CKD-EPI and EKFC GFR Estimating Equations: Performance and Other Considerations for Selecting Equations for Implementation in Adults
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
New CKD-EPI and EKFC eGFR equations using eGFRcr, 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 adults pooled from 12 studies. The mean (SD) measured GFR was 76.4 (29.6) ml/min per 1.73 m2 and 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 <±5 ml/min per 1.73 m2 and P30 >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.
Originalsprog | Engelsk |
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Tidsskrift | Journal of the American Society of Nephrology |
Vol/bind | 34 |
Udgave nummer | 12 |
Sider (fra-til) | 1953-1964 |
Antal sider | 12 |
ISSN | 1046-6673 |
DOI | |
Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:
We would like to acknowledge collaborators of studies included in our analyses. Age, Gene/ Environment Susceptibility Reykjavik study (AGES-RS): Margret B. Andresdottir, Hrefna Gudmundsdottir, Olafur S. Indridason, and Runolfur Palsson; Assessing Long Term Outcomes in Living Kidney Donors (ALTOLD): Bertram Kasiske, Matthew Weir, Todd Pesavento, and Roberto Kalil; Study of people living with HIV: Christina Wyatt, Zipporah Krishnasami, and James Hellinger; Multicenter AIDS Cohort Study (MACS), now the MACS/WIHS Combined Cohort Study (MWCCS): Alison Abraham; Multi Ethnic Study of Atherosclerosis (MESA): Tariq Shafi, Wendy Post, and Peter Rossing; NephroTest: Jerome Rossert and Benedicte Stengel; Prevent Kidney Function Loss (PERL): Andrzej Galecki, Catherine Spino, Michael Mauer, and Amy Karger; Renin Angiotensin System Study (RASS): Bernard Zinman and Ronald Klein; Steno Diabetes Center study: Hans-Henrik Parving. This work is supported by National Institute of Diabetes and Digestive and Kidney Diseases from 1R01DK116790 (L.A. Inker).
Publisher Copyright:
Copyright © 2023 by the American Society of Nephrology.
ID: 377995469