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Validation of standardized creatinine and cystatin C GFR estimating equations in a large multicentre European cohort of children

Björk, Jonas LU ; Nyman, Ulf LU ; Berg, Ulla ; Delanaye, Pierre ; Dubourg, Laurence ; Goffin, Karolien ; Grubb, Anders LU orcid ; Hansson, Magnus ; Littmann, Karin and Åsling-Monemi, Kajsa , et al. (2019) In Pediatric Nephrology
Abstract

Background: Most validations of paediatric glomerular filtration rate (GFR) estimating equations using standardized creatinine (CR) and cystatin C (CYS) assays have comprised relatively small cohorts, which makes accuracy across subgroups of GFR, age, body mass index (BMI) and gender uncertain. To overcome this, a large cohort of children referred for GFR determination has been established from several European medical centres. Methods: Three thousand four hundred eight measurements of GFR (mGFR) using plasma clearance of exogenous substances were performed in 2218 children aged 2–17 years. Validated equations included Schwartz-2009CR/2012CR/CYS/CR+CYS, FASCR/CYS/CR+CYS, LMRCR,... (More)

Background: Most validations of paediatric glomerular filtration rate (GFR) estimating equations using standardized creatinine (CR) and cystatin C (CYS) assays have comprised relatively small cohorts, which makes accuracy across subgroups of GFR, age, body mass index (BMI) and gender uncertain. To overcome this, a large cohort of children referred for GFR determination has been established from several European medical centres. Methods: Three thousand four hundred eight measurements of GFR (mGFR) using plasma clearance of exogenous substances were performed in 2218 children aged 2–17 years. Validated equations included Schwartz-2009CR/2012CR/CYS/CR+CYS, FASCR/CYS/CR+CYS, LMRCR, Schwartz-LyonCR, BergCYS, CAPACYS, CKD-EPICYS, AndersenCR+CYS and arithmetic means of the best single-marker equations in explorative analysis. Five metrics were used to compare the performance of the GFR equations: bias, precision and three accuracy measures including the percentage of GFR estimates (eGFR) within ± 10% (P10) and ± 30% (P30) of mGFR. Results: Three of the cystatin C equations, BergCYS, CAPACYS and CKD-EPICYS, exhibited low bias and generally satisfactory accuracy across all levels of mGFR; CKD-EPICYS had more stable performance across gender than the two other equations. Among creatinine equations, Schwartz-LyonCR had the best performance but was inaccurate at mGFR < 30 mL/min/1.73 m2 and in underweight patients. Arithmetic means of the best creatinine and cystatin C equations above improved bias compared to the existing composite creatinine+cystatin C equations. Conclusions: The present study strongly suggests that cystatin C should be the primary biomarker of choice when estimating GFR in children with decreased GFR. Arithmetic means of well-performing single-marker equations improve accuracy further at most mGFR levels and have practical advantages compared to composite equations.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Children, Chronic kidney disease, Glomerular filtration rate, Kidney function tests, Renal failure
in
Pediatric Nephrology
publisher
Springer
external identifiers
  • scopus:85061038083
  • pmid:30715595
ISSN
0931-041X
DOI
10.1007/s00467-018-4185-y
project
Shrunken Pore Syndrome (SPS) - morbidity and mortality in a population with measured glomerular filtration rate (GFR)
language
English
LU publication?
yes
id
f10d7067-1fc6-4481-84f5-97c4e4a9f22e
date added to LUP
2019-02-12 12:47:02
date last changed
2025-01-09 02:21:09
@article{f10d7067-1fc6-4481-84f5-97c4e4a9f22e,
  abstract     = {{<p>Background: Most validations of paediatric glomerular filtration rate (GFR) estimating equations using standardized creatinine (CR) and cystatin C (CYS) assays have comprised relatively small cohorts, which makes accuracy across subgroups of GFR, age, body mass index (BMI) and gender uncertain. To overcome this, a large cohort of children referred for GFR determination has been established from several European medical centres. Methods: Three thousand four hundred eight measurements of GFR (mGFR) using plasma clearance of exogenous substances were performed in 2218 children aged 2–17 years. Validated equations included Schwartz-2009<sub>CR</sub>/2012<sub>CR/CYS/CR+CYS</sub>, FAS<sub>CR/CYS/CR+CYS</sub>, LMR<sub>CR</sub>, Schwartz-Lyon<sub>CR</sub>, Berg<sub>CYS</sub>, CAPA<sub>CYS</sub>, CKD-EPI<sub>CYS</sub>, Andersen<sub>CR+CYS</sub> and arithmetic means of the best single-marker equations in explorative analysis. Five metrics were used to compare the performance of the GFR equations: bias, precision and three accuracy measures including the percentage of GFR estimates (eGFR) within ± 10% (P<sub>10</sub>) and ± 30% (P<sub>30</sub>) of mGFR. Results: Three of the cystatin C equations, Berg<sub>CYS</sub>, CAPA<sub>CYS</sub> and CKD-EPI<sub>CYS</sub>, exhibited low bias and generally satisfactory accuracy across all levels of mGFR; CKD-EPI<sub>CYS</sub> had more stable performance across gender than the two other equations. Among creatinine equations, Schwartz-Lyon<sub>CR</sub> had the best performance but was inaccurate at mGFR &lt; 30 mL/min/1.73 m<sup>2</sup> and in underweight patients. Arithmetic means of the best creatinine and cystatin C equations above improved bias compared to the existing composite creatinine+cystatin C equations. Conclusions: The present study strongly suggests that cystatin C should be the primary biomarker of choice when estimating GFR in children with decreased GFR. Arithmetic means of well-performing single-marker equations improve accuracy further at most mGFR levels and have practical advantages compared to composite equations.</p>}},
  author       = {{Björk, Jonas and Nyman, Ulf and Berg, Ulla and Delanaye, Pierre and Dubourg, Laurence and Goffin, Karolien and Grubb, Anders and Hansson, Magnus and Littmann, Karin and Åsling-Monemi, Kajsa and Bökenkamp, Arend and Pottel, Hans}},
  issn         = {{0931-041X}},
  keywords     = {{Children; Chronic kidney disease; Glomerular filtration rate; Kidney function tests; Renal failure}},
  language     = {{eng}},
  month        = {{02}},
  publisher    = {{Springer}},
  series       = {{Pediatric Nephrology}},
  title        = {{Validation of standardized creatinine and cystatin C GFR estimating equations in a large multicentre European cohort of children}},
  url          = {{http://dx.doi.org/10.1007/s00467-018-4185-y}},
  doi          = {{10.1007/s00467-018-4185-y}},
  year         = {{2019}},
}