Formula-Derived Prediction of the Glomerular Filtration Rate from Plasma Creatinine Concentration

Kemperman, F. A. W.; Krediet, Raymond T.; Arisz, L.

doi:10.1159/000065012

Cited by 47 publications

(32 citation statements)

References 86 publications

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“…The CKiD, Zappitelli-CysEq, and Zappitelli-CysCrEq equations had a higher accuracy in the GFR ranges Ͻ60 and Ͻ90 ml/min per 1.73 m 2 , whereas the Bö kenkamp, Bouvet, and Filler equations had greater accuracy in the GFR categories Ն135 and Ն150 ml/min per 1.73 m 2 . As an individual's day-today GFR varies by 17% (27)(28)(29), we looked at the equations with Ͼ80% cystatin C eGFR values within 30% of the measured GFR across different GFR ranges. This cutoff of accuracy was met by the Zappitelli-CysEq and ZappitelliCysCrEq equations for GFR Ͻ60 ml/min per 1.73 m 2 , by the CKiD, Zappitelli-CysEq, and Zappitelli-CysCrEq equations for GFR Ͻ90 ml/min per 1.73 m 2 , and by the Böken-kamp, Bouvet, and Filler equations for the GFR Ն135 and Ն150 ml/min per 1.73 m 2 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Cystatin C–Based eGFR Equations at Different GFR Levels in Children

Sharma

Yasin

Garg

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The diagnostic accuracy of cystatin C estimated GFR (eGFR) by various cystatin C equations have varied in different studies. We hypothesized that the GFR level of enrolled patients affects the diagnostic accuracy of a cystatin C equation.Design, setting, participants, & measurements We analyzed 240 consecutively enrolled children at a single Canadian center in a prospective and cross-sectional study. Cystatin C was analyzed with nephelometry, and cystatin C eGFR was estimated by the equations validated in children. GFR was measured by technetium-99m-diethylene-triamine penta-acetic acid ( 99m Tc DTPA).Results We compared various cystatin C equations across GFR strata Ͻ60, Ͻ90, Ն135, and Ն150 ml/min per 1.73 m 2 for an accurate prediction and appropriate classification of the measured GFR. The CKiD, Zappitelli-CysEq, and Zappitelli-CysCrEq equations had a higher accuracy, estimated by eGFR values within 10% and 30% of the respective 99m Tc DTPA, in the GFR categories Ͻ60 and Ͻ90 ml/min per 1.73 m 2 , whereas the Bö kenkamp, Bouvet, and Filler equations had a greater accuracy in the GFR categories Ն135 and Ն150 ml/min per 1.73 m 2 . The Bouvet, CKiD, Filler, Zappitelli-CysEq, and Zappitelli-CysCrEq equations had a greater sensitivity to classify GFR Ͻ60 and Ͻ90 ml/min per 1.73 m 2 , whereas the Bö kenkamp equation had a higher sensitivity for GFR Ն135 and Ն150 ml/min per 1.73 m 2 . ConclusionsThe diagnostic accuracy of various cystatin C equations varies with GFR. This issue needs consideration while applying these equations in clinical practice and for further research on eGFR equations.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Cystatin C–Based eGFR Equations at Different GFR Levels in Children

Sharma

Yasin

Garg

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…6 Although the Cockcroft-Gault equation improves the estimation, there is a nonlinear relationship between creatinine concentration and GFR, which leads to overestimation of GFR at high levels of creatinine and underestimation of GFR at low values of creatinine. 15 Recently, assays have been introduced to measure cystatin C, which has been shown to be a better marker of GFR than creatinine. 8,9 The present study is the first to demonstrate that measurement of cystatin C substantially improves the early risk stratification of the large population of patients with suspected or confirmed non-ST-elevation ACS.…”

Section: Discussionmentioning

confidence: 99%

Cystatin C

Jernberg¹,

Lindahl²,

James³

et al. 2004

Circulation

217

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Background-Patients with suspected or confirmed non-ST-elevation acute coronary syndrome (ACS) constitute a large and heterogeneous group. Measurements of renal function such as serum creatinine and estimation of creatinine clearance carry independent prognostic information in this population. Cystatin C is a new and better marker of renal function than creatinine. The aim was therefore to evaluate the prognostic value of cystatin C in this population. Methods and Results-Cystatin C was analyzed on admission in 726 patients admitted because of symptoms suggestive of an acute coronary syndrome and no ST-segment elevations. Patients were followed up with regard to death and myocardial infarction for a median of 40 and 6 months, respectively. The median cystatin C level was 1.00 mg/L (25th to 75th percentile, 0.83 to 1.24 mg/L). The risk of death during follow-up increased with increasing levels of cystatin C. In the group with non-ST-elevation ACS, patients in the second, third, and fourth quartiles had a relative risk of subsequent death of 1.8 (95% CI, 0.6 to 5.3), 3.2 (95% CI, 1.2 to 8.5), and 11.7 (95% CI, 4.7 to 29.3) compared with the lowest quartile. In Cox regression models including well-known predictors of outcome, cystatin C level was independently associated with mortality but not with the risk of subsequent myocardial infarction. In a comparison of the markers of renal function in receiver-operating curve analyses, cystatin C had the best ability to discriminate between survivors and nonsurvivors. Conclusions-A single measurement of cystatin C will substantially improve the early risk stratification of patients with suspected or confirmed non-ST-elevation ACS.

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“…Therefore, it is the most useful statistical analysis for the clinician. Because day-to-day mGFR variation was reported to be as high as 17% (3,23,78), the accuracy within Ϯ 15% of mGFR provides the clinician with the percentage of eGFRs not deviating from the mGFRs.…”

Section: Evaluating the Performance Of Egfr Formulasmentioning

confidence: 99%

“…In the current Kidney Disease Outcome Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease (K/DOQI-CKD), all individuals with GFR Ͻ60 ml/min per 1.73 m 2 for Ն3 months are classified with chronic kidney disease (CKD), and different GFR levels are used for CKD staging, where "inulin clearance is widely regarded as the gold standard for measuring GFR" (2). As an alternative to the cumbersome and costly process of GFR measurement, several serum creatinine (SCr)-based formulas for estimating the renal function in adults were created in the past (3), and the most widely used ones are the CockcroftGault (CG) formula (4), which predicts urinary creatinine clearance, and the Modification of Diet in Renal Disease Study (MDRD) prediction equation (5) for GFR. We previously described in detail the differences between these two formulas and their performance in comparison with urinary inulin clearance (Cin) (6).…”

Section: Introductionmentioning

confidence: 99%

The Clinician and Estimation of Glomerular Filtration Rate by Creatinine-based Formulas

Botev

Mallié²,

Wetzels³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryThe GFR has a paramount diagnostic and staging role in the Kidney Disease Outcome Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease (K/DOQI-CKD). The most widely used serum creatininebased formulas in adults for estimated GFR (eGFR) are the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease Study (MDRD). Recently, a new Chronic Kidney Disease Epidemiology Collaboration equation has been developed. Review of the literature revealed that CG and MDRD formulas correctly assigned overall only 64% and 62%, respectively, of the subjects to their actual K/DOQI-CKD classification's GFR groups as determined by measured GFR (mGFR). This suggests that approximately 10 million (38%) subjects may have been misclassified on the basis of estimated CKD prevalence of 26.3 million adults in the United States. The purpose of this review is to help the clinician understand the limitations of using eGFR in daily practice. We also elaborate upon issues such as the differences among markers of mGFR, the validity of adjusting GFR for body surface area in certain populations, the limited data on boundaries for normal mGFR according to age, gender, and race, the need for calibration of a wide spectrum of serum creatinine measurements, the lack of actual eGFR value above 60 ml/min per 1.73 m 2 and reference for normal mGFR in the clinical laboratories' reports, and the performance evaluation of the eGFR formulas. Several pitfalls have to be overcome before we can reliably determine health and disease in daily nephrology practice to preserve the first rule of practicing medicine: primum non nocere.Clin J Am Soc Nephrol 6: 937-950, 2011.

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Formula-Derived Prediction of the Glomerular Filtration Rate from Plasma Creatinine Concentration

Cited by 47 publications

References 86 publications

Diagnostic Accuracy of Cystatin C–Based eGFR Equations at Different GFR Levels in Children

Diagnostic Accuracy of Cystatin C–Based eGFR Equations at Different GFR Levels in Children

Cystatin C

The Clinician and Estimation of Glomerular Filtration Rate by Creatinine-based Formulas

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