The Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) equation is less accurate in patients with Type 2 diabetes when compared with healthy individuals

Camargo, Eduardo Guimarães; Soares, Ariana Aguiar; Detanico, Ana Bittencourt; Weinert, Letícia Schwerz; Veronese, Francisco Veríssimo; Gomes, Eduardo Correa; Silveiro, Sandra Pinho

doi:10.1111/j.1464-5491.2010.03161.x

Cited by 65 publications

(72 citation statements)

References 30 publications

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“…However, according to recent studies, these equations have a poor performance for patients with diabetes and markedly underestimate GFR (4,5). This disappointing performance seems to be associated with specific characteristics of the patients with diabetes, such as hyperglycemia, glomerular hyperfiltration, and obesity, which probably highlight the limitations of creatinine itself as a GFR marker.…”

Section: Discussionmentioning

confidence: 99%

“…However, the accuracy of creatinine-based equations to estimate GFR, including the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, has been questioned for patients with diabetes (4,5). Recently, Rognant et al (5) demonstrated that CKD-EPI presented a poor performance in diabetic patients with a wide range of renal function, working even worse than MDRD equation.…”

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confidence: 99%

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Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Equation Pronouncedly Underestimates Glomerular Filtration Rate in Type 2 Diabetes

et al. 2011

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OBJECTIVETo evaluate the performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to estimate glomerular filtration rate (GFR) in type 2 diabetic patients with GFR >60 mL/min/1.73 m2.RESEARCH DESIGN AND METHODSThis was a cross-sectional study including 105 type 2 diabetic patients. GFR was measured by 51Cr-EDTA method and estimated by the MDRD and CKD-EPI equations. Serum creatinine was measured by the traceable Jaffe method. Bland-Altman plots were used. Bias, accuracy (P30), and precision were evaluated.RESULTSThe mean age of patients was 57 ± 8 years; 53 (50%) were men and 90 (86%) were white. Forty-six (44%) patients had microalbuminuria, and 14 (13%) had macroalbuminuria. 51Cr-EDTA GFR was 103 ± 23, CKD-EPI GFR was 83 ± 15, and MDRD-GFR was 78 ± 17 mL/min/1.73 m2 (P < 0.001). Accuracy (95% CI) was 67% (58–74) for CKD-EPI and 64% (56–75) for MDRD. Precision was 21 and 22, respectively.CONCLUSIONSThe CKD-EPI and MDRD equations pronouncedly underestimated GFR in type 2 diabetic patients.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Equation Pronouncedly Underestimates Glomerular Filtration Rate in Type 2 Diabetes

et al. 2011

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“…Creatinine-based GFR estimating equations are more biased and less precise at normal to high GFR levels than cystatin-based estimates on both an absolute and percentage basis (17) and will likely lead to GFR slopes that are even more difficult to interpret, particularly when there are small numbers of observations or short follow-up periods. Therefore, the choice of GFR measure (or estimate) will undoubtedly influence which patients are considered to have RFD, affecting the predictive value of this measure.…”

Section: Discussionmentioning

confidence: 99%

Early Renal Function Decline in Type 2 Diabetes

Pavkov

Knowler

Lemley

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Early decline in GFR may reflect progressive kidney disease in type 1 diabetes, but its predictive value in type 2 diabetes is uncertain.Design, setting, participants, & measurements In this longitudinal study, GFR was measured serially over approximately 4.0 years in 195 Pima Indians with type 2 diabetes. Renal function decline (RFD) was defined during this initial period by an average GFR loss $3.3%/yr, as defined previously in type 1 diabetes. Subsequently, participants were followed for up to 17.8 years to ESRD onset, death, or December 31, 2010, whichever came first.Results RFD prevalence during the initial period was 32% in 68 participants with normal baseline albuminuria (albumin/creatinine ratio [ACR] , 30 mg/g), 42% in 88 with microalbuminuria (ACR 30 to ,300 mg/g), and 74% in 39 with macroalbuminuria (ACR $300 mg/g; P,0.001). The cumulative incidence of ESRD 10 years after the initial period was 41% in those with RFD and 15% in those without (P,0.001); 41 of the 49 ESRD cases (83.7%) occurred in participants who had or developed macroalbuminuria during the initial period. When adjusted for age, sex, diabetes duration, and hemoglobin A1c, the ESRD hazard rate was 4.78 times (95% confidence interval, 2.39-9.58) as high in those with RFD as in those without; further adjustment for albuminuria attenuated this association (hazard ratio, 1.79; 95% confidence interval, 0.82-3.91).Conclusions In type 2 diabetes, loss of GFR often occurs before the onset of macroalbuminuria, but a decline predictive of ESRD is strongly dependent on progression to macroalbuminuria.

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“…Serum creatinine remains the principal variable of the GFR-estimating equations, and if it is not accurately representing the individual's muscular mass [70], there is little chance that including the creatinine into the equations would improve their performance. Classical examples are hyperfiltrating diabetic patients [49,59,71] and cirrhotic [72,73], renal transplanted [21,51,55], elderly [21,73] and anorectic patients [73].…”

Section: Co N C L U S I O N : P O P U L At I O N V E R S U S P At I Ementioning

confidence: 99%

Con: Should we abandon the use of the MDRD equation in favour of the CKD-EPI equation?

Delanaye¹,

Pottel²,

Botev³

2013

Nephrology Dialysis Transplantation

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The Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) equation is less accurate in patients with Type 2 diabetes when compared with healthy individuals

Abstract: The CKD-EPI equation is less accurate in patients with Type 2 diabetes when compared with healthy individuals, with a 2.5-fold greater bias.

Cited by 65 publications

References 30 publications

Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Equation Pronouncedly Underestimates Glomerular Filtration Rate in Type 2 Diabetes

Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Equation Pronouncedly Underestimates Glomerular Filtration Rate in Type 2 Diabetes

Early Renal Function Decline in Type 2 Diabetes

Con: Should we abandon the use of the MDRD equation in favour of the CKD-EPI equation?

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