Abstract
Background: New CKD-EPI and EKFC estimated GFR (eGFR) equations using
creatinine (eGFRcr), cystatin C (eGFRcys) and both (eGFRcr-cys) have sufficient
accuracy for use in clinical practice. A better understanding of the equations, including
their performance in race, sex and age subgroups, is important for selection of eGFR
equations for global implementation.
Methods: We evaluated performance (bias and P30) of equations and methods used
for equation development in an independent study population comprising 4050
participants pooled from 12 studies. The mean (SD) mGFR was 76.4 (29.6)
ml/min/1.73 m2, age 57.0 (17.4) years, with 1557 (38%) women and 579 (14%) Black
participants.
Results: Coefficients for creatinine, cystatin C, age and sex in the CKD-EPI and EKFC
equations are similar. Performance of the eGFRcr-cys equations in the overall
population (bias 90%) was better than the eGFRcr or
eGFRcys equations, with fewer differences among race, sex and age subgroups.
Differences in performance across subgroups reflected differences in diversity of
source populations and use of variables for race and sex for equation development.
Larger differences among eGFRcr equations reflected regional population differences
in non-GFR determinants of creatinine.
Conclusion: CKD-EPI and EKFC equations are approaching convergence. It is not
possible to maximize both accuracy and uniformity in selecting one of the currently
available eGFRcr equations for implementation across regions. Decisions should
consider methods for equation development in addition to performance. Wider use of
cystatin C with creatinine could maximize both accuracy and uniformity of GFR
estimation using currently available equations.
creatinine (eGFRcr), cystatin C (eGFRcys) and both (eGFRcr-cys) have sufficient
accuracy for use in clinical practice. A better understanding of the equations, including
their performance in race, sex and age subgroups, is important for selection of eGFR
equations for global implementation.
Methods: We evaluated performance (bias and P30) of equations and methods used
for equation development in an independent study population comprising 4050
participants pooled from 12 studies. The mean (SD) mGFR was 76.4 (29.6)
ml/min/1.73 m2, age 57.0 (17.4) years, with 1557 (38%) women and 579 (14%) Black
participants.
Results: Coefficients for creatinine, cystatin C, age and sex in the CKD-EPI and EKFC
equations are similar. Performance of the eGFRcr-cys equations in the overall
population (bias 90%) was better than the eGFRcr or
eGFRcys equations, with fewer differences among race, sex and age subgroups.
Differences in performance across subgroups reflected differences in diversity of
source populations and use of variables for race and sex for equation development.
Larger differences among eGFRcr equations reflected regional population differences
in non-GFR determinants of creatinine.
Conclusion: CKD-EPI and EKFC equations are approaching convergence. It is not
possible to maximize both accuracy and uniformity in selecting one of the currently
available eGFRcr equations for implementation across regions. Decisions should
consider methods for equation development in addition to performance. Wider use of
cystatin C with creatinine could maximize both accuracy and uniformity of GFR
estimation using currently available equations.
| Original language | English |
|---|---|
| Pages (from-to) | 1953-1964 |
| Journal | Journal of the American Society of Nephrology |
| Volume | 34 |
| Issue number | 12 |
| Early online date | 2023 Oct 5 |
| DOIs | |
| Publication status | Published - 2023 |
Subject classification (UKÄ)
- Computational Mathematics
- Evolutionary Biology
