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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.
Methods
In 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.
Results
7In 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%.
Conclusions
None 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.
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Details
1 Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
2 Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
3 Physiology Department, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, INSERM U1151-CNRS UMR8253, Paris, France
4 CHU de Bordeaux, Nephrologie–Transplantation–Dialyse, Université de Bordeaux, CNRS-UMR 5164 Immuno ConcEpT, Bordeaux, France
5 The Wellchild Laboratory, Evelina London Children’s Hospital, London, UK
6 Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
7 Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
8 Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsö, Norway
9 Renal Transplantation Department, Necker Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
10 Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
11 Department of Clinical Chemistry, Skåne University Hospital Lund, Lund University, Lund, Sweden
12 Function area Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
13 Renal Transplantation Department, CHU Nantes, Nantes University, Nantes, France
14 Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
15 Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR–BMT, University Paul Sabatier, Toulouse, France
16 Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
17 Hôpital Necker, AP-HP & Université Paris Descartes, Paris, France
18 Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, France
19 Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, Hôpital Michallon, CHU Grenoble-Alpes, La Tronche, France
20 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
21 Department of Nephrology-Dialysis-Transplantation, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
22 Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium