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Standardization of serum creatinine is essential for accurate use of unbiased estimated GFR equations : Evidence from three cohorts matched on renal function

Pottel, Hans ; Cavalier, Etienne ; Björk, Jonas LU ; Nyman, Ulf LU ; Grubb, Anders LU orcid ; Ebert, Natalie ; Schaeffner, Elke ; Eriksen, Björn O. ; Melsom, Toralf and Lamb, Edmund J. , et al. (2022) In Clinical Kidney Journal 15(12). p.2258-2265
Abstract

Background: Differences in the performance of estimated glomerular filtration rate (eGFR) equations have been attributed to the mathematical form of the equations and to differences between patient demographics and measurement methods. We evaluated differences in serum creatinine (SCr) and eGFR in cohorts matched for age, sex, body mass index (BMI) and measured GFR (mGFR). Methods: White North Americans from Minnesota (n = 1093) and the Chronic Renal Insufficiency Cohort (CRIC) (n = 1548) and White subjects from the European Kidney Function Consortium (EKFC) cohort (n = 7727) were matched for demographic patient characteristics (sex, age ± 3 years, BMI ± 2.5 kg/m2) and renal function (mGFR ± 3 ml/min/1.73 m2). SCr was measured with... (More)

Background: Differences in the performance of estimated glomerular filtration rate (eGFR) equations have been attributed to the mathematical form of the equations and to differences between patient demographics and measurement methods. We evaluated differences in serum creatinine (SCr) and eGFR in cohorts matched for age, sex, body mass index (BMI) and measured GFR (mGFR). Methods: White North Americans from Minnesota (n = 1093) and the Chronic Renal Insufficiency Cohort (CRIC) (n = 1548) and White subjects from the European Kidney Function Consortium (EKFC) cohort (n = 7727) were matched for demographic patient characteristics (sex, age ± 3 years, BMI ± 2.5 kg/m2) and renal function (mGFR ± 3 ml/min/1.73 m2). SCr was measured with isotope dilution mass spectrometry (IDMS)-Traceable assays in the Minnesota and EKFC cohorts and with non-standardized SCr assays recalculated to IDMS in the CRIC. The Minnesota cohort and CRIC shared a common method to measure GFR (renal clearance of iothalamate), while the EKFC cohort used a variety of exogenous markers and methods, all with recognized sufficient accuracy. We compared the SCr levels and eGFR predictions [for Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and EKFC equations] of patients fulfilling these matching criteria. Results: For 305 matched individuals, mean SCr (mg/dL) was not different between the Minnesota and EKFC cohorts (females 0.83 ± 0.20 versus 0.86 ± 0.23, males 1.06 ± 0.23 versus 1.12 ± 0.37; P >. 05) but significantly different from the CRIC [females 1.13 ± 0.23 (P <. 0001), males 1.42 ± 0.31 (P <. 0001)]. The CKD-EPI equations performed better than the EKFC equation in the CRIC, while the opposite was true in the Minnesota and EKFC cohorts. Conclusion: Significant differences in SCr concentrations between the Minnesota and EKFC cohorts versus CRIC were observed in subjects with the same level of mGFR and equal demographic characteristics and can be explained by the difference in SCr calibration.

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@article{e8b6c094-4d59-4967-8702-2644ebb7a5de,
  abstract     = {{<p>Background: Differences in the performance of estimated glomerular filtration rate (eGFR) equations have been attributed to the mathematical form of the equations and to differences between patient demographics and measurement methods. We evaluated differences in serum creatinine (SCr) and eGFR in cohorts matched for age, sex, body mass index (BMI) and measured GFR (mGFR). Methods: White North Americans from Minnesota (n = 1093) and the Chronic Renal Insufficiency Cohort (CRIC) (n = 1548) and White subjects from the European Kidney Function Consortium (EKFC) cohort (n = 7727) were matched for demographic patient characteristics (sex, age ± 3 years, BMI ± 2.5 kg/m2) and renal function (mGFR ± 3 ml/min/1.73 m2). SCr was measured with isotope dilution mass spectrometry (IDMS)-Traceable assays in the Minnesota and EKFC cohorts and with non-standardized SCr assays recalculated to IDMS in the CRIC. The Minnesota cohort and CRIC shared a common method to measure GFR (renal clearance of iothalamate), while the EKFC cohort used a variety of exogenous markers and methods, all with recognized sufficient accuracy. We compared the SCr levels and eGFR predictions [for Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and EKFC equations] of patients fulfilling these matching criteria. Results: For 305 matched individuals, mean SCr (mg/dL) was not different between the Minnesota and EKFC cohorts (females 0.83 ± 0.20 versus 0.86 ± 0.23, males 1.06 ± 0.23 versus 1.12 ± 0.37; P &gt;. 05) but significantly different from the CRIC [females 1.13 ± 0.23 (P &lt;. 0001), males 1.42 ± 0.31 (P &lt;. 0001)]. The CKD-EPI equations performed better than the EKFC equation in the CRIC, while the opposite was true in the Minnesota and EKFC cohorts. Conclusion: Significant differences in SCr concentrations between the Minnesota and EKFC cohorts versus CRIC were observed in subjects with the same level of mGFR and equal demographic characteristics and can be explained by the difference in SCr calibration.</p>}},
  author       = {{Pottel, Hans and Cavalier, Etienne and Björk, Jonas and Nyman, Ulf and Grubb, Anders and Ebert, Natalie and Schaeffner, Elke and Eriksen, Björn O. and Melsom, Toralf and Lamb, Edmund J. and Mariat, Christophe and Dubourg, Laurence and Hansson, Magnus and Littmann, Karin and Sundin, Per Ola and Åkesson, Anna and Larsson, Anders and Rule, Andrew and Delanaye, Pierre}},
  issn         = {{2048-8505}},
  keywords     = {{serum creatinine; standardization; unbiased GFR estimation}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{2258--2265}},
  publisher    = {{Oxford University Press}},
  series       = {{Clinical Kidney Journal}},
  title        = {{Standardization of serum creatinine is essential for accurate use of unbiased estimated GFR equations : Evidence from three cohorts matched on renal function}},
  url          = {{http://dx.doi.org/10.1093/ckj/sfac182}},
  doi          = {{10.1093/ckj/sfac182}},
  volume       = {{15}},
  year         = {{2022}},
}