Estimating glomerular filtration rate for the full age spectrum from serum creatinine and cystatin C

Pottel, Hans; Delanaye, Pierre; Schaeffner, Elke; Dubourg, Laurence; Eriksen, Bjørn Odvar; Melsom, Toralf; Lamb, Edmund J.; Rule, Andrew D.; Turner, Stephen T.; Glassock, Richard J.; Souza, V. de; Selistre, Luciano; Goffin, Karolien; Pauwels, Steven; Mariat, Christophe; Flamant, Martin; Ebert, Natalie

doi:10.1093/ndt/gfw425

Cited by 144 publications

(174 citation statements)

References 32 publications

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“…As an example of this, CKD-EPI cr-cys and CAPA cys performed more poorly in the FAS study [23] . Conversely, overall, the creatinine-based equations showed similar results.…”

Section: Interpretation Of the Resultsmentioning

confidence: 94%

“…Further validation studies of these equations in external populations will improve their generalisability. Except for the original publications of the new full age spectrum (FAS) equations, no other studies have covered these equations using creatinine [22] , cystatin C, or a combination thereof in older adults [23] . The recently developed CKD-EPI equations based on B2M and BTP [24] have not been validated before in older adults.…”

mentioning

confidence: 99%

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Combining Cystatin C and Creatinine Yields a Reliable Glomerular Filtration Rate Estimation in Older Adults in Contrast to β-Trace Protein and β2-Microglobulin

Werner

Pihlsgård

Elmståhl

et al. 2017

Nephron

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Background: The glomerular filtration rate (GFR) is the most important measure of kidney function and chronic kidney disease (CKD). This study aims to validate commonly used equations for estimated GFR (eGFR) based on creatinine (cr), cystatin C (cys), β-trace protein (BTP), and β2-microglobulin (B2M) in older adults. Method: We conducted a validation study with 126 participants aged between 72 and 98 with a mean measured GFR (mGFR) by iohexol clearance of 54 mL/min/1.73 m². The eGFR equations (CKD-Epidemiology collaboration [CKD-EPI], Berlin Initiative Study [BIS], Full Age Spectrum [FAS], Modification of Diet in Renal Disease [MDRD]_cr, Caucasian-Asian-Pediatric-Adult [CAPA]_cys, Lund-Malmö Revised [LM-REV]_cr, and MEAN-LM-CAPA_cr-cys), were assessed in terms of bias (median difference: eGFR-mGFR), precision (interquartile range of the differences), and accuracy (P30: percentage of estimates ±30% of mGFR). The equations were compared to a benchmark equation: CKD-EPI_cr-cys. Results: All cystatin C-based equations underestimated the GFR compared to mGFR, whereas bias was mixed for the equations based only on creatinine. Accuracy was the highest for CKD-EPI_cr-cys (98%) and lowest for MDRD (82%). Below mGFR 45 mL/min/1.73 m² only equations incorporating cystatin C reached P30 accuracy >90%. CKD-EPI_cr-cys was not significantly more accurate than the other cystatin C-based equations. In contrast, CKD-EPI_cr-cys was significantly more accurate than all creatinine-based equations except LM-REV_cr. Conclusion: This study confirms that it is reasonable to use equations incorporating cystatin C and creatinine in older patients across a wide spectrum of GFR. However, the results call into question the use of creatinine alone below mGFR 45 mL/min/1.73 m². B2M and BTP do not demonstrate additional value in eGFR determination in older adults.

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“…As an example of this, CKD-EPI cr-cys and CAPA cys performed more poorly in the FAS study [23] . Conversely, overall, the creatinine-based equations showed similar results.…”

Section: Interpretation Of the Resultsmentioning

confidence: 94%

mentioning

confidence: 99%

Combining Cystatin C and Creatinine Yields a Reliable Glomerular Filtration Rate Estimation in Older Adults in Contrast to β-Trace Protein and β2-Microglobulin

Werner

Pihlsgård

Elmståhl

et al. 2017

Nephron

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“…Regarding cystatin C, CV A but also CV I are basically not different from serum creatinine measured by enzymatic assays (with a critical difference of 13%) [65] and the hyperbolic relationship with GFR is also true for cystatin C [57,66,67] . If we consider the same critical difference for creatinine and cystatin C, the effect of the variability of cystatin C on cystatin C-eGFR will be even slightly higher, as the exponent applied for cystatin C in an eGFRequation is even slightly higher than that used for creatinine.…”

Section: How Could We Still Decrease the Variability In Egfr?mentioning

confidence: 88%

“…The same 60-year old man with a plasma cystatin C at 1 mg/L will have an eGFR of 78 mL/min/1.73 m 2 (with the CKD-EPI equation-based on cystatin C only [57] . More interestingly is the use of eGFR including different biomarkers, the most known being the equations using both creatinine and cystatin C [27,57,66,67] . Basically, in these equations, the exponent applied to each biomarker is logically lower than the exponent applied when a single biomarker is used, but because the biomarkers (with their exponent) are multiplied in the combined equation, the mathematical effect is more or less the same than for eGFR with a single biomarker.…”

Section: How Could We Still Decrease the Variability In Egfr?mentioning

confidence: 99%

Serum Creatinine: Not So Simple!

Delanaye

Pottel²

2017

Nephron

Self Cite

244

171

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Measuring serum creatinine is cheap and commonly done in daily practice. However, interpretation of serum creatinine results is not always easy. In this review, we will briefly remind the physiological limitations of serum creatinine due notably to its tubular secretion and the influence of muscular mass or protein intake on its concentration. We mainly focus on the analytical limitations of serum creatinine, insisting on important concept such as reference intervals, standardization (and IDMS traceability), analytical interferences, analytical coefficient of variation (CV), biological CV and critical difference. Because the relationship between serum creatinine and glomerular filtration rate is hyperbolic, all these CVs will impact not only the precision of serum creatinine but still more the precision of different creatinine-based equations, especially in low or normal-low creatinine levels (or high or normal-high glomerular filtration rate range).

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“…6 The FAS creatinine and cystatin C equations were developed from assumptions about distributions of normal values for serum creatinine, cystatin C, and GFR and were validated in study populations of whites in North America and Europe. 7,8 In this report, we compare the performance of the LMR, CAPA, and FAS equations with the CKD-EPI equations in studies included in the CKD-EPI validation database. Because these studies were not used for the development of the CKD-EPI equations, they provide an unbiased study population for this comparison.…”

Section: Research Letters Comparing Newer Gfr Estimating Equations Usmentioning

confidence: 99%

Comparing Newer GFR Estimating Equations Using Creatinine and Cystatin C to the CKD-EPI Equations in Adults

Levey

Tighiouart

Simon

et al. 2017

American Journal of Kidney Diseases

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Estimating glomerular filtration rate for the full age spectrum from serum creatinine and cystatin C

Abstract: The FAS equation is not only applicable to all ages, but also for all recommended renal biomarkers and their combinations.

Cited by 144 publications

References 32 publications

Combining Cystatin C and Creatinine Yields a Reliable Glomerular Filtration Rate Estimation in Older Adults in Contrast to β-Trace Protein and β2-Microglobulin

Combining Cystatin C and Creatinine Yields a Reliable Glomerular Filtration Rate Estimation in Older Adults in Contrast to β-Trace Protein and β2-Microglobulin

Serum Creatinine: Not So Simple!

Comparing Newer GFR Estimating Equations Using Creatinine and Cystatin C to the CKD-EPI Equations in Adults

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