evaluated equations made optimal use of available data. Prospects for improved GFR estimation procedures based on creatinine exist, particularly in young adults and in settings where patients with suspected or manifest CKD are investigated. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Clinical Kidney Journal
volume
13
issue
4
pages
10 pages
publisher
Oxford University Press
external identifiers
  • pmid:32905314
  • scopus:85100881594
ISSN
2048-8505
DOI
10.1093/ckj/sfaa039
project
AIR Lund - Artificially Intelligent use of Registers
language
English
LU publication?
yes
id
ab5fdcc7-2e12-4473-b97a-e4ae7d2396f9
date added to LUP
2020-06-21 12:51:06
date last changed
2023-03-24 03:13:05
@article{ab5fdcc7-2e12-4473-b97a-e4ae7d2396f9,
  abstract     = {{Background <br/>The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation is routinely used to assess renal function but exhibits varying accuracy depending on patient characteristics and clinical presentation. The overall aim of the present study was to assess if and to what extent glomerular filtration rate (GFR) estimation based on creatinine can be improved.MethodsIn a cross-sectional analysis covering the years 2003–17, CKD-EPI was validated against measured GFR (mGFR; using various tracer methods) in patients with high likelihood of chronic kidney disease (CKD; five CKD cohorts, n = 8365) and in patients with low likelihood of CKD (six community cohorts, n = 6759). Comparisons were made with the Lund–Malmö revised equation (LMR) and the Full Age Spectrum equation.Results7In patients aged 18–39 years old, CKD-EPI overestimated GFR with 5.0–16 mL/min/1.73 m2 in median in both cohort types at mGFR levels &lt;120 mL/min/1.73 m2. LMR had greater accuracy than CKD-EPI in the CKD cohorts (P30, the percentage of estimated GFR within 30% of mGFR, 83.5% versus 76.6%). CKD-EPI was generally the most accurate equation in the community cohorts, but all three equations reached P30 above the Kidney Disease Outcomes Quality Initiative benchmark of 90%.ConclusionsNone of the evaluated equations made optimal use of available data. Prospects for improved GFR estimation procedures based on creatinine exist, particularly in young adults and in settings where patients with suspected or manifest CKD are investigated.}},
  author       = {{Björk, Jonas and Nyman, Ulf and Courbebaisse, Marie and Couzi, Lionel and Dalton, R Neil and Dubourg, Laurence and Ebert, Natalie and Eriksen, Bjørn Odvar and Gaillard, Francois and Garrouste, Cyril and Grubb, Anders and Hansson, Magnus and Jacquemont, Lola and Jones, Ian and Kamar, Nassim and Lamb, Edmund J. and Legendre, Christophe and Littmann, Karin and Mariat, Christophe and Melsom, Toralf and Rostaing, Lionel and Rule, Andrew D. and Schaeffner, Elke and Sundin, Per-Ola and Turner, Stephen and Åkesson, Anna and Delanaye, Pierre and Pottel, Hans}},
  issn         = {{2048-8505}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{4}},
  pages        = {{674--683}},
  publisher    = {{Oxford University Press}},
  series       = {{Clinical Kidney Journal}},
  title        = {{Prospects for improved glomerular filtration rate estimation based on creatinine—results from a transnational multicentre study}},
  url          = {{http://dx.doi.org/10.1093/ckj/sfaa039}},
  doi          = {{10.1093/ckj/sfaa039}},
  volume       = {{13}},
  year         = {{2020}},
}