Comparison of bias and accuracy using cystatin C and creatinine in CKD-EPI equations for GFR estimation

Zou, Lu-Xi; Sun, Ling; Nicholas, Susanne B.; Lu, Yan; K, Satyesh Sinha; Hua, Rui-Xue

doi:10.1016/j.ejim.2020.04.044

Cited by 37 publications

(29 citation statements)

References 35 publications

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“…In this study, the association between renal function and NF-L is based on cyctatin C. Cystatin C was initially chosen because creatinine is known to be influenced by muscle mass and this cohort was initially designed to evaluate prevalence of sarcopenia. Cystatin C is as good as or even better than creatinine in estimating GFR [ 26 ] although cystatin C is less commonly used on a routine basis because it is more expensive for patients. In previous studies [ 22 , 24 ], renal function was assessed based on creatinine rather than cystatin C emphasizing that our conclusions are driven by renal function rather than by the method that estimates renal function.…”

Section: Discussionmentioning

confidence: 99%

Neurofilament light chain concentration in an aging population

et al. 2022

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Background Neurofilament light chain (NF-L) concentration is recognized to be modified in neurological diseases and traumatic brain injuries, but studies in the normal aging population are lacking. It is, therefore, urgent to identify influencing factors of NF-L concentration in the aging population. Method We assessed NF-L concentration in sera of a large cohort of 409 community-dwelling adults aged over 65 years. We studied the association between NF-L and various physiological factors but also with self-reported comorbidities or life-style habits. Results We showed that NF-L concentration in serum was tightly associated with cystatin C concentration (r = 0.501, p < 0.0001) and consequently, to the estimated glomerular filtration rate (eGFR) (r = − 0.492; p < 0.0001). Additionally, NF-L concentration was dependent on age and body mass index (BMI) but not sex. Among the self-reported comorbidities, subjects who reported neurological disorders, cardiovascular diseases or history of fracture had higher NF-L concentration in univariate analysis, whereas it was only the case for subjects who reported neurological disorders in the multivariate analysis. NF-L concentration was also increased when Mini-Mental State Examination (MMSE) was decreased (≤ 25 points) but not when geriatric depression score (GDS) was increased (> 5 points) in both univariate and multivariate analysis. Finally, we are providing reference ranges by age categories for subjects with or without altered renal function. Conclusion NF-L concentration in the aging population is not driven by the increasing number of comorbidities or depression. Yet, NF-L blood concentration is dependent on kidney function and NF-L interpretation in patients suffering from renal failure should be taken with caution.

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Section: Discussionmentioning

confidence: 99%

Neurofilament light chain concentration in an aging population

et al. 2022

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“…11,[40][41][42][43][44][45][46] A meta-analysis among populations relevant to primary health care also reported that eGFRcys and eGFRcr-cys were less biased and more accurate than eGFRcr. 49 The heterogenous findings in the performance of eGFRcys could be related to the higher prevalence of smoking or other clinical characteristics in our study population that differ from others. [50][51][52][53] Unlike our decision to develop eGFRcr-PK to account for bias in eGFRcr, presumably because of lower muscle mass and lower dietary protein intakes 19 in Pakistan compared with North American and European populations in which the CKD-EPI eGFRcr was developed, we elected not to develop a calibration factor for eGFRcys in Pakistan because the cause of the large bias of eGFRcys is not known, and therefore we were not confident that the calibrated equation would be robust across the country.…”

Section: Discussionmentioning

confidence: 78%

Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians

Wang

Levey

Inker

et al. 2021

Kidney International Reports

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Introduction: The creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation was calibrated for the general Pakistan population (eGFRcr-PK) to eliminate bias and improve accuracy. Cystatin C-based CKD-EPI equations (eGFRcys and eGFRcr-cys) have not been assessed in this population, and non-GFR determinants of cystatin C are unknown. Methods: We assessed eGFRcys, eGFRcr-cys, and non-GFR determinants of cystatin C in a cross-sectional study of 557 participants ($40 years of age) from Pakistan. We compared bias (median difference in measured GFR [mGFR] and eGFR), precision (interquartile range [IQR] of differences), accuracy (percentage of eGFR within 30% of mGFR), root mean square error (RMSE), and classification of mGFR <60 ml/ min/1.73 m 2 (area under the receiver operating characteristic curve [AUC] and net reclassification index [NRI]) among eGFR equations. Results: We found that eGFRcys underestimated mGFR (bias, 12.7 ml/min/1.73 m 2 [95% confidence interval {CI} 10.7-15.2]). eGFRcr-cys did not improve performance over eGFRcr-PK in precision (P ¼ 0.52), accuracy (P ¼ 0.58), or RMSE (P ¼ 0.49). Results were consistent among subgroups by age, sex, smoking, body mass index (BMI), and eGFR. NRI was 7.31% (95% CI 1.52%-13.1%; P < 0.001) for eGFRcr-cys versus eGFRcr-PK, but AUC was not improved (0.92 [95% CI 0.87-0.96] vs. 0.90 [95% CI 0.86-0.95]; P ¼ 0.056). Non-GFR determinants of higher cystatin C included male sex, smoking, higher BMI and total body fat, and lower lean body mass. Conclusion: eGFRcys underestimated mGFR in South Asians and eGFRcr-cys did not offer substantial advantage compared with eGFRcr-PK. Future studies are warranted to better understand the large bias in eGFRcys and non-GFR determinants of cystatin C in South Asians.

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“…They also indicated that the MDRD equation performed better for females or elderly patients [ 40 ]. In contrast, according to a meta-analyses by Zou et al, CKD-EPI cys was the most accurate compared with CKD-EPI crea/cys , and CKD-EPI crea and performed best in the analyses of sub-group such as those persons with mGFR < 60 mL/min/1.73 m 2 , aged less than 70 years and those participants who were of the Asia ethnic group [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, in a meta-analysis of 35 studies with 23,667 persons, eGFR measured using CKD-EPI cys had less bias compared with CKD-EPI crea/cys , and CKD-EPI crea . The authors also reported that the projected values from CKD-EPI crea/cys displayed greater accuracy than those from CKD-EPI crea [ 28 ]. Moreover, a systematic and meta-analysis 48 studies of 26,875 patients from diverse populations showed that eGFR values using CKD-EPI equations had lower mean bias and performed better than the MDRD formula [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…There are serum creatinine (crea) and cystatin C (cys)-based CKD-EPI equations, and clinical trials have presented validation data and compared their clinical performance in accurately predicting GFR [ 25 , 26 , 27 ]. The CKD-EPI equations include CKD-EPI crea , CKD-EPI cys and CKD-EPI crea/cys , and a recent meta-analysis comprising 35 studies with 23,667 participants found that estimates of CKD-EPI cys and CKD-EPI crea/cys were closer to mGFR and were more accurate and less bias compared with CKD-EPI crea [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Prospective Comparison of 24-Hour Urine Creatinine Clearance with Estimated Glomerular Filtration Rates in Chronic Renal Disease Patients of African Descent

et al. 2021

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Background: The 24-hour (24-h) creatinine clearance (CrCl) is the most common method for measuring GFR in clinical laboratories. However, the limitations of CrCl have resulted in the widespread acceptance of mathematically derived estimated glomerular filtration rate (eGFR) using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in predicting eGFR. The aim of the study was to compare 24-h CrCl with eGFR derived from these formulae and to identify which could be the best alternative. Method: A prospective study was conducted involving 140 CKD patients. Creatinine and cystatin C concentrations were determined using the cobas 6000 analyzer. The eGFR was calculated using the CG formula, 4-variable MDRD and CKD-EPI equations, and Bland-Alman plots bias was determined. Results: The CG and MDRD formulas had mean eGFR values similar to CrCl and correlation coefficients (r) were highest for CG (0.906) and lowest for MDRD (0.799). The CG equation was in agreement with 24-h CrCl in all but stage V CKD while the MDRD equation compared well in all except Stage IV CKD. The CG equation was positively biased (0.9857) while the MDRD had a negative bias (−0.05). Conclusion: The Cockcroft-Gault formula provides a more accurate assessment of GFR than 24-h CrCl and would be recommended as a substitute to provide the best estimate of GFR in our population.

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Comparison of bias and accuracy using cystatin C and creatinine in CKD-EPI equations for GFR estimation

Cited by 37 publications

References 35 publications

Neurofilament light chain concentration in an aging population

Neurofilament light chain concentration in an aging population

Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians

Prospective Comparison of 24-Hour Urine Creatinine Clearance with Estimated Glomerular Filtration Rates in Chronic Renal Disease Patients of African Descent

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