The need for robust validation for MDRD-based glomerular filtration rate estimation in various CKD populations

Praditpornsilpa, Kearkiat; Townamchai, Natavudh; Chaiwatanarat, Tawatchai; Tiranathanagul, Khajohn; Katawatin, Pisut; Susantitaphong, Paweena; Trakarnvanich, Thananda; Kanjanabuch, Talerngsak; Avihingsanon, Yingyos; Tungsanga, Kriang; Eiam‐Ong, Somchai

doi:10.1093/ndt/gfq815

Cited by 97 publications

(85 citation statements)

References 16 publications

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“…(2) The proliferation of proposed ethnicity coefficients for adjusting the MDRD and CKD-EPI equations is alarming, as study designs may not have permitted such conclusions to be drawn. (16,19) The results of the present study suggest that the new creatinine-cystatin C CKD-EPI equation is able to produce eGFRs with reasonable accuracy over a broader range of GFRs, in patients with and without CKD. It is unlikely that there will be a perfectly accurate GFR estimation equation for all clinical scenarios.…”

Section: Discussionmentioning

confidence: 66%

Performance of the CKD-EPI creatinine-cystatin C glomerular filtration rate estimation equations in a multiethnic Asian population

Teo

Koh²,

Toh³

et al. 2014

smedj

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INTRODUCTIONThe use of coefficients to adjust for ethnicity in equations estimating glomerular filtration rate (GFR) is impractical. (1,2) Although coefficients for ethnicities other than 'white' or 'black' have been derived for the Modification of Diet in Renal Disease (MDRD) equation, these coefficients do not necessarily yield accurate estimations.(1,3) The combined use of serum creatinine and cystatin C biomarkers in equations estimating GFR has been shown to improve the accuracy of GFR estimation and reduce the effect of ethnicity as a predictor.(4) In fact, a recent study showed that the effect ethnicity had on GFR estimation was rendered insignificant when beta-trace protein (BTP), creatinine and cystatin C were used in the equation. (5) The equation developed by the Chronic Kidney DiseaseEpidemiology Collaborative Group (CKD-EPI) is preferred when estimating GFRs in multiethnic populations because of its reduced bias. CKD-EPI has also developed a new equation that incorporates both serum creatinine and cystatin C, using a population comprising both healthy individuals and chronic kidney disease (CKD) patients.(2) We assessed the performance of the new creatinine-cystatin C CKD-EPI equation in a study cohort consisting of healthy participants and patients with CKD who have undergone radionuclide GFR measurement. METHODSThe present study, which was approved by the institution review board, utilised the serum samples of research participants (n = 335) from the Asian Kidney Disease Study and Singapore Kidney Function Study. (3,6) The stored serum samples were assayed for cystatin C. In the Asian Kidney Disease Study, patients with stable CKD from the outpatient renal clinics of National University Hospital, Singapore, were recruited (n = 232).(3) In the Singapore Kidney Function Study, healthy participants who had normal kidney function and who reported having no diagnosis of hypertension or diabetes mellitus were recruited (n = 103). (6) All participants from both studies underwent urine dipstick tests to exclude microalbuminuria, leucocyturia and erythrocyturia. Participants were recruited consecutively using stratified sampling; they were stratified according to the four ethnic groups (Chinese, Malay, Indian and others) and then by gender. In both studies, participants performed self-directed 24-hour urine collections and underwent GFR measurements the next day, during which blood and spot urine samples were also collected.

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Section: Discussionmentioning

confidence: 66%

Performance of the CKD-EPI creatinine-cystatin C glomerular filtration rate estimation equations in a multiethnic Asian population

Teo

Koh²,

Toh³

et al. 2014

smedj

View full text Add to dashboard Cite

show abstract

“…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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“…All recipients underwent surveillance kidney allograft biopsy from the specific time points (1st, 6th, 12th, 24th, 36th, and 48th month after kidney transplantation) and also if clinically indicated. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)-derived equation [19].…”

Section: Immunosuppression Protocol and Patient Follow Upmentioning

confidence: 99%

The Cytochrome P450 3A5 Non-Expressor Kidney Allograft as a Risk Factor for Calcineurin Inhibitor Nephrotoxicity

et al. 2018

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Background: Tacrolimus is mainly metabolized by cytochrome P450 3A5 (CYP3A5), which is expressed in the liver. However, CYP3A5 is also expressed in the kidney tissue and may contribute to local tacrolimus clearance in the kidney allograft. We aimed to evaluate the association between the allograft CYP3A5 genotype and transplant outcomes. Methods: We conducted a retrospective cohort study at the King Chulalongkorn Memorial Hospital, Thailand, comparing 2 groups of donor and recipient CYP3A5 genotypes, the expressor (*1/*1 and *1/*3) and the non-expressor (*3/*3). The primary outcomes were allograft complications including calcineurin inhibitor (CNI) nephrotoxicity and acute rejection episode. Results: Of the 50 enrolled patients, 21 donors were expressors and 29 donors were the non-expressors. Tacrolimus trough concentrations were similar between the 2 genotypes. The incidence of CNI nephrotoxicity was higher in recipients with non-expressor donor genotype compared with the expressor donor genotype (72.4 vs. 33.3%, p = 0.006). CNI nephrotoxicity incidence was not different when recipient’s genotypes were compared. Multivariate analysis from Cox-regression showed a hazard ratio of 3.18 (p = 0.026) for CNI nephrotoxicity in the non-expressor compared with the expressor donor. The recipient CYP3A5 genotypes did not significantly contribute to CNI nephrotoxicity. Kaplan-Meier analysis demonstrated the lowest CNI nephrotoxicity-free survival in recipients with the expressor genotype who received allograft from the non-expressor donors (p = 0.005). Conclusion: In conclusion, our results suggest that donor CYP3A5 non-expressor genotype (*3/*3) is a risk for CNI nephrotoxicity.

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The need for robust validation for MDRD-based glomerular filtration rate estimation in various CKD populations

Abstract: Differences in race/ethnicity can significantly affect the results obtained from MDRD-based eGFR equation. It is highly recommended that each population should validate eGFR equations before applying the equation in epidemiologic studies or clinical use.

Cited by 97 publications

References 16 publications

Performance of the CKD-EPI creatinine-cystatin C glomerular filtration rate estimation equations in a multiethnic Asian population

Performance of the CKD-EPI creatinine-cystatin C glomerular filtration rate estimation equations in a multiethnic Asian population

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

The Cytochrome P450 3A5 Non-Expressor Kidney Allograft as a Risk Factor for Calcineurin Inhibitor Nephrotoxicity

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