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Clin Chem Lab Med. 2018 Feb 23;56(3):422-435. doi: 10.1515/cclm-2017-0563.

GFR estimation based on standardized creatinine and cystatin C: a European multicenter analysis in older adults.

Author information

1
Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
2
Department of Clinical Chemistry, Skåne University Hospital, Lund, Sweden.
3
Division of Nephrology and Intensive Care Medicine, Charite´ Campus Virchow, Berlin, Germany.
4
Department of Clinical Sciences Intervention and Technology, Karolinska Institute and Karolinska University Hospital Huddinge, Stockholm, Sweden.
5
Department of Clinical Chemistry, Karolinska Institute and Karolinska University Hospital Huddinge, Stockholm, Sweden.
6
Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
7
Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK.
8
Institute of Medical Biostatistics, Eberhard Karls University Tübingen, Tübingen, Germany.
9
Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden, Phone: +46-733-842244.

Abstract

BACKGROUND:

Although recommended by the Kidney Disease Improving Global Outcomes, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICR) creatinine equation was not targeted to estimate glomerular filtration rate (eGFR) among older adults. The Berlin Initiative Study (BIS1CR) equation was specifically developed in older adults, and the Lund-Malmö revised (LMRCR) and the Full Age Spectrum (FASCR) equations have shown promising results in older adults. Our aim was to validate these four creatinine equations, including addition of cystatin C in a large multicenter cohort of Europeans ≥70 years.

METHODS:

A total of 3226 individuals (2638 with cystatin C) underwent GFR measurement (mGFR; median, 44 mL/min/1.73 m2) using plasma iohexol clearance. Bias, precision (interquartile range [IQR]), accuracy (percent of estimates ±30% of mGFR, P30), eGFR accuracy diagrams and probability diagrams to classify mGFR<45 mL/min/1.73 m2 were compared.

RESULTS:

The overall results of BIS1CR/CKD-EPICR/FASCR/LMRCR were as follows: median bias, 1.7/3.6/0.6/-0.7 mL/min/1.73 m2; IQR, 11.6/12.3/11.1/10.5 mL/min/1.73 m2; and P30, 77.5%/76.4%/80.9%/83.5% (significantly higher for LMR, p<0.001). Substandard P30 (<75%) was noted for all equations at mGFR<30 mL/min/1.73 m2, and at body mass index values <20 and ≥35 kg/m2. LMRCR had the most stable performance across mGFR subgroups. Only LMRCR and FASCR had a relatively constant small bias across eGFR levels. Probability diagrams exhibited wide eGFR intervals for all equations where mGFR<45 could not be confidently ruled in or out. Adding cystatin C improved P30 accuracy to 85.7/86.8/85.7/88.7 for BIS2CR+CYS/CKD-EPICR+CYS/FASCR+CYS/MEANLMR+CAPA.

CONCLUSIONS:

LMRCR and FASCR seem to be attractive alternatives to CKD-EPICR in estimating GFR by creatinine-based equations in older Europeans. Addition of cystatin C leads to important improvement in estimation performance.

KEYWORDS:

chronic kidney disease; creatinine; cystatin C; glomerular filtration rate; kidney function tests; renal failure

PMID:
28985182
DOI:
10.1515/cclm-2017-0563
[Indexed for MEDLINE]

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