GFR Estimating Equations in a Multiethnic Asian Population

Teo, Boon Wee; Xu, Hui; Wang, Danhua; Li, Jialiang; Sinha, Arvind; Shuter, Borys; Sethi, Sunil; Lee, Evan J.C.

doi:10.1053/j.ajkd.2011.02.393

Cited by 239 publications

(185 citation statements)

References 12 publications

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“…Physiologic variability and dif- ferent GFR measurement techniques may result in up to 20% differences (13,17,23 ). We previously showed that varying the protocol for the calculation of GFR measurements by the slope-intercept method reduced a derived Chinese coefficient for the MDRD study equation by 2% (9 ). Moreover, with the exception of the Indian and others group, equation eGFR3 yielded ethnicity coefficients for the Malay and Chinese groups that were marginally higher than 1 within their 95% CIs, further supporting the idea that ethnicity adjustment is not required for the combination biomarker equation in multiethnic Asian populations.…”

Section: Ward (8 )mentioning

confidence: 71%

“…We previously argued that unless there is a consistent, Ͼ10% bias between measured and estimated GFR, it would be difficult to attribute derived ethnicity coefficients to true ethnic differences in GFR (9 ). This is because the bias may be a result of differences arising from the constituting derivation population, biomarker assay calibration, GFR measurement method, and physiologic variability.…”

Section: Ward (8 )mentioning

confidence: 99%

“…Therefore, ethnicity coefficients may arise due to chance, particularly if the study population is small. Serum creatinine calibration is an important source of bias and may be the cause of the ethnicity coefficient (9,21,22 ). Physiologic variability and dif- ferent GFR measurement techniques may result in up to 20% differences (13,17,23 ).…”

Section: Ward (8 )mentioning

confidence: 99%

“…These equations, however, were not vali-dated in multiethnic Asian CKD populations outside of the original derivation populations, and the question exists whether GFR estimation is improved using cystatin C-based equations so that adjustments for ethnicity are not required. In an earlier study, we determined that GFR estimation with the CKD-EPI equation is more accurate than the MDRD equation in a multiethnic Asian CKD population for a wider GFR range (9 ). In this study, we compared the accuracy of the CKD-EPI equation to several serum cystatin C-based equations and evaluated derived ethnicity coefficients in a multiethnic Asian population with chronic kidney disease.…”

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confidence: 99%

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Estimating Glomerular Filtration Rates by Use of Both Cystatin C and Standardized Serum Creatinine Avoids Ethnicity Coefficients in Asian Patients with Chronic Kidney Disease

Teo

Xu²,

Wang³

et al. 2012

Clinical Chemistry

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BACKGROUND The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is most accurate for estimating glomerular filtration rate (GFR) but requires an adjustment for African-American patients. Estimation equations are also improved with the use of serum cystatin C combined with standardized creatinine. Combination equations have been derived by the CKD-EPI and Chinese investigators. We investigated whether these cystatin C–based equations improve estimation adequately, so that adjustments for ethnicity are not required in a multiethnic Asian population with chronic kidney disease (CKD). METHODS This was a cross-sectional study of 232 stable CKD patients who underwent GFR measurements using 3-sample plasma clearances of 99mTc-DTPA, and for whom serum cystatin C and creatinine were quantified. RESULTS For all patients, the median biases with cystatin C equations were generally greater than with the CKD-EPI equation, and precision and root mean square error (RMSE) were not significantly better. However, the combination serum creatinine and cystatin C equation improved the precision, RMSE, and percentage of estimated GFR to within 15% and 30% of the measured GFR (57.3% vs 50.0%, 88.4% vs 82.8%, respectively). The derived ethnicity coefficients for the combination equation were all >1 (1.009–1.082) but small, suggesting that coefficients are not required. The Chinese-specific equations were more biased and performed more poorly than the CKD-EPI equation. CONCLUSIONS The use of a cystatin C and creatinine combination equation for estimating GFR in a multiethnic Asian population with CKD does not require ethnicity coefficients because the derived coefficients are very close to each other.

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Section: Ward (8 )mentioning

confidence: 71%

Section: Ward (8 )mentioning

confidence: 99%

Section: Ward (8 )mentioning

confidence: 99%

mentioning

confidence: 99%

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Estimating Glomerular Filtration Rates by Use of Both Cystatin C and Standardized Serum Creatinine Avoids Ethnicity Coefficients in Asian Patients with Chronic Kidney Disease

Teo

Xu²,

Wang³

et al. 2012

Clinical Chemistry

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“…Reference method varied considerably across studies. For example, 125 I-iothalamate clearance was used for developing MDRD [14] and CKD-EPI [15] equations, inulin clearance was used for Korean [23] and Japan [22] equations, while 99m Tc-DTPA clearance was used for Asian [21], Thai [24] and China equations [25,26]. The inconsistent references may bias the true GFR values.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Ten Creatinine-based Equations for Estimation of Glomerular Filtration Rate in Chinese Postmenopausal Women with Normal or Mildly Reduced Renal Function

Liu¹,

Ho²

2014

J Med Diagn Meth

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Comparison of Risk Prediction Using the CKD-EPI Equation and the MDRD Study Equation for Estimated Glomerular Filtration Rate

Matsushita

Mahmoodi

Woodward

et al. 2012

JAMA

887

664

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LOMERULAR FILTRATION RATE(GFR) is used in the diagnosis of chronic kidney disease (CKD) 1,2 and is an independent predictor of all-cause and cardiovascular mortality and kidney failure in a wide range of populations. [3][4][5][6] Clinical guidelines recommend reporting estimated GFR when serum creatinine level is measured 1,2 ; 84% of US laboratories report estimated GFR. 7 Although the Modification of Diet in Renal Disease (MDRD) Study equation is recommended for estimating GFR, 1,2,8,9 the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) has recently proposed an alternative equation, which applies different coefficients to the same 4 variables used in the MDRD Study equation (age, sex, race, and serum creatinine level). 10 The new CKD-EPI equation estimates measured GFR more accurately than the MDRD Study equation in most, [10][11][12][13][14][15][16][17][18] but For editorial comment see p 1976.Author Affiliations and a list of the investigators and collaborators for the Chronic Kidney Disease Prognosis Consortium appear at the end of this article.

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GFR Estimating Equations in a Multiethnic Asian Population

Cited by 239 publications

References 12 publications

Estimating Glomerular Filtration Rates by Use of Both Cystatin C and Standardized Serum Creatinine Avoids Ethnicity Coefficients in Asian Patients with Chronic Kidney Disease

Estimating Glomerular Filtration Rates by Use of Both Cystatin C and Standardized Serum Creatinine Avoids Ethnicity Coefficients in Asian Patients with Chronic Kidney Disease

Comparison of Ten Creatinine-based Equations for Estimation of Glomerular Filtration Rate in Chinese Postmenopausal Women with Normal or Mildly Reduced Renal Function

Comparison of Risk Prediction Using the CKD-EPI Equation and the MDRD Study Equation for Estimated Glomerular Filtration Rate

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