In:
Clinical Chemistry and Laboratory Medicine (CCLM), Walter de Gruyter GmbH, Vol. 56, No. 3 ( 2018-2-23), p. 422-435
Abstract:
Although recommended by the Kidney Disease Improving Global Outcomes, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI CR ) creatinine equation was not targeted to estimate glomerular filtration rate (eGFR) among older adults. The Berlin Initiative Study (BIS1 CR ) equation was specifically developed in older adults, and the Lund-Malmö revised (LMR CR ) and the Full Age Spectrum (FAS CR ) 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 m 2 ) using plasma iohexol clearance. Bias, precision (interquartile range [IQR]), accuracy (percent of estimates ±30% of mGFR, P 30 ), eGFR accuracy diagrams and probability diagrams to classify mGFR 〈 45 mL/min/1.73 m 2 were compared. Results: The overall results of BIS1 CR /CKD-EPI CR /FAS CR /LMR CR were as follows: median bias, 1.7/3.6/0.6/−0.7 mL/min/1.73 m 2 ; IQR, 11.6/12.3/11.1/10.5 mL/min/1.73 m 2 ; and P 30 , 77.5%/76.4%/80.9%/83.5% (significantly higher for LMR, p 〈 0.001). Substandard P 30 ( 〈 75%) was noted for all equations at mGFR 〈 30 mL/min/1.73 m 2 , and at body mass index values 〈 20 and ≥35 kg/m 2 . LMR CR had the most stable performance across mGFR subgroups. Only LMR CR and FAS CR 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 P 30 accuracy to 85.7/86.8/85.7/88.7 for BIS2 CR+CYS /CKD-EPI CR+CYS /FAS CR+CYS /MEAN LMR+CAPA . Conclusions: LMR CR and FAS CR seem to be attractive alternatives to CKD-EPI CR in estimating GFR by creatinine-based equations in older Europeans. Addition of cystatin C leads to important improvement in estimation performance.
Type of Medium:
Online Resource
ISSN:
1437-4331
,
1434-6621
DOI:
10.1515/cclm-2017-0563
Language:
English
Publisher:
Walter de Gruyter GmbH
Publication Date:
2018
detail.hit.zdb_id:
1492732-9
SSG:
15,3
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