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PLoS One. 2015 Feb 20;10(2):e0118676. doi: 10.1371/journal.pone.0118676. eCollection 2015.

Exploration of chronic kidney disease prevalence estimates using new measures of kidney function in the health survey for England.

Author information

1
Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, United Kingdom.
2
Geography & Environment, Faculty of Social and Human Sciences, University of Southampton, Southampton, SO171BJ, United Kingdom.
3
Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham at Derby, Derby, DE22 3DT, United Kingdom.
4
Research Department of Epidemiology and Public Health, UCL (University College London), London, WC1E 6BT, United Kingdom.
5
Department of Clinical Biochemistry, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, United Kingdom.
6
Renal Unit, Salford Royal NHS Foundation Trust, Salford, M6 8HD, United Kingdom.

Abstract

BACKGROUND:

Chronic kidney disease (CKD) diagnosis relies on glomerular filtration rate (eGFR) estimation, traditionally using the creatinine-based Modification of Diet in Renal Disease (MDRD) equation. The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation performs better in estimating eGFR and predicting mortality and CKD progression risk. Cystatin C is an alternative glomerular filtration marker less influenced by muscle mass. CKD risk stratification is improved by combining creatinine eGFR with cystatin C and urinary albumin to creatinine ratio (uACR). We aimed to identify the impact of introducing CKDEPI and cystatin C on the estimated prevalence and risk stratification of CKD in England and to describe prevalence and associations of cystatin C.

METHODS AND FINDINGS:

Cross sectional study of 5799 people in the nationally representative 2009 and 2010 Health Surveys for England.

PRIMARY OUTCOME MEASURES:

prevalence of MDRD, CKDEPI and cystatin C-defined eGFR<60 ml/min/1.73 m(2); prevalence of CKD biomarker combinations (creatinine, cystatin C, uACR). Using CKDEPI instead of MDRD reduced the prevalence of eGFR<60 ml/min/1.73 m(2) from 6.0% (95% CI 5.4-6.6%) to 5.2% (4.7-5.8%) equivalent to around 340,000 fewer individuals in England. Those reclassified as not having CKD evidenced a lower risk profile. Prevalence of cystatin C eGFR<60 ml/min/1.73 m(2) was 7.7% and independently associated with age, lack of qualifications, being an ex-smoker, BMI, hypertension, and albuminuria. Measuring cystatin C in the 3.9% people with CKDEPI-defined eGFR<60 ml/min/1.73 m(2) without albuminuria (CKD Category G3a A1) reclassified about a third into a lower risk group with one of three biomarkers and two thirds into a group with two of three. Measuring cystatin C in the 6.7% people with CKDEPI eGFR >60 ml/min/1.73 m(2) with albuminuria (CKD Category G1-2) reclassified almost a tenth into a higher risk group.

LIMITATIONS:

Cross sectional study, single eGFR measure, no measured ('true') GFR.

CONCLUSIONS:

Introducing the CKDEPI equation and targeted cystatin C measurement reduces estimated CKD prevalence and improves risk stratification.

PMID:
25700182
PMCID:
PMC4336286
DOI:
10.1371/journal.pone.0118676
[Indexed for MEDLINE]
Free PMC Article

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