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Performance of creatinine- and cystatin C-based formulas to estimate glomerular filtration rate

  • Giorgio Gentile
    Affiliations
    Royal Cornwall Hospitals NHS Trust, Truro, UK

    The University of Exeter Medical School, Exeter, UK

    Department of Medicine, University of Perugia, Perugia, Italy
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  • Fabio Angeli
    Affiliations
    Department of Medicine and Surgery, University of Insubria, Varese, Italy

    Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri, Care and Research Institutes, IRCCS Tradate, Varese, Italy
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  • Gianpaolo Reboldi
    Correspondence
    Corresponding author at: Chair of Nephrology, Department of Medicine, University of Perugia, Perugia, Italy.
    Affiliations
    Department of Medicine, University of Perugia, Perugia, Italy
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Published:August 13, 2020DOI:https://doi.org/10.1016/j.ejim.2020.08.011
      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 [
      • Gentile G.
      • Remuzzi G.
      Novel biomarkers for renal diseases? None for the moment (but one).
      ]. Despite huge efforts to identify novel and more specific kidney biomarkers [
      • Perico L.
      • Perico N.
      • Benigni A.
      The incessant search for renal biomarkers: is it really justified?.
      ], 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 [
      • Levey A.S.
      • Bosch J.P.
      • Lewis J.B.
      • Greene T.
      • Rogers N.
      • Roth D.
      A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group.
      ] and, more recently, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, based on serum creatinine (CKD-EPIcrea) [
      • Levey A.S.
      • Stevens L.A.
      • Schmid C.H.
      • Zhang Y.L.
      • Castro 3rd, A.F.
      • Feldman H.I.
      • et al.
      A new equation to estimate glomerular filtration rate.
      ], 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 [
      • 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.
      ]. 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.

      Keywords

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