Predictive performance of the estimating equations of renal function in Sri Lankan subjects

Abstract

Objectives This study validates two popular predictive equations of renal function firstly, Modifications of Diet in Renal Disease and secondly, Chronic Kidney Disease Epidemiology Collaboration equations for Sri Lankan cohort. We used data of the patients referred to Renal Research lab of University of Colombo for creatinine clearance measurement. Results Predictive performances varied with the gender. Creatinine clearance and predicted renal functions were compared. Both fared unsatisfactorily with R2 ranging from 0.632 to 0.652, and overestimated renal function by 6–15%. The proportion chronic kidney disease staging 1 and 2 returned by Chronic Kidney Disease Epidemiology Collaboration equation showed significant difference, in females. Modifications of Diet in Renal Disease equation significantly under-estimated advanced chronic kidney disease in females. Chronic Kidney Disease Epidemiology Collaboration equation had better accuracy. The study sample had more females, Asian and lower body size and better renal functions than historic cohorts. Thai and Pakistani studies show both equations and their Asian adaptations fare poorly. Chronic kidney disease stages differ significantly with the equation used. Predictive equations have fared unsatisfactorily by overestimating renal functions. We recommend further studies using gold standards of measuring renal function.

CKD and CKDu in Northern Peru: a cross-sectional analysis under the DEGREE protocol

“…Second, only a single eGFR measurement was carried out, so we were not able to con rm cases of CKD as we were unable to demonstrate chronicity -however, this would not affect our main nding that CKDu prevalence was very low. In addition, the CKD-EPI equation has not been validated in Peru and may potentially underestimate the number of cases with eGFR < 60, especially among women [39]. Nonetheless, due to the low prevalence of eGFR < 60 and even < 90 in young adults, it is unlikely that this would explain our ndings.…”

CKD and CKDu in Northern Peru: a cross-sectional analysis under the DEGREE protocol

“…Second, only a single eGFR measurement was carried out, so we were not able to con rm cases of CKD as we were unable to demonstrate chronicity -however, this would not affect our main nding that CKDu prevalence was very low. In addition, the CKD-EPI equation has not been validated in Peru and may potentially underestimate the number of cases with eGFR<60, especially among women [37]. Nonetheless, due to the low prevalence of eGFR<60 and even <90 in young adults, it is unlikely that this would explain our ndings.…”

Performance of creatinine-based equations for estimating glomerular filtration rate compared to endogenous creatinine clearance

“…The original CKD-EPI equation was developed in a North American population, with SCr modeled for mean values of 0.7 mg/dL for women and 0.9 mg/dL for men 3 . The authors recommend adjusting the SCr for local values [8][9][10] , as well as the KDIGO guideline 7 , however there are few studies that do. Following these guidelines, we adjusted the SCr for the population of the northeast region of Rio Grande do Sul, obtaining median values higher than those of North Americans, of 0.8 mg/dL for women and 1.0 mg/dL for men.…”

“…ClCr is widely used as a measure of renal function in clinical practice, but it tends to overestimate GFR 8 , 14 , mainly due to the proximal tubular secretion of 10% to 40% of urinary creatinine. Another relevant problem with ClCr is the high probability of error in urine collection within 24 hours 14 , despite the lack of quantitative data in the literature 15 - 17 .…”