Is the Chronic Kidney Disease Epidemiology Collaboration creatinine&amp;ndash;cystatin C equation useful for glomerular filtration rate estimation in the elderly?

Liu, Xun; Ma, Huijuan; Huang, Hui; Wang, Cheng; Tang, Hua; Li, Ming; Wang, Yanni; Lou, Tanqi

doi:10.2147/cia.s52774

Cited by 25 publications

(15 citation statements)

References 21 publications

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“…Targeted use of cystatin C in this context would offset the increased cost of cystatin C compared to creatinine, a potential consideration when additional testing is ordered. (28, 29)…”

Section: Discussionmentioning

confidence: 99%

Performance of Cystatin C– and Creatinine-Based Estimated Glomerular Filtration Rate Equations Depends on Patient Characteristics

Meeusen¹,

Rule

Voskoboev³

et al. 2015

Clinical Chemistry

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Background The Kidney Disease Improving Global Outcomes (KDIGO) guideline recommends use of a cystatin C-based estimated glomerular filtration rate (eGFR) to confirm creatinine-based eGFR between 45–59 mL/min/1.73m2. Prior studies have demonstrated that comorbidities such as solid-organ transplant strongly influence the relationship between measured GFR, creatinine and cystatin C. Our objective was to evaluate the performance of cystatin C based eGFR equations compared to creatinine-based eGFR and measured GFR across different clinical presentations. Methods The performance of the CKD-EPI 2009 creatinine-based estimated GFR equation (eGFRCr) and the newer CKD-EPI 2012 cystatin C-based equations (eGFRCys and eGFRCr-Cys) were compared with measured GFR (iothalamate renal clearance) across defined patient populations. Patients (n = 1,652) were categorized as transplant recipients (n=568 kidney; n=319 other organ [non-kidney]), known chronic kidney disease (CKD) patients (n=618), or potential kidney donors (n=147). Results eGFRCr-Cys showed the most consistent performance across different clinical populations. Among potential kidney donors without CKD (stage 2 or higher; eGFR >60mL/min/1.73m2), eGFRCys and eGFRCr-Cys demonstrated significantly less bias than eGFRCr, however, all three equations substantially underestimated GFR when eGFR <60 mL/min/1.73m2. Among transplant recipients with CKD stage 3B or lower (eGFR <45mL/min/1.73m2), eGFRCys was significantly more biased than eGFRCr. No clear differences among eGFR bias between equations were observed among known CKD patients regardless of eGFR range, or in any patient group with a GFR between 45–59 mL/min/1.73m2. Conclusions The performance of eGFR equations depends on patient characteristics readily apparent upon presentation. Among the three CKD-EPI equations, eGFRCr-Cys performed most consistently across the studied patient populations.

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“…Targeted use of cystatin C in this context would offset the increased cost of cystatin C compared to creatinine, a potential consideration when additional testing is ordered. (28, 29)…”

Section: Discussionmentioning

confidence: 99%

Performance of Cystatin C– and Creatinine-Based Estimated Glomerular Filtration Rate Equations Depends on Patient Characteristics

Meeusen¹,

Rule

Voskoboev³

et al. 2015

Clinical Chemistry

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“…Participants were excluded if they had any of the following: 1) younger than 18 years, or 2) type 1 diabetes, or 3) type 2 diabetes with known non-diabetic renal disease. The other exclusion criteria were described elsewhere [12] . GFR category was classified according to the National Kidney Foundation Disease Outcomes Quality Initiative clinical practice guidelines [13] .…”

Section: Subjects Materials and Methodsmentioning

confidence: 99%

A New Modified CKD-EPI Equation for Chinese Patients with Type 2 Diabetes

et al. 2014

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ObjectiveTo improve the performance of glomerular filtration rate (GFR) estimating equation in Chinese type 2 diabetic patients by modification of the CKD-EPI equation.Design and patientsA total of 1196 subjects were enrolled. Measured GFR was calibrated to the dual plasma sample 99mTc-DTPA-GFR. GFRs estimated by the re-expressed 4-variable MDRD equation, the CKD-EPI equation and the Asian modified CKD-EPI equation were compared in 351 diabetic/non-diabetic pairs. And a new modified CKD-EPI equation was reconstructed in a total of 589 type 2 diabetic patients.ResultsIn terms of both precision and accuracy, GFR estimating equations all achieved better results in the non-diabetic cohort comparing with those in the type 2 diabetic cohort (30% accuracy, P≤0.01 for all comparisons). In the validation data set, the new modified equation showed less bias (median difference, 2.3 ml/min/1.73 m2 for the new modified equation vs. ranged from −3.8 to −7.9 ml/min/1.73 m2 for the other 3 equations [P<0.001 for all comparisons]), as was precision (IQR of the difference, 24.5 ml/min/1.73 m2 vs. ranged from 27.3 to 30.7 ml/min/1.73 m2), leading to a greater accuracy (30% accuracy, 71.4% vs. 55.2% for the re-expressed 4 variable MDRD equation and 61.0% for the Asian modified CKD-EPI equation [P = 0.001 and P = 0.02]).ConclusionA new modified CKD-EPI equation for type 2 diabetic patients was developed and validated. The new modified equation improves the performance of GFR estimation.

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“…The best performance of the CKD-EPI creatinine–cystatin C equation in older people was also confirmed in community-based AGES-Reykjavik Study [ 18 ]. In contrast, in the older Chinese cohort, the bias of the CKD-EPI creatinine–cystatin C equation was greater than with other equations, including short MDRD equation [ 19 ]. Finally, the comparison of CKD-EPI and MDRD formulas in large cohort of nearly 175,000 primary care patients showed that mean bias, although statistically significant at all age groups, diminished with age, from 13% in the 18–29 years age group to − 7.5% in those aged over 90 years [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical factors increasing discrepancies of renal function assessment with MDRD and Cockcroft–Gault equations in old individuals

et al. 2018

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PurposeAbstractIn a daily clinical practice, glomerular filtration rate (GFR) is still estimated on the basis of short MDRD formula, whereas medications’ Summaries of Product Characteristics suggest that GFR used for the dosage adjustment should be estimated based on the Cockcroft–Gault (C–G) equation. The aim of the study was to compare eGFR values calculated on the basis of short and full MDRD and C–G equations in PolSenior study participants with decreased eGFR.MethodsWe have assessed differences in the estimation of GFR between short and full MDRD, as well as C–G formula, all equations utilizing non-isotope-dilution mass spectrometry-calibrated measurements of serum creatinine, in the community-based population of 760 persons aged 65 years or above (mean age 82 ± 8 years) with estimated GFR < 60 ml/min/1.73 m2 (according to short MDRD). In addition, in our analysis, we have included the detailed characteristics of comorbidities and different aspects of mobility and functional performance.ResultsThe better concordance, precision, and accuracy with MDRD short formula were found for MDRDfull than C–G equation. In logistic regression analysis, female gender, activities in daily living (ADL) ≤ 4, and age > 80 years diminished, while visceral obesity improved accuracy (P30) of eGFR calculated according to C–G equation as compared to MDRDshort. Similar analysis did not found factors influencing P30 for MDRDfull equation.ConclusionsIn very old subjects, especially females, dependent patients and those with visceral obesity, estimation of GFR based on short MDRD formula should not be used interchangeably with Cockcroft–Gault equation for the medicines dose tailoring.

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Is the Chronic Kidney Disease Epidemiology Collaboration creatinine–cystatin C equation useful for glomerular filtration rate estimation in the elderly?

Cited by 25 publications

References 21 publications

Performance of Cystatin C– and Creatinine-Based Estimated Glomerular Filtration Rate Equations Depends on Patient Characteristics

Performance of Cystatin C– and Creatinine-Based Estimated Glomerular Filtration Rate Equations Depends on Patient Characteristics

A New Modified CKD-EPI Equation for Chinese Patients with Type 2 Diabetes

Clinical factors increasing discrepancies of renal function assessment with MDRD and Cockcroft–Gault equations in old individuals

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