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

Björk, Jonas; Bäck, Sten Erik; Ebert, Natalie; Evans, Marie; Grubb, Anders; Hansson, Magnus; Jones, Ian; Lamb, Edmund J.; Martus, Peter; Schaeffner, Elke; Sjöström, Per; Nyman, Ulf

doi:10.1515/cclm-2017-0563

Cited by 37 publications

(40 citation statements)

References 43 publications

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“…In a recent study, Björk et al . conclude that the LMR CR and FAS CR seem to be attractive alternatives to CKD‐EPI CR in estimating GFR by creatinine‐based equations in older Europeans.…”

Section: Introductionmentioning

confidence: 92%

“…Consequently, none of the development populations for the existing GFR equations were representative for older KTR. The equations are, with a few exceptions , not evaluated in an elderly population of KTR, and as far as we know, no studies have evaluated eGFR equations in KTR older than 70 years. Masson et al .…”

Section: Introductionmentioning

confidence: 99%

“…The Lund-Malm€ o revised (LMR CR ) equation was developed from a Swedish cohort including 850 individuals aging 18-95 years (median 60 years) [10], and the full age spectrum (FAS) equation has been presented as an equation representative for all ages [11]. In a recent study, Bj€ ork et al [12] conclude that the LMR CR and FAS CR seem to be attractive alternatives to CKD-EPI CR in estimating GFR by creatinine-based equations in older Europeans.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, none of the development populations for the existing GFR equations were representative for older KTR. The equations are, with a few exceptions [12][13][14][15], not evaluated in an elderly population of KTR, and as far as we know, no studies have evaluated eGFR equations in KTR older than 70 years. Masson et al [16] compared the CKD-EPI with the Modification of Diet in Renal Diseases (MDRD) [17] equation in KTR and found that the CKD-EPI did not offer a better prediction of GFR.…”

Section: Introductionmentioning

confidence: 99%

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Estimated glomerular filtration rate in stable older kidney transplant recipients-are present algorithms valid? A national cross-sectional cohort study

et al. 2018

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Several equations have been developed for estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD), but none were developed based on data from elderly kidney transplant recipients (KTR). The primary aim of this study was to evaluate different creatinine-based equations in stable elderly KTR. A national cross-sectional study was performed using data from 263 consecutive kidney transplant recipients 60 years or older who performed a routine GFR measurement one year after engraftment. GFR was measured by iohexol clearance calculation based on two samples. eGFR was calculated from a range of different creatinine-based equations using information obtained at the time of GFR measurement. Bias, precision, and accuracy were evaluated for each equation. All equations apart from Nankivell had accuracy (P30) > 80%. The BIS1, FAS, LMR , and Cockcroft & Gault equations in recipients older than 70 years and the FAS, LMR , and MDRD in recipients 60-69 years old had nonsignificant bias. The CKD-EPI had significant bias in both groups. If one should choose a single equation for follow-up of individual CKD progression in all recipients ≥ 60 years, the FAS or LMR equations are probably the best alternatives.

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Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Estimated glomerular filtration rate in stable older kidney transplant recipients-are present algorithms valid? A national cross-sectional cohort study

et al. 2018

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“…In fact, when drug dosing is considered, the various regulatory bodies (Kidney Disease Improving Global Outcomes (KDIGO), European Medicines Agency (EMA) and FDA) recommend a de‐indexed eGFR (mL/min), and eGFR that is not adjusted for BSA, but do not provide specific guidance. In a multicentre study, Bjork et al also noted a significant discrepancy between mGFR and eGFR at a BMI of less than 20 and a BMI of more than 35 kg/m 2 .…”

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confidence: 94%

De‐indexed estimated glomerular filtration rates: A simple step towards improving accuracy of drug dosing of renally excreted medications in moderate to severe obesity

2019

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Kidney function is underestimated in obese individuals when standard equations are applied. Laboratory‐reported estimated glomerular filtration rates (eGFR) report glomerular filtration rates corrected for body surface area in mL/min per 1.73 m2 using modification of diet in renal disease or the chronic kidney disease‐Epidemiology Collaboration equations. This may result in premature discontinuation or reduction in dosage of renally excreted medications. Currently, there are no clinical guidelines defining thresholds beyond which physicians should consider de‐indexing patient eGFR values. We compared standard and de‐indexed eGFR values for 281 consecutive patients seen in our chronic kidney disease clinic. In our study, half of the patients with a body mass index above 35 had clinically significant changes in their eGFR, with an improvement in chronic kidney disease stage, when eGFR was de‐indexed. We propose that eGFR de‐indexing should be considered in patients with moderate to severe obesity when calculating the dose, especially for medications that are excreted by the kidneys.

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Diagnostic Performance of Creatinine-Based Equations for Estimating Glomerular Filtration Rate in Adults 65 Years and Older

et al. 2019

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IMPORTANCE Estimating glomerular filtration rate (GFR) is useful in many clinical conditions. However, very few studies have evaluated the performance of GFR-estimating equations in older adults at various degrees of kidney impairment. OBJECTIVE To determine the performance of plasma-creatinine-based equations Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI), Lund-Malmö Revised, (LMR), full age spectrum (FAS), and Berlin Initiative Study (BIS) 1 in older adults across a broad spectrum of GFRs. DESIGN, SETTING, AND PARTICIPANTS Single-center cross-sectional study performed in France including 2247 participants aged 65 to 90 years who underwent inulin GFR measurements from July 1, 2003, to July 30, 2017, for suspected or established renal dysfunction, for renal risk, before kidney donation, or after kidney transplant. MAIN OUTCOMES AND MEASURES The main outcome measure was GRF measured by inulin clearance. Equation performance criteria considered bias (difference between estimated and measured GFR), precision (interquartile range of the median difference), and accuracy P 30 (percentage of estimated GFRs lying between [measured GFR-30% of measured GFR] and [measured GFR + 30% of measured GFR]). RESULTS The mean (SD) age of the 2247 participants was 71.5 (5) years and 1192 (53.0%) were male. The difference in median (95% CI) bias was significant between CKD-EPI vs LMR (−4.0 [-4.0 to-3.5 mL/min/1.73 m 2 ; P < .001]) and CKD-EPI vs FAS (-2.0 [-3.5 to-2.5] mL/min/1.73 m 2 , P < .001) but not significant between CKD-EPI vs BIS 1 (0.0 [-1.5 to 0.5], P = .07, Mood test). In patients aged 65 to 74 years with measured GFR<45 mL/min/1.73 m 2 , the difference in median P 30 (95% CI) was not significant between CKD-EPI vs LMR (P = .08) and CKD-EPI vs FAS (P = .48) but significant vs BIS 1 (P = .004, McNemar test). In subjects 75 years and older, with measured GFR less than 45 mL/min/1.73 m 2 , LMR and BIS 1 were more accurate than CKD-EPI and FAS (P 30 = 74.

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

Abstract: 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.

Cited by 37 publications

References 43 publications

Estimated glomerular filtration rate in stable older kidney transplant recipients-are present algorithms valid? A national cross-sectional cohort study

Estimated glomerular filtration rate in stable older kidney transplant recipients-are present algorithms valid? A national cross-sectional cohort study

De‐indexed estimated glomerular filtration rates: A simple step towards improving accuracy of drug dosing of renally excreted medications in moderate to severe obesity

Diagnostic Performance of Creatinine-Based Equations for Estimating Glomerular Filtration Rate in Adults 65 Years and Older

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