Two Novel Equations to Estimate Kidney Function in Persons Aged 70 Years or Older

Schaeffner, Elke; Ebert, Natalie; Delanaye, Pierre; Frei, Ulrich; Gaedeke, Jens; Jakob, Olga; Kuhlmann, Martin K.; Schuchardt, Mirjam; Tölle, Markus; Ziebig, Reinhard; Giet, Markus van der; Martus, Peter

doi:10.7326/0003-4819-157-7-201210020-00003

Cited by 497 publications

(468 citation statements)

References 53 publications

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“…6,7,15 Two prior studies in elderly participants suggest that the combination of creatinine and cystatin C provide the most accurate estimates. 10,17 Our results using the CKD-EPI equations are consistent with these studies. We also showed that the combined equation provided the most accurate estimate of prevalence of mGFR,60 ml/min per 1.73 m 2 .…”

Section: Discussionsupporting

confidence: 82%

“…[9][10][11][12][13] Current guidelines recommend using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations for GFR estimation in clinical practice or other equations using standardized creatinine and cystatin C if they are more accurate than the CKD-EPI equations. 14 Among other equations, only the Japanese equations, 15,16 the Berlin Initiative Study (BIS) equations, 17 and the Caucasian and Asian pediatric and adult subjects (CAPA) equation 18 are based on standardized creatinine and standardized cystatin C assays. A comparison of the performance of equations developed by these four groups in elderly individuals has not been reported.…”

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confidence: 99%

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Comparing GFR Estimating Equations Using Cystatin C and Creatinine in Elderly Individuals

Fan

Levey

Gudnason

et al. 2015

Journal of the American Society of Nephrology

136

116

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Current guidelines recommend reporting eGFR using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations unless other equations are more accurate, and recommend the combination of creatinine and cystatin C (eGFRcr-cys) as more accurate than either eGFRcr or eGFRcys alone. However, preferred equations and filtration markers in elderly individuals are debated. In 805 adults enrolled in the community-based Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study, we measured GFR (mGFR) using plasma clearance of iohexol, standardized creatinine and cystatin C, and eGFR using the CKD-EPI, Japanese, Berlin Initiative Study (BIS), and Caucasian and Asian pediatric and adult subjects (CAPA) equations. We evaluated equation performance using bias, precision, and two measures of accuracy. We first compared the Japanese, BIS, and CAPA equations with the CKD-EPI equations to determine the preferred equations, and then compared eGFRcr and eGFRcys with eGFRcr-cys using the preferred equations. Mean (SD) age was 80.3 (4.0) years. Median (25th, 75th) mGFR was 64 (52, 73) ml/min per 1.73 m 2 , and the prevalence of decreased GFR was 39% (95% confidence interval, 35.8 to 42.5). Among 24 comparisons with the other equations, CKD-EPI equations performed better in 9, similar in 13, and worse in 2. Using the CKD-EPI equations, eGFRcr-cys performed better than eGFRcr in four metrics, better than eGFRcys in two metrics, and similar to eGFRcys in two metrics. In conclusion, neither the Japanese, BIS, nor CAPA equations were superior to the CKD-EPI equations in this cohort of community-dwelling elderly individuals. Using the CKD-EPI equations, eGFRcr-cys performed better than eGFRcr or eGFRcys.

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Section: Discussionsupporting

confidence: 82%

mentioning

confidence: 99%

Comparing GFR Estimating Equations Using Cystatin C and Creatinine in Elderly Individuals

Fan

Levey

Gudnason

et al. 2015

Journal of the American Society of Nephrology

136

116

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“…Second, we classified the subjects by using eGFR. Recently, it has been reported that kidney function might be more accurately assessed by using both serum cystatin and creatinine levels in persons aged 70 years or older (Schaeffner et al, 2012). Thus, the appropriateness of our classification will need to be re‐evaluated in relation to geriatric medicine.…”

Section: Discussionmentioning

confidence: 99%

Association between periodontal condition and kidney dysfunction in Japanese adults: A cross‐sectional study

Naruishi

Oishi

Inagaki

et al. 2016

Clinical & Exp Dental Res

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Recent studies have demonstrated that chronic kidney disease (CKD) may be associated with the progression of periodontal disease. Diabetes mellitus (DM) is a major risk factor for CKD. The objective of this study was to clarify the relationship between periodontal condition and kidney dysfunction in patients who had kidney failure with or without DM. One hundred sixty‐four patients with kidney dysfunction were enrolled (male: N = 105; female: N = 59), and the relationship between periodontal condition and kidney dysfunction was analyzed in a cross‐sectional study. The subjects were divided into three groups: (a) patients with DM, (b) dialysis patients with nephropathy due to various kidney diseases, and (c) dialysis patient with nephropathy due to DM (diabetic nephropathy). Then, the effect of DM on the periodontal condition was analyzed. The patients were also stratified by CKD stage (into G1–G5) using the estimated glomerular filtration rate (eGFR), and the G5 group was divided in patients with or without DM. Correlations between eGFR and parameters of periodontal condition were calculated in patients from G1 to G4. The number of missing teeth was significantly higher in dialysis patients with diabetic nephropathy than in patients with DM, whereas alveolar bone loss did not show a significant difference among the three groups. In addition, the G5 patients with DM had a significantly higher number of missing teeth than the other CKD groups, whereas alveolar bone loss did not show a significant difference. In G5 patients with DM, Community Periodontal Index and Oral Hygiene Index scores were significantly higher than in G1‐4 patients with DM. There was a significant negative correlation between eGFR and the number of missing teeth. Patients with diabetic nephropathy have a higher rate of periodontal problems such as missing teeth in Japanese adults.

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“…It has been shown that eGFR Cr-Cys does indeed improve the accuracy of mGFR estimation over eGFR Cr or eGFR Cys in a variety of populations (criterion 1) (4,18,19,44,45). However, eGFR Cr-Cys is inferior to eGFR Cr by another criterion (criterion 3).…”

Section: The Egfr Cr-cys Paradoxmentioning

confidence: 97%

GFR Estimating Equations

Rule

Glassock

2013

Clinical Journal of the American Society of Nephrology

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SummaryThe application of serum creatinine and cystatin C in patients with CKD has been limited to using estimated glomerular filtration rate (eGFR). Criteria for choosing the best GFR estimating equation are 1) accuracy in estimating measured GFR, 2) optimal discrimination of clinical outcomes, and 3) association with CKD risk factors and outcomes similar to that of measured GFR. Notably, these criteria are often not in agreement; and while the last criterion is the most important, it has been widely overlooked. The primary problem with eGFR is that the non-GFR determinants of serum creatinine and cystatin C, as well as their surrogates (age, sex, and race), associate with CKD risk factors and outcomes. This leads to a distorted understanding of CKD, though eGFR based on serum creatinine appears to be less biased than eGFR based on cystatin C. Because of this problem, the use of eGFR should be limited to settings where knowing actual GFR is relevant and eGFR is more informative about GFR than serum creatinine or cystatin C alone. Such settings include staging CKD severity by GFR and dosing medications cleared by glomerular filtration. Alternatively, the diagnosis of CKD, the longitudinal progression of CKD, and prognostic models for CKD are settings where serum creatinine and cystatin C can be better applied and interpreted without eGFR.

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Two Novel Equations to Estimate Kidney Function in Persons Aged 70 Years or Older

Cited by 497 publications

References 53 publications

Comparing GFR Estimating Equations Using Cystatin C and Creatinine in Elderly Individuals

Comparing GFR Estimating Equations Using Cystatin C and Creatinine in Elderly Individuals

Association between periodontal condition and kidney dysfunction in Japanese adults: A cross‐sectional study

GFR Estimating Equations

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