Validation of the EKFC equation for glomerular filtration rate estimation and comparison with the Asian-modified CKD-EPI equation in Chinese chronic kidney disease patients in an external study

Abstract

Objectives The aim of this study is to determine whether new European Kidney Function Consortium (EKFC) equation is more applicable than Asian-modified CKD-EPI equation in clinical practice, having a higher accuracy in estimating GFR in our external CKD population. Methods We calculated estimated GFR EKFC and GFR CKD-EPI independently using the EKFC and Asian-modified CKD-EPI formulas, respectively. The clinical diagnostic performance of the two equations was assessed and compared by median bias, precision, accuracy ( P 30 ) and so on, using 99m Tc-DTPA dual plasma sample clearance method as a reference method for GFR measurement (mGFR). The equation that met the following targets was superior: (1) median bias within ± 3 mL/min/1.73 m 2 ; (2) P 30 > 75%; and (3) better precision and 95% limits of agreement in Bland–Altman analysis. Results Totally, 160 CKD patients were recruited in our external cohort. GFR EKFC was highly related to mGFR, with a regression equation of GFR EKFC =mGFR × 0.87 + 5.27. Compared with the Asian-modified CKD-EPI equation, EKFC equation demonstrated a wider median bias (–1.64 vs. 0.84 mL/min/1.73 m 2 , p < 0.01) that was within 3 mL/min/1.73 m 2 and not clinically meaningful. Furthermore, the precision (12.69 vs. 12.72 mL/min/1.73 m 2 , p = 0.42), 95% limits of agreement in Bland–Altman analysis (42.4 vs. 44.4 mL/min/1.73 m 2 ) and incorrect reclassification index of the two target equations were almost identical. Although, EKFC equation had a slightly better P 30 (80.0% vs. 74.4%, p = 0.01). Conclusions The overall performance of EKFC equation is acceptable. There is no clinically meaningful difference in the performance of the Asian-modified CKD-EPI and EKFC equations within the limits imposed by the small sample size.

Exploring Renal Function Assessment: Creatinine, Cystatin C, and Estimated Glomerular Filtration Rate Focused on the European Kidney Function Consortium Equation

“…It should be noted that standardization of SCr is essential for accurate use of unbiased eGFR equations when these equations were developed using standardized SCr, as has recently been demonstrated [ 21 ]. Recently, it has been shown that the EKFC equation performs very well in populations other than White Europeans, notably in Black populations of Europe, Brazil, and Africa [ 22 ] and in the Korean and Chinese populations [ 23 - 25 ].…”

Estimation of Glomerular Filtration Rate Using the New Ekfc Equation in Healthy and Chronic Kidney Disease Adult Subjects from Sub-Saharan Africa

“…This decline in performance in the chronic kidney disease population was also described in the Asian population, where in the subgroup of patients with GFR<= 60 ml/min/1.73m2, P30 was 68.1%, while in the GFR > 60 ml/min/1.73 m2 group, P30 was 95.7%. Although overall, the performance of the EKFC equation remains acceptable [23], the results are not conclusive. Furthermore, P30s in both groups were lower when using creatinine as a biomarker.…”

Application of the European Kidney Function Consortium Equation to Estimate Glomerular Filtration Rate: A Comparison Study of the CKiD and CKD-EPI Equations Using the Korea National Health and Nutrition Examination Survey (KNHANES 2008–2021)

“…Even though these newly proposed eGFR equations can be applied globally, their evaluation is mandatory before being adopted in regions other than North America or Europe, and is important, considering the conflicting recommendations on the new equations. Several studies have explored the performance of these new equations in Asian populations [18][19][20]; however, there has been only one large-scale study, and there has been no study conducted in the pediatric age group. Thus, it would be necessary to compare and verify the results of each equation in Asian populations including children, adolescent, and adults.…”