Estimating glomerular filtration rates in elderly Chinese patients with chronic kidney disease: performance of six modified formulae developed in Asian populations

Abstract

ObjectivesThe aim of the present study was to evaluate modified glomerular filtration rate (GFR) prediction formulae in an elderly Chinese population with chronic kidney disease (CKD).MethodsA total of 378 elderly Chinese patients with CKD were enrolled. The GFR was estimated with six modified GFR prediction formulae. The performances of the estimated GFRs were compared with those of the standard GFRs measured by technetium-99m diethyl-enetraminepentaacetic acid.ResultsBiases were similar for Chinese formula 1, the Asian formula, and Chinese formula 2 (median difference, 2.22 mL/min/1.73 m2 and 2.59 mL/min/1.73 m2 for Chinese formula 1 and the Asian formula, respectively, versus (vs) 3.69 mL/min/1.73 m2 for Chinese formula 2 [P = 0.298 and P = 0.913, respectively]). Precision was improved with the Japanese formula (interquartile range of the difference, 3.14 mL/min/1.73 m2 of the Japanese formula versus 15.53–23.06 mL/min/1.73 m2 of the other formulae). The accuracy of Chinese formula 2 was the highest (30% accuracy, 59.3% vs range 37.8–54.0% [P < 0.05 for all comparisons]). However, none of the modified formulae surpassed the acceptable tolerance (>70%), and the GFR category misclassification rates for all the formulae exceeded 50%.ConclusionOur findings suggest that all six modified formulae developed in Asian populations may show great bias in elderly Chinese patients with CKD. Also, our study suggests the need for uniform measures for the assessment of CKD in the elderly to guarantee better sensitivity and specificity.

Is the Chronic Kidney Disease Epidemiology Collaboration creatinine&ndash;cystatin C equation useful for glomerular filtration rate estimation in the elderly?

“…Performances of the GFR estimating equations were assessed by three aspects, including bias, precision, and accuracy. An optimal score system4 was developed. The equation that performed the best in each aspect in the entire cohort was scored as 1, and in each GFR subgroup as 0.5.…”

“…Glomerular filtration rate (GFR) is the best index of overall kidney function 2. In two previous studies,3,4 we found that creatinine-based GFR predicting equations were not suitable for elderly Chinese patients with CKD. In the present study several improvements to study design were made.…”

Accuracy and precision of the CKD-EPI and MDRD predictive equations compared with glomerular filtration rate measured by inulin clearance in a Saudi population

“…This is in agreement with Liu et al who reported that the bias of the CKD-EPI creatinine-cystatin C equation was greater than with other equations. 15 However, they suggested that the CKD-EPI creatinine-cystatin C equation is suitable for an elderly Chinese population.…”