Positive Predictive Value of a Single Assessment of Estimated GFR in the Diagnosis of Chronic Kidney Disease

Abstract

Objectives The positive predictive value (PPV) of a single assessment of estimated glomerular filtration rate (eGFR) in the diagnosis of chronic kidney disease (CKD) is not known. Our objective was to determine the PPV of a single assessment of eGFR among adults with at least one eGFR <60 mL/min in their lifetime, using the Distributed Area Research and Therapeutics Network CKD natural history dataset. Methods In all, 47,104 adults who were cared for by 113 practices in the United States were included. Proportions of patients in eGFR categories at baseline were calculated using the following categories: <15 mL/min, 15 to 29.99 mL/min, 30 to 44.99 mL/min, and 45 to 59.99 mL/min. Comparisons were then made between the baseline and the endpoint to identify patients who had a follow-up eGFR that remained at <60 mL/min. The proportions of patients in each eGFR category were compared baseline to endpoint using cross-tabulations. To test the proposed cutpoint, the proportions of patients who had an eGFR that remained at <60 mL/min were measured, using the cutpoints that included the highest cumulative proportion of patients. The sensitivity and specificity of that cutpoint were calculated. Results A cutpoint of <45 mL/min was identified, yielding a PPV of 93% with a sensitivity of 28% and a specificity of 94%. Conclusions A valid cutpoint to screen for CKD was identified. This cutpoint may prove important to early screening for CKD while reducing the burden on the healthcare system and patients suspected of having CKD.

Comparison of perioperative, renal and oncologic outcomes in robotic‐assisted versus open partial nephrectomy

“…Furthermore, factors such as age, smoking history, hypertension, diabetes mellitus and intraoperative hypotension also affect post‐operative eGFR . CKD risk is reduced when eGFR is >60 mL/min while an eGFR of <45 mL/min has been found to have a 93% positive predictive value for CKD, with higher overall and cardiovascular mortality . Majority of our cohort had a baseline and 6‐month eGFR of ≥60 mL/min (87.27% OPN; 89.66% RAPN) indicating low CKD risk and minimal renal functional impact.…”

“…sCr and eGFR are instead better indicators of chronic kidney disease (CKD) or CKD risk. Hence, their usefulness after PN is in inferring long‐term effects of ischaemia on kidney function . Furthermore, factors such as age, smoking history, hypertension, diabetes mellitus and intraoperative hypotension also affect post‐operative eGFR .…”

“…Hence, their usefulness after PN is in inferring long-term effects of ischaemia on kidney function. 12 Furthermore, factors such as age, smoking history, hypertension, diabetes mellitus and intraoperative hypotension also affect post-operative eGFR. 13 CKD risk is reduced when eGFR is >60 mL/min while an eGFR of <45 mL/ min has been found to have a 93% positive predictive value for CKD, with higher overall and cardiovascular mortality.…”

“…Immediate post‐operative change in sCr, and Day‐1 and 6‐month post‐operative eGFR stage, were used to determine renal functional outcomes (Table ). Patients were grouped into eGFR stages based on the KDIGO 2012 Clinical Practice Guidelines using corresponding eGFR cut‐offs of ≥60, <6 and <45 mL/min …”

“…Patients were grouped into eGFR stages based on the KDIGO 2012 Clinical Practice Guidelines using corresponding eGFR cut-offs of ≥60, <6 and <45 mL/min. [11][12][13] Patients were stratified into low, intermediate or high risk of recurrence and underwent follow-up with cross-sectional imaging and serum biochemistry at corresponding intervals. Patients with less than 6 months of follow-up were excluded from oncological outcome evaluation.…”