Clinical Implications of Estimating Glomerular Filtration Rate with Three Different Equations among Older People. Preliminary Results of the Project “Screening for Chronic Kidney Disease among Older People across Europe (SCOPE)”

Corsonello, Andrea; Roller‐Wirnsberger, Regina; Wirnsberger, Gerhard; Ärnlöv, Johan; Carlsson, Axel C.; Tap, Lisanne; Mattace-Raso, Francesco; Formiga, Francesç; Moreno-González, Rafael; Weingart, Christian; Sieber, Cornel; Kostka, Tomasz; Guligowska, Agnieszka; Gil, Pedro; Martínez, Sara Laínez; Artzi‐Medvedik, Rada; Melzer, Itshak; Lattanzio, Fabrizia

doi:10.3390/jcm9020294

Cited by 12 publications

(8 citation statements)

References 41 publications

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“…eGFR <60 mL/ min/1.73 m 2 compared to the CKD EPI equation. This is in line with results published by Tarantini et al on 7845 subjects older than 70 years, where BIS1 equation classified 20.1% subjects more to eGFR <60 mL/min/1.73 m 2 than CKD EPI equation 19 11,18,20 . Bland Altman analysis showed mean difference of 8.0 mL/min/1.73 m 2 being lower using BIS1 than CKD EPI (95% limits of agreement: +1.9 to -17.8).…”

Section: Discussionsupporting

confidence: 93%

“…found a systematic difference between equations, with the BIS1 mean difference of 8.9 mL/min/1.73 m 2 being lower than CKD EPI (95% limits of agreement: +3.4 to -21.3) 19 . Furthermore, multicentric observational study on 2257 subjects also reported lower mean difference of 8.97 mL/min/1.73 m 2 using BIS1 20 . Fan et al showed no superiority to CKD EPI equation compared with other equations (Japanese, BIS, and Caucasian and Asian pediatric and adult subjects (CAPA) equation) 21 .…”

Section: Discussionmentioning

confidence: 85%

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Berlin Initiative Study 1 equation and HUGE formula for more accurate estimation of kidney function in elderly

Matašin¹,

Domislović²,

Fuček³

et al. 2021

Rad Hrvatske akademije znanosti i umjetnosti

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Introduction: Chronic kidney disease (CKD) is one of the leading public health problems and a significant concern in the elderly population. Assessment of renal function in elderly is difficult due to the physiological decline of GFR with aging. Furthermore, recommended eGFR CKD EPI equation has not been validated in the elderly. Our aim was to analyze in a group of subjects older than 70 years the differences in CKD prevalence and eGFR stages using CKD EPI and BIS1 equations (validated in elderly) and to distinguish the presence normal kidney aging from CKD using the HUGE equation. Materials and Methods: This cross-sectional observational study included 383 subjects older than 70 years who were part of ENAH study (N=2193). CKD was defined as an eGFR <60mL/min/1.73m 2 ; CKD stages were classified according to the KDIGO guidelines. The eGFR was calculated using CKD EPI and BIS1 equation. The HUGE equation was calculated in subset of 75 subjects. Results: The average age of the study population was 75 years. BIS1 classified 22.7% subjects more to a GFR <60 mL/min/1.73m 2 than CKD EPI. A systematic difference was found between the equations, with BIS1 mean value being lower for 8.0 mL/min than that of CKD EPI. Less falsely CKD (8.6% subjects) i.e. more normal kidney aging was detected using BIS1 instead of CKD EPI equation. Conclusions: The prevalence of CKD was higher with BIS1 than with CKD EPI equation i.e. CKD EPI underestimated CKD prevalence in elderly. More accurate diagnosis of CKD, and better determination of CKD prevalence in subjects older than 70 years could be obtained using BIS1 equation with addition of HUGE equation.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 85%

Berlin Initiative Study 1 equation and HUGE formula for more accurate estimation of kidney function in elderly

Matašin¹,

Domislović²,

Fuček³

et al. 2021

Rad Hrvatske akademije znanosti i umjetnosti

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“…An alternative explanation for the observed positive association between protein intake and SCr may reflect a better nutritional status and higher muscle mass percent in individuals with higher dietary protein intake. In contrast, elderly individuals with lower muscle mass might appear to have higher eGFR levels because of lower creatine and, consequently, creatinine production [40]. Also, specifically animal protein sources may contribute to a short-term increase in exogenous creatinine, resulting in higher total SCr and lower eGFR.…”

Section: Discussionmentioning

confidence: 99%

Association of dietary proteins with serum creatinine and estimated glomerular filtration rate in a general population sample: the CHRIS study

et al. 2022

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Background Diet is known to affect kidney function. However, population-based studies provide contrasting evidence, resulting in a poor understanding of the effect of proteins from specific foods on kidney health. Methods We analyzed the effect of total daily protein intake (TDPI) and source-specific daily protein intake (DPI) on fasting serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) in the Cooperative Health Research In South Tyrol (CHRIS) cross-sectional study (n = 5889), using the GA2LEN food frequency questionnaire for TDPI and DPI estimation. We fitted multivariable adjusted mixed models of SCr and eGFR on TDPI and DPI quartiles (Q1-Q4) in the overall sample, and after removing individuals with known hypertension, diabetes or chronic kidney disease (CKD). Results Higher TDPI as well as DPI from overall animal sources, fish, and poultry, were associated with higher SCr (trend test p, ptrend < 0.01), with larger effect after excluding individuals with known hypertension, diabetes or CKD. The eGFR was lower at higher TDPI (Q4 vs Q1: − 1.6 ml/min/1.73 m2; 95% CI − 2.5, − 0.7; ptrend = 3e−4) and DPI from fish (Q4 vs Q1: − 2.1 ml/min/1.73 m2; 95% CI − 2.9, − 1.20; ptrend = 4.3e−6), overall animal source (Q4 vs Q1: − 1.6 ml/min/1.73 m2; 95% CI −2.5, − 0.8), processed meat (Q4 vs Q1: − 1.4 ml/min/1.73 m2; ptrend = 0.027), red meat, offal and processed meat (Q4 vs Q1: − 1.4 ml/min/1.73 m2; ptrend = 0.015) and poultry (Q4 vs Q1: − 0.9 ml/min/1.73 m2; ptrend = 0.015). Conclusions TDPI and DPI from specific animal sources were positively associated with SCr and negatively associated with eGFR. Lacking an alternative marker of kidney function, confounding involving muscle mass metabolism cannot be fully excluded. Graphical abstract

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“…As regards, potential sources of discrepancy among eGFR equations, serum creatinine, and muscle mass were recently reported to be relevant correlates of disagreement, also impacting known sex differences of the CKD-EPI and BIS or FAS equations ( 42 ). While muscle mass was not assessed in the present study, our findings add to current knowledge by showing that BUN may also be involved in determining differences among equations in a population of older NH residents.…”

Section: Discussionmentioning

confidence: 99%

“…We used a limited set of data in our study, and we cannot exclude that the study equations may be differently sensitive to not measured factors, such as hydration status and body composition. Indeed, sarcopenia is known to impact creatinine production, and muscle mass may affect differences among creatinine-based eGFR equations ( 49 ). Given that body composition was not assessed in our study, further comparative analysis including extended datasets in these kinds of patients seems desirable.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Prognostic Implications of Estimating Glomerular Filtration Rate by Three Different Creatinine-Based Equations in Older Nursing Home Residents

et al. 2022

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BackgroundAccording to the international literature, the percentage of nursing home (NH) residents with renal insufficiency is very high, ranging between 22 and 78%. Diminished kidney function represents a risk factor for drug overdosage, adverse drug reactions, end-stage renal disease, disability, morbidity, and mortality. Several studies suggested that screening for chronic kidney disease (CKD) in high-risk and older populations may represent a cost-effective approach to reducing progression to renal failure and CKD mortality.ObjectiveThis study aimed (i) to investigate to what extent CKD may be staged interchangeably by three different creatinine-based estimated glomerular filtration rate (eGFR) equations in a sample of older adults living in long-term care facilities; (ii) to investigate factors explaining differences among eGFR equations; and (iii) to compare the predictivity of different creatinine-based eGFR equations with respect to all-cause mortality.MethodsA total of 522 residents aged 65 years and older participated in a prospective cohort study of 9 long-term care facilities in Calabria. eGFR was calculated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Berlin initiative study (BIS), and full age spectrum (FAS) equations. Disability in at least one activity of daily living (ADL), depression, cognitive impairment, comorbidity, and malnutrition was considered in the analysis. Statistical analysis was carried out by Bland–Altman analysis, and 2-year mortality was investigated by Kaplan–Meier curves and Cox regression analysis.ResultsDepending on the adopted equation, the prevalence of NH residents with impaired renal function (eGFR < 60 ml/min/1.73 m2) ranged between 58.2% for the CKD-EPI and 79.1% for the BIS1 equation. The average difference between BIS and FAS was nearly negligible (0.45 ml/min/1.73 m2), while a significant bias was detected between CKD-EPI and BIS and also between CKD-EPI and FAS (6.21 ml/min/1.73 m2 and 6.65 ml/min/1.73 m2, respectively). Although the eGFR study equations had comparable prognostic accuracy in terms of mortality risk, BIS and FAS were able to reclassify NH residents pertaining to a low-risk group with CKD-EPI, and this reclassification improves the discriminative capacity of CKD-EPI with respect to overall mortality.ConclusionDespite the relatively good correlation between eGFRs calculated using all adopted equations, the findings in this study reported clearly demonstrated that CKD-EPI and BIS/FAS equations are not interchangeable to assess eGFR among older people and particularly in institutionalized and frail older subjects.

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Clinical Implications of Estimating Glomerular Filtration Rate with Three Different Equations among Older People. Preliminary Results of the Project “Screening for Chronic Kidney Disease among Older People across Europe (SCOPE)”

Cited by 12 publications

References 41 publications

Berlin Initiative Study 1 equation and HUGE formula for more accurate estimation of kidney function in elderly

Berlin Initiative Study 1 equation and HUGE formula for more accurate estimation of kidney function in elderly

Association of dietary proteins with serum creatinine and estimated glomerular filtration rate in a general population sample: the CHRIS study

Clinical and Prognostic Implications of Estimating Glomerular Filtration Rate by Three Different Creatinine-Based Equations in Older Nursing Home Residents

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