Chronic kidney disease (CKD) affects 8-16% of the population worldwide and is a huge
global health issue, given its strong association with higher cardiovascular morbidity
and mortality, progression towards end-stage renal disease, and other complications
including cognitive decline, mineral bone disease and anaemia [
[1]
]. Despite huge efforts to identify novel and more specific kidney biomarkers [
[2]
], estimation of glomerular filtration rate (GFR) remains the mainstay of initial CKD
diagnosis, its staging, and its subsequent management. Several international guidelines
recommend the usage of different estimation formulas, including the 4- and 6-variable
Modification of Diet in Renal Disease (MDRD) formulas [
[3]
] and, more recently, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)
equations, based on serum creatinine (CKD-EPIcrea) [
[4]
], cystatin C (CKD-EPIcys), or both (CKD-EPIcrea/cys), which are more reliable in people with estimated GFR higher than 60 mL/min/1.73
m2. In this issue of the Journal, the timely systematic review by Zou and colleagues
provides original insights on the performance of GFR estimating equations. The analysis
included 35 studies, relevant to primary care, with 23,667 adult participants, aimed
to establish the bias, accuracy and precision of estimated GFR using the three CKD-EPI
equations [
[5]
]. The mean bias was expressed as the difference between measured GFR and estimated
GFR by the CKD-EPIcrea, CKD-EPIcys, and CKD-EPIcrea/cys formulas, in mL/min/1.73 m2. Accuracy was expressed as percentage of eGFR readings within 30% of measured GFR,
or P30. Specifically, the Authors assessed the different accuracy of the three CKD-EPI
formulas in people with measured GFR above or below 60 mL/min/1.73 m2, aged < 70 versus ≥ 70 years, or Asians versus non-Asians. Precision was assessed
by the coefficient of correlation (R) between measured GFR and estimated GFR.- Zou L.-X.
- Sun L.
- Nicholas S.B.
- Lu Y.
- K S.S.
- Hua R.
Comparison of bias and accuracy using cystatin C and creatinine in CKD-EPI equations
for GFR estimation.
Eur J Inter Med. 2020; https://doi.org/10.1016/j.ejim.2020.04.044
Keywords
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Article info
Publication history
Published online: August 13, 2020
Accepted:
August 10,
2020
Received:
August 6,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
