Biological variation of measured and estimated glomerular filtration rate in patients with chronic kidney disease

Rowe, Ceri; Sitch, Alice; Barratt, Jonathan; Brettell, Elizabeth; Cockwell, Paul; Dalton, R. Neil; Deeks, Jonathan J; Eaglestone, Gillian; Pellatt-Higgins, Tracy; Kalra, Philip A.; Khunti, Kamlesh; Loud, Fiona; Morris, F S; Ottridge, Ryan; Stevens, Paul E.; Sharpe, Claire C.; Sutton, Andrew; Taal, Maarten W.; Lamb, Edmund J.

doi:10.1016/j.kint.2019.02.021

Cited by 70 publications

(42 citation statements)

References 48 publications

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“…Several studies have shown that ScysC is a better marker than Scr [7][8][9] and is less affected by muscle mass and nutritional status. Current research confirms that within-subject variability in estimated GFR was lower than measured GFR, which indicates that estimates of GFR are at least as reliable as measured GFR for monitoring patients over time [10]. According to the epidemiology of mGFR in China, China has a large population base, with obvious differences in sex, region and race compared to these parameters in white people [11].…”

Section: Introductionsupporting

confidence: 60%

“…In recent reports, the rate of change in biomarkers was shown to be smaller than that in kidney nuclear radiography. The eGFR computed by equations is at least as reliable as the mGFR measured by nuclear medicine for monitoring patients over time [10]. The comparative verification data adopted in this study are more applicable to China's national conditions, and its statistical results have more practical clinical significance.…”

Section: Comparison Between Mgfr and Egfrmentioning

confidence: 81%

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Comparisons of Five Equations Used for Estimating the Glomerular Filtrations Rate in Chinese Adults

Fu¹,

Yang²,

Xu³

et al. 2020

Preprint

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Background We aimed to assess the performance of revised MDRD, CKD-EPI, BIS, FAS and XiangYa equation in Chinese adults Methods We collected blood biochemical data of 623 chinese adult hospitalised patients within 48 hours before they underwent 99m Tc-DTPA GFR measurement. We computed the bias (mGFR-eGFR), the precision (IQR) ,the accuray (P30）and root mean square error (RMSE) relative to mGFR of each equation to evaluate performance. The ROC curves, Kappa value of McNemar test, Bland-Altman plot and the Intraclass correlation coefficient (ICC) were used to evaluate diagnostic accuracy and concordance. Results Totally, the FAS combined Scr and cysC equation performed supreme accuracy(P30=57.5%, RMSE=19.26), the cysC-based equation performed superior to Scr-based equation. Detailed P30 of the CKD-EPI cysC , FAS cysC , MDRD, CKD-EPI Scr-cysC , CKD-EPI Scr , FAS Scr , XiangYa was 56.7%, 56.0%, 53.5%, 52.2%, 48.8%, 51.4%, 43.0%. The CKD-EPI cysC equation showed the lowest bias and the highest accuracy(bias=-2.23, P30=57.4%) in GFR<60ml/min/1.73m 2 , followed by the FASscr-cysC equation(bias=-6.89, P30=55.4%). The XiangYa equation perfomed best in GFR≥60ml/min/1.73m 2 while worst in GFR<60 ml/min/1.73m 2 with bias(-5.79 vs -19.05), IQR(18.21 vs 10.85), P30(86.2% vs 21.1%), RMSE(16.68 vs 21.34). The CKD-EPI cysC equation had the lowest bias and the best accuracy(bias=-2.23, P30=59.4%) in age ≥70 years adults, followed by the FAS Scr-cysC equation equivalented to BIS-2 Scr-cysC equation(bias -5.33 vs -4.90, P30=57.3%), while the XiangYa equation performed worstly (bias=-20.39, P30=26.6%). Best ROC AUC was gaven by the FAS Scr-cysC equation(0.951),so was it had the highest Kappa value(0.364). The lowest Bias showed in Bland-Altman plot was the CKD-EPI cysC equation(bias=7.46). The highest ICC value was gaven by the FAS Scr-cysC equation(0.921). Secondly, it was the XiangYa equation with the ICC of 0.912. Conclusions The FAS Scr-cysC equation is verified most suitable and simpler applied to Chinese population. The CKD-EPI cysC equation is appropriate used in moderately and severely injured GFR(CKD3-5stage) and Seniors over 70 years old. The XiangYa equation performed perfectly in slightly injured GFR (CKD1-2stage), while further verification of XiangYa equation in multiple region need to carried out especially in moderately and severely injured GFR and older adults.

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Section: Introductionsupporting

confidence: 60%

Section: Comparison Between Mgfr and Egfrmentioning

confidence: 81%

Comparisons of Five Equations Used for Estimating the Glomerular Filtrations Rate in Chinese Adults

Fu¹,

Yang²,

Xu³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…All methods to estimate GFR are associated with systematic and random error; however, on a positive note, they have less time-to-time variability than measured GFR [ 47 ]. Furthermore, it is important to consider the underlying risk profile of the population on the impact of the relative risk estimates.…”

Section: Discussionmentioning

confidence: 99%

Contribution of cystatin C- and creatinine-based definitions of chronic kidney disease to cardiovascular risk assessment in 20 population-based and 3 disease cohorts: the BiomarCaRE project

Rothenbacher

Rehm

Iacoviello

et al. 2020

BMC Med

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Background Chronic kidney disease has emerged as a strong cardiovascular risk factor, and in many current guidelines, it is already considered as a coronary heart disease (CHD) equivalent. Routinely, creatinine has been used as the main marker of renal function, but recently, cystatin C emerged as a more promising marker. The aim of this study was to assess the comparative cardiovascular and mortality risk of chronic kidney disease (CKD) using cystatin C-based and creatinine-based equations of the estimated glomerular filtration rate (eGFR) in participants of population-based and disease cohorts. Methods The present study has been conducted within the BiomarCaRE project, with harmonized data from 20 population-based cohorts (n = 76,954) from 6 European countries and 3 cardiovascular disease (CVD) cohorts (n = 4982) from Germany. Cox proportional hazards models were used to assess hazard ratios (HRs) for the various CKD definitions with adverse outcomes and mortality after adjustment for the Systematic COronary Risk Evaluation (SCORE) variables and study center. Main outcome measures were cardiovascular diseases, cardiovascular death, and all-cause mortality. Results The overall prevalence of CKD stage 3–5 by creatinine- and cystatin C-based eGFR, respectively, was 3.3% and 7.4% in the population-based cohorts and 13.9% and 14.4% in the disease cohorts. CKD was an important independent risk factor for subsequent CVD events and mortality. For example, in the population-based cohorts, the HR for CVD mortality was 1.72 (95% CI 1.53 to 1.92) with creatinine-based CKD and it was 2.14 (95% CI 1.90 to 2.40) based on cystatin-based CKD compared to participants without CKD. In general, the HRs were higher for cystatin C-based CKD compared to creatinine-based CKD, for all three outcomes and risk increased clearly below the conventional threshold for CKD, also in older adults. Net reclassification indices were larger for a cystatin-C based CKD definition. Differences in HRs (between the two CKD measures) in the disease cohorts were less pronounced than in the population-based cohorts. Conclusion CKD is an important risk factor for subsequent CVD events and total mortality. However, point estimates of creatinine- and cystatin C-based CKD differed considerably between low- and high-risk populations. Especially in low-risk settings, the use of cystatin C-based CKD may result in more accurate risk estimates and have better prognostic value.

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“…To the editor: The recent article by Rowe et al 1 found less variation in the longitudinal measured glomerular filtration rate versus estimated glomerular filtration rate (eGFR). Not considered in their study are variations in eGFR equations and the method for determining serum creatinine that confounds the interpretation of eGFR results.…”

Section: Variation In Serum Creatinine Methodology and Egfr Equationsmentioning

confidence: 99%

Variation in serum creatinine methodology and eGFR equations confound longitudinal eGFR data

Rosansky¹,

Thamer²

2020

Kidney International

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Biological variation of measured and estimated glomerular filtration rate in patients with chronic kidney disease

Cited by 70 publications

References 48 publications

Comparisons of Five Equations Used for Estimating the Glomerular Filtrations Rate in Chinese Adults

Comparisons of Five Equations Used for Estimating the Glomerular Filtrations Rate in Chinese Adults

Contribution of cystatin C- and creatinine-based definitions of chronic kidney disease to cardiovascular risk assessment in 20 population-based and 3 disease cohorts: the BiomarCaRE project

Variation in serum creatinine methodology and eGFR equations confound longitudinal eGFR data

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