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Am J Kidney Dis. 2012 Aug;60(2):250-61. doi: 10.1053/j.ajkd.2012.04.012. Epub 2012 Jun 2.

Estimating GFR among participants in the Chronic Renal Insufficiency Cohort (CRIC) Study.

Collaborators (225)

Feldman HI, Landis JR, Appleby DH, Ballard S, Cifelli D, Curley RM, Dickson J, Durborow M, Durborow S, Glenn M, Hanish A, Helker C, Helker ES, Hyre Anderson A, Joffe M, Kasner S, Kimmel SE, Kumanyika S, Mazurick C, Nessel L, Mohler ER 3rd, Messe SR, Robinson N, Rosen L, Schwartz JS, Smith S, Stahl J, Tao K, Teal VL, Wang X, Xie D, Yang P, Zhang X, Townsend RR, Balaram M, Cappola TP, Cohen D, Cuevas M, Daniel E, Duckworth MJ, Dries DL, Ford V, Gorman CM, Grunwald J, Hannah HM, Kanetsky PA, Kellem K, Kibe L, Leonard MB, Maguire M, McDowell S, McWilliams K, Murphy J, Reilly M, Rosas SE, Seamon WM, Sheridan A, Teff K, Ying GS, Appel LJ, Anderson C, Charleston J, Etheredge N, Jaar B, Mantegna K, Martin C, Miller E, Ngoh P, Scialla J, Sozio S, Turban S, Venkatesh H, Fink J, Fink W, Parsa A, Scism B, Seliger S, Weir M, Rahman M, Dobre MA, Corrigan V, Dancie R, Kisin G, Kanthety R, Strauss L, Wright JT Jr, Schelling J, Kao P, Horwitz E, Bjaloncik J, Fallon T, Sedor JR, Shella MA, Theurer J, Thornton JD, Schreiber MJ, Taliercio J, Coleman M, Fatica R, Halliburton S, Horner C, Markle T, Rafey MA, Ramos M, Russo A, Slattery S, Spirko R, Stelmach K, Stephens V, Danziger-Isakov L, Ojo A, Sundaram B, Briesmiester J, Cornish-Zirker D, Gadegbeku C, Hill N, Jamerson K, Kretzler M, Robinson B, Saran R, Welliver B, Wilson J, Young E, Steigerwalt SP, Bellovich K, DeLuca J, Gasko S, Makos G, Parmelee C, Smith S, Walls K, Flack JM, Sondheimer J, Mahn J, Maysura M, Migdal S, Mohanty MJ, Zhuang Y, Lash JP, Arruda J, Carolyn B, Carmona E, Cohan J, Michael F, Frydrych A, Lopez A, Lora C, Martinez M, Matos A, Mercado A, Moreno B, Meslar P, Ricardo A, Stamos T, Van Cauter E, He J, Alper B, Batuman V, Bazzano LA, Borja B, Burridge A, Chen J, Cooke C, Delafontaine P, DeSalvo KB, Fonseca VA, Hamm L, Hurly MR, Legarde J, Lustigova E, Muntner P, Patrocollo-Emerson M, Powers L, Shelton S, Starcke C, Whelton P, Go AS, Ackerson LM, Dorin P, Fernandez D, Jensvold NG, Lo JC, Ordonez JD, Perloff R, Tan T, Thompson D, Valladares GM, Wiggins A, Wong DB, Yang J, Hsu CY, Chertow GM, Bansal N, Kurella M, Shlipak MG, Yaffe K, Kusek JW, Narva AS, Faber-Langendoen K, Kiberd BA, Lee ET, Lewis J, McClellan W, Meyer T, Nathan D, Stokes JB, Taylor H, Wilson PW, Shah V, Raj D, Wolf M, Ridker PM, Rader DJ, DiFlorio A, Master S, Mifflin T, Hall L, Rolin H, Saunders S, Budoff M, Dailing C, Soliman EZ, Zhang ZM, St John Sutton M, Keane MG.

Author information

1
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA. andersah@mail.med.upenn.edu

Abstract

BACKGROUND:

Glomerular filtration rate (GFR) is considered the best measure of kidney function, but repeated assessment is not feasible in most research studies.

STUDY DESIGN:

Cross-sectional study of 1,433 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study (ie, the GFR subcohort) to derive an internal GFR estimating equation using a split-sample approach.

SETTING & PARTICIPANTS:

Adults from 7 US metropolitan areas with mild to moderate chronic kidney disease; 48% had diabetes and 37% were black.

INDEX TEST:

CRIC GFR estimating equation.

REFERENCE TEST OR OUTCOME:

Urinary (125)I-iothalamate clearance testing (measured GFR [mGFR]).

OTHER MEASUREMENTS:

Laboratory measures, including serum creatinine and cystatin C, and anthropometrics.

RESULTS:

In the validation data set, the model that included serum creatinine level, serum cystatin C level, age, sex, and race was the most parsimonious and similarly predictive of mGFR compared with a model additionally including bioelectrical impedance analysis phase angle, CRIC clinical center, and 24-hour urinary creatinine excretion. Specifically, root mean square errors for the separate models were 0.207 versus 0.202, respectively. Performance of the CRIC GFR estimating equation was most accurate for the subgroups of younger participants, men, nonblacks, non-Hispanics, those without diabetes, those with body mass index <30 kg/m(2), those with higher 24-hour urine creatinine excretion, those with lower high-sensitivity C-reactive protein levels, and those with higher mGFRs.

LIMITATIONS:

Urinary clearance of (125)I-iothalamate is an imperfect measure of true GFR; cystatin C level is not standardized to certified reference material; lack of external validation; small sample sizes limit analyses of subgroup-specific predictors.

CONCLUSIONS:

The CRIC GFR estimating equation predicts mGFR accurately in the CRIC cohort using serum creatinine and cystatin C levels, age, sex, and race. Its performance was best in younger and healthier participants.

PMID:
22658574
PMCID:
PMC3565578
DOI:
10.1053/j.ajkd.2012.04.012
[Indexed for MEDLINE]
Free PMC Article

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