Performance of the CKD-EPI and MDRD equations to estimate the glomerular filtration rate: a systematic review of Latin American studies

Abstract

BackgroundMost commonly used equations to estimate the glomerular filtration rate (GFR) are the CKD-Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD). However, it is not clear which one shows a better performance in Latin America. Objective To assess the performance of both estimated GFR (eGFR) equations in Latin American countries. Methods In January 2019, we performed a systematic search in PubMed, Scopus, and “Biblioteca Regional de Medicina” (BIREME) to identify studies that reported eGFR using CKD-EPI and MDRD equations and compared them with a measured GFR (mGFR) using exogenous filtration markers, among adults from Latin American countries. Study selection, data extraction, and risk of bias evaluation were performed by two reviewers independently. We performed meta-analyses of P30, bias (using mean difference [MD] and its 95% confidence intervals [95% CI]), sensitivity, and specificity; and evaluated certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results We included 12 papers, six of them were meta-analyzed (5 from Brazil and 1 from Mexico). Meta-analyses that compared CKD-EPI using creatinine measured with calibration traceable to isotope dilution mass spectrometry (CKD-EPI-Cr IDMS) and MDRD-4 IDMS did not show statistically significant differences in bias (5 studies, MD: 0.55 mL/min/1.73m 2 , 95% CI: -3.34 to 4.44), P30 (2 studies, MD: 4%, 95% CI: -4% to 13%), sensitivity (2 studies, 76% and 75%), and specificity (2 studies, 91% and 89%), with very low certainty of evidence for bias and P30, and low certainty of evidence for sensitivity and specificity. Conclusions We found that the performance of CKD-EPI-Cr IDMS and MDRD-4 IDMS do not differ significantly, although CKD-EPI-Cr IDMS tends to have a non-significant better performance in terms of P30. However, since most of the meta-analyzed studies were from Brazil, results may not be extrapolated to other Latin American countries. Trial registration CRD42019123434, PROSPERO. Registered 18 February 2019.