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Madero M, Levin A, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Robinson KA, Wilson LM, Wilson RF, Kasiske BL, Cheung M, Earley A, Stevens PE, Schaeffner E. Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2024 Clinical Practice Guideline. Ann Intern Med 2025; 178:705-713. [PMID: 40063957 DOI: 10.7326/annals-24-01926] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2025] Open
Abstract
DESCRIPTION The Kidney Disease: Improving Global Outcomes (KDIGO) organization updated its existing clinical practice guideline in 2024 to provide guidance on the evaluation, management, and treatment of chronic kidney disease (CKD) in adults and children who are not receiving kidney replacement therapy. METHODS The KDIGO CKD Guideline Work Group defined the scope of the guideline and determined topics for systematic review. An independent Evidence Review Team systematically reviewed the evidence and graded the certainty of evidence for each of the review topics. Latest searches of the English-language literature were done in July 2023. Final modification of the guideline was informed by a public review process during summer of 2023 involving registered stakeholders. RECOMMENDATIONS The full guideline included 28 recommendations and 141 practice points. This synopsis focuses on the recommendations that have the greatest evidence. Practice points reflect the expert opinion of the group where evidence is not that strong. Recommendations include greater emphasis on cystatin C for assessment of glomerular filtration rate, point-of-care testing in remote areas, a shift to an individualized risk-based approach to predict kidney failure, sodium-glucose cotransporter-2 inhibitors for some patients with CKD with and without diabetes, and statin use for adults older than 50 years and CKD. Together the recommendations and practice points provide guidance for how to evaluate and manage persons with CKD.
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Affiliation(s)
- Magdalena Madero
- Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico (M.M.)
| | - Adeera Levin
- University of British Columbia, Vancouver, British Columbia, Canada (A.L.)
| | - Sofia B Ahmed
- University of Alberta, Edmonton, Alberta, Canada (S.B.A.)
| | | | | | - Anna Francis
- Queensland Children's Hospital, Brisbane, Australia (A.F.)
| | | | - William G Herrington
- Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H.)
| | - Guy Hill
- Patient partner, Manchester, United Kingdom (G.H.)
| | | | | | - Edmund Lamb
- East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom (E.L.)
| | - Peter Lin
- Canadian Heart Research Center, Toronto, Ontario, Canada (P.L.)
| | - Natasha McIntyre
- Western University, London Health Sciences Centre-Victoria Hospital, London, Ontario, Canada (N.M.)
| | - Kelly Morrow
- Bastyr University, Osher Center for Integrative Medicine, University of Washington, Kenmore, Washington (K.M.)
| | - Glenda Roberts
- UW Center for Dialysis Innovation & Kidney Research Institute, Seattle, Washington (G.R.)
| | | | - Michael Shlipak
- University of California, San Francisco, San Francisco, California (M.S.)
| | - Rukshana Shroff
- UCL Great Ormond Street Hospital Institute of Child Health, London, United Kingdom (R.S.)
| | - Navdeep Tangri
- University of Manitoba, Winnipeg, Manitoba, Canada (N.T.)
| | | | - Ifeoma Ulasi
- University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria (I.U.)
| | - Germaine Wong
- University of Sydney, Sydney, Australia (D.S., G.W.)
| | - Chih-Wei Yang
- Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan (C.-W.Y.)
| | - Luxia Zhang
- Peking University First Hospital, Beijing, China (L.Z.)
| | - Karen A Robinson
- The Johns Hopkins University Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland (K.A.R., L.M.W., R.F.W.)
| | - Lisa M Wilson
- The Johns Hopkins University Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland (K.A.R., L.M.W., R.F.W.)
| | - Renee F Wilson
- The Johns Hopkins University Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland (K.A.R., L.M.W., R.F.W.)
| | - Bertram L Kasiske
- Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota (B.L.K.)
| | | | | | - Paul E Stevens
- Kent Kidney Care Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom (P.E.S.)
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Khader NA, Kamath VG, Kamath SU, Rao IR, Prabhu AR. Kidney function estimation equations: a narrative review. Ir J Med Sci 2025; 194:725-743. [PMID: 39873963 PMCID: PMC12031902 DOI: 10.1007/s11845-025-03874-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 01/13/2025] [Indexed: 01/30/2025]
Abstract
Glomerular filtration rate (GFR) as a marker of kidney function is important in health and disease management because decreased kidney function is associated with all-cause and cardiovascular mortality, progression of kidney disease, predisposition to acute kidney injury (AKI), and for drug dosage modification. While measured glomerular filtration rate (mGFR) is acknowledged as the most accurate method for evaluating kidney function, it is at present not feasible to be applied in the clinical arena. Estimated glomerular filtration rate (eGFR) is preferred due to its convenience, cost-effectiveness, and seamless integration into standard clinical practice for kidney function evaluation. The presence of multiple equations for eGFR with applications to differing populations makes their use challenging for clinicians. We reviewed available estimated glomerular filtration rate (GFR) equations and their application in different clinical settings both in normal and chronic kidney disease (CKD) patients. These formulae incorporate serum creatinine and/or serum cystatin C levels and correlate them with measured kidney function. Among the many available equations, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is the most recommended due to its robustness and accuracy across diverse patient populations. Strengths and limitations of different eGFR equations are discussed emphasizing the importance of selecting the appropriate equation based on specific patient demographics and clinical scenarios. There is need for regional validation studies to ensure the global applicability of these equations, considering the variations in population characteristics.
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Affiliation(s)
- Nisha Abdul Khader
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Veena Ganesh Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shobha Ullas Kamath
- Department of Biochemistry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Attur Ravindra Prabhu
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Rutter CE, Njoroge M, Cooper PJ, Prabhakaran D, Jha V, Kaur P, Mohan S, Tatapudi RR, Biggeri A, Rohloff P, Hathaway MH, Crampin AC, Dhimal M, Poudyal A, Bernabe-Ortiz A, O'Callaghan-Gordo C, Chulasiri P, Gunawardena N, Ruwanpathirana T, Wickramasinghe SC, Senanayake S, Kitiyakara C, Gonzalez-Quiroz M, Cortés S, Jakobsson K, Correa-Rotter R, Glaser J, Singh A, Hamilton S, Nair D, Aragón A, Nitsch D, Robertson S, Caplin B, Pearce N. International prevalence patterns of low eGFR in adults aged 18-60 without traditional risk factors from a population-based cross-sectional disadvantaged populations eGFR epidemiology (DEGREE) study. Kidney Int 2025; 107:541-557. [PMID: 39708999 DOI: 10.1016/j.kint.2024.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 10/29/2024] [Accepted: 11/22/2024] [Indexed: 12/23/2024]
Abstract
The disadvantaged populations eGFR (estimated glomerular filtration rate) epidemiology (DEGREE) study was designed to gain insight into the burden of chronic kidney disease (CKD) of undetermined cause (CKDu) using standard protocols to estimate the general-population prevalence of low eGFR internationally. Therefore, we estimated the age-standardized prevalence of eGFR under 60 ml/min per 1.73m2 in adults aged 18-60, excluding participants with commonly known causes of CKD; an ACR (albumin/creatinine ratio) over 300 mg/g or equivalent, or self-reported or measured (HT) hypertension or (DM) diabetes mellitus, stratified by sex and location. We included population-representative surveys conducted around the world that were either designed to estimate CKDu burden or were re-analyses of large surveys. There were 60,964 participants from 43 areas across 14 countries, with data collected 2007- 2023. The highest prevalence was seen in rural men in Uddanam, India (14%) and Northwest Nicaragua (14%). Prevalence above 5% was generally only observed in rural men, with exceptions for rural women in Ecuador (6%) and parts of Uddanam (6%‒8%), and for urban men in Leon, Nicaragua (7%). Outside of Central America and South Asia, prevalence was below 2%. Our observations represent the first attempts to estimate the prevalence of eGFR under 60 without commonly known causes of CKD around the world, as an estimate of CKDu burden, and provide a starting point for global monitoring. It is not yet clear what drives the differences, but available evidence supports a high general-population burden of CKDu in multiple areas within Central America and South Asia, although the possibility that unidentified clusters of disease may exist elsewhere cannot be excluded.
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Affiliation(s)
- Charlotte E Rutter
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
| | - Mary Njoroge
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Philip J Cooper
- Institute of Infection and Immunity, St George's University of London, London, UK; School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Prabhdeep Kaur
- Isaac Centre for Public Health, Indian Institute of Science, Bengaluru, India
| | - Sailesh Mohan
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | | | - Annibale Biggeri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Peter Rohloff
- Center for Indigenous Health Research, Maya Health Alliance, Wuqu' Kawoq, Guatemala
| | - Michelle H Hathaway
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Amelia C Crampin
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Malawi; School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Meghnath Dhimal
- Research Section, Nepal Health Research Council, Kathmandu, Nepal
| | - Anil Poudyal
- Research Section, Nepal Health Research Council, Kathmandu, Nepal
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cristina O'Callaghan-Gordo
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain; Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Networking Centre of Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Nalika Gunawardena
- World Health Organization South-East Asia Regional Office, New Delhi, India
| | | | | | - Sameera Senanayake
- Health Services and Systems Research, Duke-NUS (National University of Singapore) Medical School, Singapore
| | - Chagriya Kitiyakara
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Marvin Gonzalez-Quiroz
- Department of Environmental and Occupational Health, UT School of Public Health San Antonio, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Centre for Kidney and Bladder Health, University College London, London, UK; Center for Indigenous Health Research, Wuqu' Kawoq - Maya Health Alliance, Chimaltenango, Guatemala
| | - Sandra Cortés
- Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden; La Isla Network, Ada, Michigan, USA
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Salvador Zubirán National Institute of Health Sciences and Nutrition, Mexico City, Mexico; National Autonomous University of Mexico, Mexico
| | | | - Ajay Singh
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Sophie Hamilton
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Devaki Nair
- Centre for Kidney and Bladder Health, University College London, London, UK; Department of Clinical Biochemistry, Royal Free Hospital, London, UK; Health Services Laboratories, London, UK
| | - Aurora Aragón
- Center for Indigenous Health Research, Wuqu' Kawoq - Maya Health Alliance, Chimaltenango, Guatemala
| | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Steven Robertson
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Centre for Kidney and Bladder Health, University College London, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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Yadav AK, Kaur J, Kaur P, Kamboj K, Yasuda Y, Horio M, Pal A, Shafiq N, Sahni N, Kohli HS, Matsuo S, Kumar V, Jha V. Evaluation of Race-Neutral Glomerular Filtration Rate Estimating Equations in an Indian Population. Kidney Int Rep 2024; 9:3414-3426. [PMID: 39698357 PMCID: PMC11652306 DOI: 10.1016/j.ekir.2024.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 09/26/2024] [Accepted: 09/30/2024] [Indexed: 12/20/2024] Open
Abstract
Introduction Glomerular filtration rate (GFR) estimation equations have not been extensively validated in the Indian population. Preliminary data showed that the widely used creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICr) 2009 significantly overestimated GFR in Indians. Newer estimated GFR (eGFR) equations based on creatinine and cystatin C, omitting the race, have been recently proposed. We investigated the performance of race-free eGFR equations in the Indian population. Methods Patients with chronic kidney disease (CKD) and potential kidney donors attending the outpatient clinic at the Postgraduate Institute of Medical Education and Research Chandigarh, India, were screened for enrolment. GFR was measured by urinary clearance of inulin and plasma clearance of iohexol. Performance of eGFR equations (CKD-EPICr(2021), CKD-EPICr-Cys(2021), CKD-EPICr(2009), CKD-EPICr-Cys(2012), CKD-EPICys, 2020Csy-B2M-BTP and 2020Cr-Csy-B2M-BTP, EKFCcr, EKFCcys, and EKFCcr-cys) were assessed against measured GFR (mGFR) using bias, precision, and accuracy (root mean square error [RMSE], mean absolute error [MAE] and P30 [% with eGFR within 30% of mGFR]). Results A total of 412 subjects (55% with CKD), average age 47 ± 11 years with an equal distribution of males and females were enrolled. The mean mGFR in the study population was 54.2 ± 30.2 ml/min per 1.73 m2. The average mGFR in the potential kidney donor's subgroup was 79.5 ± 23.2 ml/min per 1.73 m2. Bias was highest for creatinine-based eGFR equations (CKD-EPIcr(2021): -19.2 [-21.3 to -17.0] ml/min per 1.73 m2and CKD-EPIcr(2009): -17.0 [-19.1 to -15.0] ml/min per 1.73 m2). Cystatin C- (either alone or with other markers) based equations were slightly better but still did not reach P30 ≥ 80%. Conclusions Race-neutral CKD-EPICr(2021) equation did not significantly improve performance as compared to CKD-EPICr(2009) equation. These observations emphasize the need for developing new eGFR equations for Indians and to standardize the mGFR for easy access to care providers for individualized patient care.
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Affiliation(s)
- Ashok Kumar Yadav
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaskiran Kaur
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabhjot Kaur
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kajal Kamboj
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yoshinari Yasuda
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of CKD Initiatives, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaru Horio
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Arnab Pal
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nancy Sahni
- Department of Dietetics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harbir Singh Kohli
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Seiichi Matsuo
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivekanand Jha
- The George Institute for Global Health, New Delhi
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
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Rutter CE, Njoroge M, Cooper P, Dorairaj P, Jha V, Kaur P, Mohan S, Tatapudi RR, Biggeri A, Rohloff P, Hathaway MH, Crampin A, Dhimal M, Poudyal A, Bernabe-Ortiz A, O’Callaghan-Gordo C, Chulasiri P, Gunawardena N, Ruwanpathirana T, Wickramasinghe SC, Senanayake S, Kitiyakara C, Gonzalez-Quiroz M, Cortés S, Jakobsson K, Correa-Rotter R, Glaser J, Singh A, Hamilton S, Nair D, Aragón A, Nitsch D, Robertson S, Caplin B, Pearce N, DEGREE Study Group. International prevalence patterns of low eGFR in adults aged 18-60 without traditional risk factors from population-based cross-sectional studies: a disadvantaged populations eGFR epidemiology (DEGREE) study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.24.24309380. [PMID: 39574842 PMCID: PMC11581094 DOI: 10.1101/2024.06.24.24309380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2024]
Abstract
The disadvantaged populations eGFR (estimated glomerular filtration rate) epidemiology (DEGREE) study was designed to gain insight into the burden of chronic kidney disease (CKD) of undetermined cause (CKDu) using standard protocols to estimate the general-population prevalence of low eGFR internationally. We estimated the age-standardised prevalence of eGFR<60ml/min/1.73m2 in adults aged 18-60, excluding participants with commonly known causes of CKD, i.e., ACR>300mg/g or equivalent, or self-reported or measured hypertension or diabetes (eGFR<60[absent HT,DM,high ACR]), and stratified by sex and location. We included population-representative surveys conducted around the world that were either designed to estimate CKDu burden or were re-analyses of large surveys. There were 60 964 participants from 43 areas across 14 countries, with data collected during 2007-2023. The highest prevalence was seen in rural men in Uddanam, India (14%) and Northwest Nicaragua (14%). Prevalence above 5% was generally only observed in rural men, with exceptions for rural women in Ecuador (6%) and parts of Uddanam (6-8%), and for urban men in Leon, Nicaragua (7%). Outside of Central America and South Asia, prevalence was below 2%. These observations represent the first attempts to estimate the prevalence of eGFR<60[absent HT,DM,high ACR] around the world, as an estimate of CKDu burden, and provide a starting point for global monitoring. It is not yet clear what drives the differences, but available evidence to date supports a high general-population burden of CKDu in multiple areas within Central America and South Asia, although the possibility that unidentified clusters of disease may exist elsewhere cannot be excluded.
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Affiliation(s)
- Charlotte E Rutter
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Mary Njoroge
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Phil Cooper
- Institute of Infection and Immunity, St George’s University of London, UK; School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | | | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | | | | | - Annibale Biggeri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Peter Rohloff
- Center for Indigenous Health Research, Maya Health Alliance, Wuqu’ Kawoq, Guatemala
| | - Michelle H Hathaway
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, USA
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Malawi; University of Glasgow, UK
| | | | | | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Peru
| | - Cristina O’Callaghan-Gordo
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain; ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | | | | | | | | | | | | | - Marvin Gonzalez-Quiroz
- Department of Environmental and Occupational Health, UT School of Public Health San Antonio, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Centre for Kidney and Bladder Health, University College London, London, UK
- Wuqu’ Kawoq Maya Health Alliance, Chimaltenango, Guatemala
| | - Sandra Cortés
- Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, University of Gothenburg, Sweden
- La Isla Network, Ada, Michigan, USA
| | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; National Autonomous University of Mexico, Mexico
| | | | | | - Sophie Hamilton
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Devaki Nair
- Centre for Kidney and Bladder Health, University College London, London, UK
- Department of Clinical Biochemistry, Royal Free Hospital, London, UK; Health Services Laboratories, London, UK
| | - Aurora Aragón
- Wuqu’ Kawoq Maya Health Alliance, Chimaltenango, Guatemala
| | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Steven Robertson
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Caplin
- Centre for Kidney and Bladder Health, University College London, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
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Lamb EJ, Barratt J, Brettell EA, Cockwell P, Dalton RN, Deeks JJ, Eaglestone G, Pellatt-Higgins T, Kalra PA, Khunti K, Loud FC, Ottridge RS, Potter A, Rowe C, Scandrett K, Sitch AJ, Stevens PE, Sharpe CC, Shinkins B, Smith A, Sutton AJ, Taal MW. Accuracy of glomerular filtration rate estimation using creatinine and cystatin C for identifying and monitoring moderate chronic kidney disease: the eGFR-C study. Health Technol Assess 2024; 28:1-169. [PMID: 39056437 PMCID: PMC11331378 DOI: 10.3310/hyhn1078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
Background Estimation of glomerular filtration rate using equations based on creatinine is widely used to manage chronic kidney disease. In the UK, the Chronic Kidney Disease Epidemiology Collaboration creatinine equation is recommended. Other published equations using cystatin C, an alternative marker of kidney function, have not gained widespread clinical acceptance. Given higher cost of cystatin C, its clinical utility should be validated before widespread introduction into the NHS. Objectives Primary objectives were to: (1) compare accuracy of glomerular filtration rate equations at baseline and longitudinally in people with stage 3 chronic kidney disease, and test whether accuracy is affected by ethnicity, diabetes, albuminuria and other characteristics; (2) establish the reference change value for significant glomerular filtration rate changes; (3) model disease progression; and (4) explore comparative cost-effectiveness of kidney disease monitoring strategies. Design A longitudinal, prospective study was designed to: (1) assess accuracy of glomerular filtration rate equations at baseline (n = 1167) and their ability to detect change over 3 years (n = 875); (2) model disease progression predictors in 278 individuals who received additional measurements; (3) quantify glomerular filtration rate variability components (n = 20); and (4) develop a measurement model analysis to compare different monitoring strategy costs (n = 875). Setting Primary, secondary and tertiary care. Participants Adults (≥ 18 years) with stage 3 chronic kidney disease. Interventions Estimated glomerular filtration rate using the Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease equations. Main outcome measures Measured glomerular filtration rate was the reference against which estimating equations were compared with accuracy being expressed as P30 (percentage of values within 30% of reference) and progression (variously defined) studied as sensitivity/specificity. A regression model of disease progression was developed and differences for risk factors estimated. Biological variation components were measured and the reference change value calculated. Comparative costs of monitoring with different estimating equations modelled over 10 years were calculated. Results Accuracy (P30) of all equations was ≥ 89.5%: the combined creatinine-cystatin equation (94.9%) was superior (p < 0.001) to other equations. Within each equation, no differences in P30 were seen across categories of age, gender, diabetes, albuminuria, body mass index, kidney function level and ethnicity. All equations showed poor (< 63%) sensitivity for detecting patients showing kidney function decline crossing clinically significant thresholds (e.g. a 25% decline in function). Consequently, the additional cost of monitoring kidney function annually using a cystatin C-based equation could not be justified (incremental cost per patient over 10 years = £43.32). Modelling data showed association between higher albuminuria and faster decline in measured and creatinine-estimated glomerular filtration rate. Reference change values for measured glomerular filtration rate (%, positive/negative) were 21.5/-17.7, with lower reference change values for estimated glomerular filtration rate. Limitations Recruitment of people from South Asian and African-Caribbean backgrounds was below the study target. Future work Prospective studies of the value of cystatin C as a risk marker in chronic kidney disease should be undertaken. Conclusions Inclusion of cystatin C in glomerular filtration rate-estimating equations marginally improved accuracy but not detection of disease progression. Our data do not support cystatin C use for monitoring of glomerular filtration rate in stage 3 chronic kidney disease. Trial registration This trial is registered as ISRCTN42955626. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 11/103/01) and is published in full in Health Technology Assessment; Vol. 28, No. 35. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Edmund J Lamb
- Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Elizabeth A Brettell
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Renal Medicine, Queen Elizabeth Hospital Birmingham and Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - R Nei Dalton
- WellChild Laboratory, Evelina London Children's Hospital, St. Thomas' Hospital, London, UK
| | - Jon J Deeks
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gillian Eaglestone
- Kent Kidney Care Centre, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | | | - Philip A Kalra
- Department of Renal Medicine, Salford Royal Hospital Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Ryan S Ottridge
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aisling Potter
- Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Ceri Rowe
- Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Katie Scandrett
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alice J Sitch
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul E Stevens
- Kent Kidney Care Centre, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Claire C Sharpe
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alison Smith
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andrew J Sutton
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Maarten W Taal
- Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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7
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Delanaye P, Pottel H, Cavalier E, Flamant M, Stehlé T, Mariat C. Diagnostic standard: assessing glomerular filtration rate. Nephrol Dial Transplant 2024; 39:1088-1096. [PMID: 37950562 DOI: 10.1093/ndt/gfad241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Indexed: 11/12/2023] Open
Abstract
Creatinine-based estimated glomerular filtration rate (eGFR) is imprecise at individual level, due to non-GFR-related serum creatinine determinants, including atypical muscle mass. Cystatin C has the advantage of being independent of muscle mass, a feature that led to the development of race- and sex-free equations. Yet, cystatin C-based equations do not perform better than creatinine-based equations for estimating GFR unless both variables are included together. The new race-free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation had slight opposite biases between Black and non-Black subjects in the USA, but has poorer performance than that the previous version in European populations. The European Kidney Function Consortium (EKFC) equation developed in 2021 can be used in both children and adults, is more accurate in young and old adults, and is applicable to non-white European populations, by rescaling the Q factor, i.e. population median creatinine, in a potentially universal way. A sex- and race-free cystatin C-based EKFC, with the same mathematical design, has also be defined. New developments in the field of GFR estimation would be standardization of cystatin C assays, development of creatinine-based eGFR equations that incorporate muscle mass data, implementation of new endogenous biomarkers and the use of artificial intelligence. Standardization of different GFR measurement methods would also be a future challenge, as well as new technologies for measuring GFR. Future research is also needed into discrepancies between cystatin C and creatinine, which is associated with high risk of adverse events: we need to standardize the definition of discrepancy and understand its determinants.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium
| | - Martin Flamant
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, and Université Paris Cité, UMR 1149, Paris, France
| | - Thomas Stehlé
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, France
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Balasch MM, Roumelioti ME, Argyropoulos CP. Comparison of Glomerular Filtration Rate Equations in a Rural New Mexico Cohort: Results from the COMPASS Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.10.24308724. [PMID: 38946981 PMCID: PMC11213067 DOI: 10.1101/2024.06.10.24308724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Rationale and Objective The NKF-ASN Task Force recommends accurate kidney function estimation avoiding biases through racial adjustments. We explored the use of multiple kidney function biomarkers and hence estimated glomerular filtration rate (eGFR) equations to improve kidney function calculations in an ethnically diverse patient population. Study design Prospective community cohort study. Setting and Participants rural New Mexico clinic with patients > 18 yo. Methods Markers of kidney function, IDMS-Creatinine (SCr), chemiluminescence Beta-2 Microglobulin (B2M), Nephelometry-calibrated ELISA Cystatin C (CysC), inflammation, glucose tolerance, demographics, BUN/UACR from the baseline visit of the COMPASS cohort, were analyzed by Kernel-based Virtual Machine learning methods. Results Among 205 participants, the mean age was 50.1, 62% were female, 54.1% Hispanic American and 30.2% Native American. Average kidney function biomarkers were: SCr 0.9 mg/dl, B2M 1.8 mg/L, and CysC 0.7 mg/dl. The highest agreement was observed between SCr and B2M-based eGFR equations [mean difference in eGFRs: (4.48 ml/min/1.73m2], and the lowest agreement between B2M and CysC-based eGFR equations (-24.75 ml/min/1.73m2). There was no pattern of association between the differences in eGFR measures and gender. In the continuous analyses, the absolute eGFR value (p<2 x 10-16) and serum albumin (p =6.4 x 10-5) predicted the difference between B2M- and SCr-based e-GFR. The absolute eGFR value (p<2 x 10-16) and age (p =7.6 x 10-5) predicted the difference between CysC- and SCr-based e-GFR. Limitations Relatively small sample size, elevated inflammatory state in majority of study participants and no inulin excretion rate measurements. Conclusion B2M should be strongly considered as a kidney function biomarker fulfilling the criteria for the NKF-ASN. B2M's eGFR equation does not need adjustment for gender or race and showed the highest agreement with SCr-based eGFR equations.
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Affiliation(s)
- Monica Moya Balasch
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, MSC 04-2785, Albuquerque, New Mexico, USA
| | - Maria-Eleni Roumelioti
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, MSC 04-2785, Albuquerque, New Mexico, USA
| | - Christos P Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, MSC 04-2785, Albuquerque, New Mexico, USA
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9
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Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 515] [Impact Index Per Article: 515.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
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10
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Safdar A, Akram W, Khan MA, Tahir D, Butt MH. Comparison of EKFC, Pakistani CKD-EPI and 2021 Race-Free CKD-EPI creatinine equations in South Asian CKD population: A study from Pakistani CKD community cohort. PLoS One 2024; 19:e0300428. [PMID: 38512913 PMCID: PMC10956795 DOI: 10.1371/journal.pone.0300428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/27/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION South Asian individuals possess a high risk of chronic kidney disease. There is a need to study, evaluate, and compare the newly suggested glomerular filtration rate (eGFR) equations for accurate CKD diagnosis, staging, and drug dosing. This study aimed to (1) evaluate the European Kidney Function Consortium (EKFC), Pakistani CKD-EPI, and 2021 Race-Free CKD-EPI creatinine equation in the South Asian population with CKD and (2) to examine the expected implications on both CKD classification as well as End Stage Renal Disease (ESRD) prevalence across these equations in South Asian population. METHODS We carried out a cross-sectional investigation on 385 participants, a CKD cohort ≥ 18 years, at Allama Iqbal Medical College, Jinnah Hospital, Lahore. Serum creatinine was measured by Jaffe's method and rGFR was measured by inulin clearance. RESULTS Pakistani CKD-EPI has a lower median difference at -1.33 ml/min/1.73m2 elevated precision (IQR) at 2.33 (-2.36, -0.03) and higher P30 value at 89.35% than 2021 CKD-EPI and EKFC equations. The mean difference (ml/min/1.73m2), 95% agreement limits (ml/min/1.73m2) of CKD-EPI PK: -1.18, -6.14, 2021 CKD-EPI: -5.98, -13.24 and EKFC: -5.62, -13.01 (P <0.001). These equations highly correlated to rGFR (P <0.001). An upward re-classification in GFR categories was shown by 2021 CKD-EPI and EKFC compared to the Pakistani CKD-EPI equation. However, there was an exception regarding the G5 category, where an elevated count of 217 (56.36%) was shown for CKD-EPI PK. The prevalence of ESRD was seen in entire age groups and prevailed among females more than in males overall equations. CONCLUSIONS Pakistani CKD-EPI exhibited outstanding performance, while 2021 CKD-EPI and EKFC demonstrated poor performances and could not show an adequate advantage for both CKD classification and prevalence of ESRD compared to Pakistani CKD-EPI. Therefore, Pakistani CKD-EPI appears optimal for this region and warrants future validation in other South Asian countries. In contrast, suitable measures must be implemented in Pakistani laboratories.
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Affiliation(s)
- Aqsa Safdar
- Faculty of Pharmaceutical Sciences, University of Central Punjab, Lahore, Punjab, Pakistan
| | - Waqas Akram
- Faculty of Pharmaceutical Sciences, University of Central Punjab, Lahore, Punjab, Pakistan
| | - Mahtab Ahmad Khan
- Faculty of Pharmaceutical Sciences, University of Central Punjab, Lahore, Punjab, Pakistan
| | - Danish Tahir
- Faculty of Pharmaceutical Sciences, University of Central Punjab, Lahore, Punjab, Pakistan
| | - Muhammad Hammad Butt
- Department of Medicinal Chemistry, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
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Zinab B, Ali R, Megersa BS, Belachew T, Kedir E, Girma T, Abdisa A, Berhane M, Admasu B, Friis H, Abera M, Olsen MF, Andersen GS, Wells JCK, Filteau S, Wibaek R, Nitsch D, Yilma D. Association of linear growth velocities between 0 and 6 years with kidney function and size at 10 years: A birth cohort study in Ethiopia. Am J Clin Nutr 2023; 118:1145-1152. [PMID: 37758061 DOI: 10.1016/j.ajcnut.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Risk of noncommunicable diseases accrues from fetal life, with early childhood growth having an important role in adult disease risk. There is a need to understand how early-life growth relates to kidney function and size. OBJECTIVES This study aimed to assess the association of linear growth velocities among children between 0 and 6 y with kidney function and size among children aged 10 y. METHODS The Ethiopian Anthropometric and Body Composition birth cohort recruited infants born at term to mothers living in Jimma with a birth weight of ≥1500 g and without congenital malformations. Participants were followed up with 13 measurements between birth and 6 y of age. The latest follow-up was at ages 7-12 y with measurement of serum cystatin C as a marker of kidney function and ultrasound assessment of kidney dimensions. Kidney volume was computed using an ellipsoid formula. Linear-spline multilevel modeling was used to compute linear growth velocities between 0 and 6 y. Multiple linear regression modeling was used to examine the associations of linear growth velocities in selected age periods with cystatin C and kidney size. RESULTS Data were captured from 355 children, at a mean age of 10 (range 7-12) y. The linear growth velocity was high between 0 and 3 mo and then decreased with age. There was no evidence of an association of growth velocity ≤24 mo with cystatin C at 10 y. Between 24 and 48 and 48 and 76 mo, serum cystatin C was higher by 2.3% [95% confidence interval (CI): 0.6, 4.2] and 2.1% (95% CI: 0.3, 4.0) for 1 SD higher linear growth velocity, respectively. We found a positive association between linear growth velocities at all intervals between 0 and 6 y and kidney volume. CONCLUSIONS Greater linear growth between 0 and 6 y of development was positively associated with kidney size, and greater growth velocity after 2 y was associated with higher serum cystatin C concentrations.
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Affiliation(s)
- Beakal Zinab
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia; Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark.
| | - Rahma Ali
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia; Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Bikila S Megersa
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Elias Kedir
- Department of Radiology, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Department of Pediatrics and Child Health Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | | | - Melkamu Berhane
- Department of Pediatrics and Child Health Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Bitiya Admasu
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Henrik Friis
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mette F Olsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Jonathan C K Wells
- Childhood Nutrition Research Center, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Yilma
- Department of Internal Medicine, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
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12
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Wang Y, Adingwupu OM, Shlipak MG, Doria A, Estrella MM, Froissart M, Gudnason V, Grubb A, Kalil R, Mauer M, Rossing P, Seegmiller J, Coresh J, Levey AS, Inker LA. Discordance Between Creatinine-Based and Cystatin C-Based Estimated GFR: Interpretation According to Performance Compared to Measured GFR. Kidney Med 2023; 5:100710. [PMID: 37753251 PMCID: PMC10518599 DOI: 10.1016/j.xkme.2023.100710] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Rationale & Objective Use of cystatin C in addition to creatinine to estimate glomerular filtration rate (estimated glomerular filtration rate based on cystatin C [eGFRcys] and estimated glomerular filtration rate based on creatinine [eGFRcr], respectively) is increasing. When eGFRcr and eGFRcys are discordant, it is not known which is more accurate, leading to uncertainty in clinical decision making. Study Design Cross-sectional analysis. Setting & Participants Four thousand fifty participants with measured glomerular filtration rate (mGFR) from 12 studies in North America and Europe. Exposures Serum creatinine and serum cystatin C. Outcomes Performance of creatinine-based and cystatin C-based glomerular filtration rate estimating equations compared to mGFR. Analytical Approach We evaluated the accuracy of eGFRcr, eGFRcys, and the combination (eGFRcr-cys) compared to mGFR according to the magnitude of the difference between eGFRcr and eGFRcys (eGFRdiff). We used CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equations to estimate glomerular filtration rate. eGFRdiff was defined as eGFRcys minus eGFRcr and categorized as less than -15, -15 to <15, and ≥15 mL/min/1.73 m2 (negative, concordant, and positive groups, respectively). We compared bias (median of mGFR minus eGFR) and the percentage of eGFR within 30% of mGFR. Results Thirty percent of participants had discordant eGFRdiff (21.0% and 9.6% negative and positive eGFRdiffs, respectively). In the concordant eGFRdiff group, all equations displayed similar accuracy. In the negative eGFRdiff groups, eGFRcr had a large overestimation of mGFR (-13.4 [-14.5 to -12.2] mL/min/1.73 m2) and eGFRcys had a large underestimation (9.9 [9.1-11.2] mL/min/1.73m2), with opposite results in the positive eGFRdiff group. In both negative and positive eGFRdiff groups, eGFRcr-cys was more accurate than either eGFRcr or eGFRcys. These results were largely consistent across age, sex, race, and body mass index. Limitations Few participants with major comorbid conditions. Conclusions Discordant eGFRcr and eGFRcys are common. eGFR using the combination of creatinine and cystatin C provides the most accurate estimates among persons with discordant eGFRcr or eGFRcys.
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Affiliation(s)
- Yeli Wang
- Department of Nutrition, Harvard University T.H. Chan School of Public Health, Boston, MA
| | | | - Michael G. Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affair Medical Center and University of California, San Francisco, CA
| | - Alessandro Doria
- Section on Genetics & Epidemiology, Joslin Diabetes Center, and the Department of Medicine, Harvard Medical School, Boston, MA
| | - Michelle M. Estrella
- Division of Nephrology, Department of Medicine, San Francisco VA Health Care System and University of California, San Francisco, CA
| | - Marc Froissart
- Clinical Trial Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, and the Icelandic Heart Association, Kopavogur, Iceland
| | - Anders Grubb
- Department of Clinical Chemistry and Pharmacology, Institute of Laboratory Medicine, Lund University, Sweden
| | - Roberto Kalil
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
| | - Michael Mauer
- Divisions of Pediatric and Adult Nephrology, University of Minnesota, Minneapolis, MN
| | - Peter Rossing
- Steno Diabetes Center Copenhagen and the Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesse Seegmiller
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Josef Coresh
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD
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Chavan AS, Bale CB, Wakhare PS, Shinde N, Kulkarni AR, Sajgure AD, Dighe TA. Measured Glomerular Filtration Rate in Live Related Kidney Donors Three Months Post-Kidney Donation: A Single-Center Experience From Western India. Cureus 2023; 15:e45103. [PMID: 37842396 PMCID: PMC10569230 DOI: 10.7759/cureus.45103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Background Glomerular filtration rate (GFR) estimation is pivotal in the evaluation of kidney donors. There are various methods available for assessing GFR, but there has been a lack of consensus on the measurement of GFR and the frequency of renal evaluation after kidney donation. Our study aims to analyze the measured GFR (m-GFR) before and three months after kidney donation and note the compensatory abilities of the remnant kidney in live related kidney donors. Methods This prospective observational study was conducted at the Department of Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, from April 2021 to December 2022. The study included 30 donors from both genders aged between 23 and 73 years. The measured GFR was calculated using a technetium-99m diethylene triamine pentaacetic acid (Tc-99m DTPA) scan. We analyzed donor characteristics and various parameters that included demography, anthropometry, blood pressure, and serum creatinine and measured GFR (m-GFR) using a Tc-99m DTPA scan, which was compared before and three months after donor nephrectomy. Results Of the 30 donors, 25 (83.3%) were females and five (16.7%) were males. The mean age of donors was 49.23 ± 12.29 years. The mean body mass index (BMI) was noted to be 24.73 ± 5.58 kg/m2, whereas the mean body surface area (BSA) was 1.59 ± 0.12 m2. In terms of the measured GFR by DTPA scan, pre-donation and post-donation, the average GFR for our population was 103.83 ± 10.07 mL/minute/1.73 m2 and 60.47±6.57 mL/minute/1.73 m2, respectively. The mean measured GFR of remnant kidney increased by 9.21 ± 4.39 mL/minute/1.73 m2 in 28 donors, while two donors had a fall in the mean measured GFR by 6.8 ± 1.69 mL/minute/1.73 m2. Conclusions To safeguard donor health, accurate measurement of GFR at various timelines after kidney donation should be considered as there are various limitations associated with the use of serum creatinine-based GFR estimating equations for solitary kidneys. However, long-term studies are required to analyze the changes in GFR after nephrectomy and determine the adequacy of compensatory changes in the remnant kidney post-kidney donation.
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Affiliation(s)
- Abhijit S Chavan
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Charan B Bale
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Pavan S Wakhare
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Nilesh Shinde
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Akshay R Kulkarni
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Atul D Sajgure
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Tushar A Dighe
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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Ziauddeen N, Jeffrey RF, Waiblinger D, Fraser SD, Alwan NA, Yuen HM, Azad R, Mason D, Wright J, Coward RJ, Roderick PJ. Ethnic differences in kidney function in childhood: the Born in Bradford Cohort Renal Study. Wellcome Open Res 2023; 7:112. [PMID: 37274450 PMCID: PMC10233317 DOI: 10.12688/wellcomeopenres.17796.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 07/27/2023] Open
Abstract
Background: Endstage kidney failure rates are higher in South Asians than in White Europeans. Low birth weight is associated with adult chronic kidney disease and is more common in South Asians. Foetal kidney size was smaller in South Asians in the Born in Bradford (BiB) birth cohort. As part of BiB follow up, we aimed to investigate if there were ethnic differences in kidney function and blood pressure in early childhood and whether this was different by foetal kidney size. Methods: Serum creatinine, cystatin C, urea, and urinary albumin to creatinine ratio (ACR), protein to creatinine ratio (PCR) and retinol binding protein (RBP) were analysed in blood and urine samples from those who participated in the BiB follow-up at 7-11 years. Ethnicity was categorised by parental self-report as White European and South Asian. Estimated glomerular filtration rate (eGFR) was calculated using Schwartz, and cystatin C Zappitelli and Filler equations. Linear regression was used to examine the association between ethnicity and eGFR, PCR and blood pressure. Results: 1591 children provided blood (n=1403) or urine (n=625) samples. Mean eGFR was 92 ml/min/1.73m 2 (standard deviation (SD) 9) using Schwartz (n=1156) and 94 (SD 11) using Zappitelli (n=1257). CKD prevalence was rare (1 with eGFR <60 ml/min/1.73m 2, 14 (2.4%) had raised ACR (>2.5 mg/mmol in boys/3.5 mg/mmol in girls). Diastolic blood pressure was higher in South Asian children (difference 2.04 mmHg, 95% CI 0.99 to 3.10) but was not significant in adjusted analysis. There was no evidence of association in adjusted models between ethnicity and any eGFR or urinary measure at this age. Conclusions: There was no evidence of significant ethnic differences in kidney function at pre-pubertal age despite differences in kidney volume at birth. Longitudinal follow-up is required to track ethnic patterns in kidney function and blood pressure as children develop through puberty.
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Affiliation(s)
- Nida Ziauddeen
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton, UK
| | - Robin F. Jeffrey
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Dagmar Waiblinger
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Simon D.S. Fraser
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton, UK
| | - Nisreen A. Alwan
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ho M. Yuen
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rafaq Azad
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Dan Mason
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | - Paul J. Roderick
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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Vijayan M, Deshpande K, Anand S, Deshpande P. Risk Amplifiers for Vascular Disease and CKD in South Asians: When Intrinsic β-Cell Dysfunction Meets a High-Carbohydrate Diet. Clin J Am Soc Nephrol 2023; 18:681-688. [PMID: 36758530 PMCID: PMC10278793 DOI: 10.2215/cjn.0000000000000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
South Asians, comprising almost one fourth of the world population, are at higher risk of type 2 diabetes mellitus, hypertension, cardiovascular disease, and CKD compared with other ethnic groups. This has major public health implications in South Asia and in other parts of the world to where South Asians have immigrated. The interplay of various modifiable and nonmodifiable risk factors confers this risk. Traditional models of cardiometabolic disease progression and CKD evaluation may not be applicable in this population with a unique genetic predisposition and phenotype. A wider understanding of dietary and lifestyle influences, genetic and metabolic risk factors, and the pitfalls of conventional equations estimating kidney function in this population are required in providing care for kidney diseases. Targeted screening of this population for metabolic and vascular risk factors and individualized management plan for disease management may be necessary. Addressing unhealthy dietary patterns, promoting physical activity, and medication management that adheres to cultural factors are crucial steps to mitigate the risk of cardiovascular disease and CKD in this population. In South Asian countries, a large rural and urban community-based multipronged approach using polypills and community health workers to decrease the incidence of these diseases may be cost-effective.
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Affiliation(s)
- Madhusudan Vijayan
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
- Institute for Critical Care Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Kavita Deshpande
- Department of Family Medicine, La Maestra Community Health Centers, San Diego, California
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Priya Deshpande
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
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Chanda R, Singh S, Eapen A, David VG, Mukha RP, Pandian RM, Antonisamy B, Deborah MN, Eapen JJ, Thomas A, John EE, Yusuf S, Alexander S, Varughese S, Valson AT. Whole and cortical kidney volume predict 5-year post-nephrectomy eGFR in Indian living kidney donors. Nephrology (Carlton) 2023; 28:136-147. [PMID: 36342651 PMCID: PMC7615851 DOI: 10.1111/nep.14129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/24/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
AIM To study the additional utility of pre-nephrectomy whole and cortical kidney volumes (WKV, CKV) in predicting long-term post-nephrectomy kidney function in Indian living kidney donors (LKDs). METHODS This retrospective cohort study included all LKDs who underwent nephrectomy between 1 January 2006 and 31 December 2015 at our centre, had pre-nephrectomy height, weight and computed tomography (CT) angiography with arterial and nephrographic phase documented, and 5-year post-nephrectomy creatinine values measured. Correlation between body surface area (BSA) adjusted pre-nephrectomy total CKV, WKV and pre-nephrectomy CKD EPI eGFR; BSA-adjusted remnant pre-nephrectomy CKV (rCKV), WKV (rWKV) and 5-year post-nephrectomy CKD EPI creatinine eGFR (5yeGFRCr ); predictors of 5yeGFRCr < 70% of pre-nephrectomy CKD EPI creatinine eGFR (pre-eGFRCr ), and an equation to predict 5yeGFRCr from pre-nephrectomy variables were calculated. RESULTS A total of 196 LKDs (74% female, mean age 41.7 ± 11.0 years) were included in the study. Total WKV showed higher correlation with pre-nephrectomy eGFR than CKV, the highest with CKD EPI cystatin eGFR. Remnant WKV showed higher correlation than rCKV with post-nephrectomy eGFRCr and this increased over time. Older age, lower rWKV or rCKV, higher BSA, and higher pre-eGFRCr identified LKDs with 5yeGFRCr < 70% of pre-eGFRCr , with rCKV identifying a higher proportion (4.5%) of such LKDs. A model including rWKV or rCKV predicted 5yeGFRCr better than one including age, gender, BSA and pre-eGFRCr alone. CONCLUSION Inclusion of pre-nephrectomy remnant CKV and WKV into models for 5yeGFRCr and sub-optimal post-nephrectomy adaptation in Indian LKDs improves their accuracy. CKD EPI cystatin eGFR correlates better with functional renal mass.
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Affiliation(s)
- Reettika Chanda
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shweta Singh
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anu Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinoi George David
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv Paul Mukha
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | | | - Jeethu Joseph Eapen
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Athul Thomas
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Sabina Yusuf
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Suceena Alexander
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anna T. Valson
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
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17
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Construct a classification decision tree model to select the optimal equation for estimating glomerular filtration rate and estimate it more accurately. Sci Rep 2022; 12:14877. [PMID: 36050407 PMCID: PMC9436941 DOI: 10.1038/s41598-022-19185-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/25/2022] [Indexed: 11/08/2022] Open
Abstract
Chronic kidney disease (CKD) has become a worldwide public health problem and accurate assessment of renal function in CKD patients is important for the treatment. Although the glomerular filtration rate (GFR) can accurately evaluate the renal function, the procedure of measurement is complicated. Therefore, endogenous markers are often chosen to estimate GFR indirectly. However, the accuracy of the equations for estimating GFR is not optimistic. To estimate GFR more precisely, we constructed a classification decision tree model to select the most befitting GFR estimation equation for CKD patients. By searching the HIS system of the First Affiliated Hospital of Zhejiang Chinese Medicine University for all CKD patients who visited the hospital from December 1, 2018 to December 1, 2021 and underwent Gate's method of 99mTc-DTPA renal dynamic imaging to detect GFR, we eventually collected 518 eligible subjects, who were randomly divided into a training set (70%, 362) and a test set (30%, 156). Then, we used the training set data to build a classification decision tree model that would choose the most accurate equation from the four equations of BIS-2, CKD-EPI(CysC), CKD-EPI(Cr-CysC) and Ruijin, and the equation was selected by the model to estimate GFR. Next, we utilized the test set data to verify our tree model, and compared the GFR estimated by the tree model with other 13 equations. Root Mean Square Error (RMSE), Mean Absolute Error (MAE) and Bland-Altman plot were used to evaluate the accuracy of the estimates by different methods. A classification decision tree model, including BSA, BMI, 24-hour Urine protein quantity, diabetic nephropathy, age and RASi, was eventually retrieved. In the test set, the RMSE and MAE of GFR estimated by the classification decision tree model were 12.2 and 8.5 respectively, which were lower than other GFR estimation equations. According to Bland-Altman plot of patients in the test set, the eGFR was calculated based on this model and had the smallest degree of variation. We applied the classification decision tree model to select an appropriate GFR estimation equation for CKD patients, and the final GFR estimation was based on the model selection results, which provided us with greater accuracy in GFR estimation.
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18
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George C, Echouffo-Tcheugui JB, Jaar BG, Okpechi IG, Kengne AP. The need for screening, early diagnosis, and prediction of chronic kidney disease in people with diabetes in low- and middle-income countries-a review of the current literature. BMC Med 2022; 20:247. [PMID: 35915501 PMCID: PMC9344711 DOI: 10.1186/s12916-022-02438-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/14/2022] [Indexed: 12/30/2022] Open
Abstract
Chronic kidney disease (CKD) in people with diabetes is becoming an increasing major public health concern, disproportionately burdening low- and middle-income countries (LMICs). This rising burden is due to various factors, including the lack of disease awareness that results in late referral and the cost of screening and consequent treatment of the comorbid conditions, as well as other factors endemic to LMICs relating to inadequate management of risk factors. We critically assessed the extant literature, by performing searches of Medline via PubMed, EBSCOhost, Scopus, and Web of Science, for studies pertaining to screening, diagnosis, and prediction of CKD amongst adults with diabetes in LMICs, using relevant key terms. The relevant studies were summarized through key themes derived from the Wilson and Jungner criteria. We found that screening for CKD in people with diabetes is generally infrequent in LMICs. Also, LMICs are ill-equipped to appropriately manage diabetes-associated CKD, especially its late stages, in which supportive care and kidney replacement therapy (KRT) might be required. There are acceptable and relatively simple tools that can aid diabetes-associated CKD screening in these countries; however, these tools come with limitations. Thus, effective implementation of diabetes-associated CKD screening in LMICs remains a challenge, and the cost-effectiveness of such an undertaking largely remains to be explored. In conclusion, for many compelling reasons, screening for CKD in people with diabetes should be a high policy priority in LMICs, as the huge cost associated with higher mortality and morbidity in this group and the cost of KRT offers a compelling economic incentive for improving early detection of diabetes in CKD.
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Affiliation(s)
- Cindy George
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Cape Town, South Africa.
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Diabetes Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernard G Jaar
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Nephrology Center of Maryland, Baltimore, MD, USA
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa.,Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Cape Town, South Africa
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19
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Kim H, Hur M, Lee S, Lee GH, Moon HW, Yun YM. European Kidney Function Consortium Equation vs. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Refit Equations for Estimating Glomerular Filtration Rate: Comparison with CKD-EPI Equations in the Korean Population. J Clin Med 2022; 11:jcm11154323. [PMID: 35893414 PMCID: PMC9331398 DOI: 10.3390/jcm11154323] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/14/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is the most commonly used equation for estimated glomerular filtration rate (eGFR). Recently, the European Kidney Function Consortium (EKFC) announced a full-age spectrum equation, and the CKD-EPI announced the CKD-EPI refit equations (CKD-EPI-R). We compared CKD-EPI, EKFC, and CKD-EPI-R equations in a large-scale Korean population and investigated their potential implications for CKD prevalence. In a total of 106,021 individuals who received annual check-ups from 2018 to 2020, we compared the eGFR equations according to the Clinical and Laboratory Standards Institute guidelines. Weighted kappa (κ) agreement was used to compare the potential implications for CKD prevalence across the equations. The median value of eGFR tended to increase in the order of EKFC, CKD-EPI, and CKD-EPI-R equations (92.4 mL/min/1.73 m2, 96.0 mL/min/1.73 m2, and 100.0 mL/min/1.73 m2, respectively). The EKFC and CKD-EPI-R equations showed a very high correlation of eGFR and good agreement for CKD prevalence with CKD-EPI equation (r = 0.98 and 1.00; κ = 0.80 and 0.82, respectively). Compared with the CKD-EPI equation, the EFKC equation overestimated CKD prevalence (3.5%), and the CKD-EPI-R equation underestimated it (1.5%). This is the first study comparing CKD-EPI, EKFC, and CKD-EPI-R equations simultaneously. The EKFC and CKD-EPI-R equations were statistically interchangeable with CKD-EPI equations in this large-scale Korean population. The transition of eGFR equations, however, would lead to sizable changes in the CKD prevalence. To improve kidney health, in-depth discussion considering various clinical aspects is imperative for the transition of eGFR equations.
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Affiliation(s)
- Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 05030, Korea; (H.K.); (G.-H.L.); (H.-W.M.); (Y.-M.Y.)
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 05030, Korea; (H.K.); (G.-H.L.); (H.-W.M.); (Y.-M.Y.)
- Correspondence: ; Tel.: +82-2-2030-5581
| | - Seungho Lee
- Department of Preventive Medicine, Dong-A University College of Medicine, Busan 49201, Korea;
| | - Gun-Hyuk Lee
- Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 05030, Korea; (H.K.); (G.-H.L.); (H.-W.M.); (Y.-M.Y.)
| | - Hee-Won Moon
- Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 05030, Korea; (H.K.); (G.-H.L.); (H.-W.M.); (Y.-M.Y.)
| | - Yeo-Min Yun
- Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 05030, Korea; (H.K.); (G.-H.L.); (H.-W.M.); (Y.-M.Y.)
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20
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Wang Y, Levey AS, Inker LA, Jessani S, Bux R, Samad Z, Yaqub S, Karger AB, Allen JC, Jafar TH. Performance of Serum β2-Microglobulin- and β-Trace Protein-Based Panel Markers and 2021 Creatinine- and Cystatin-Based GFR Estimating Equations in Pakistan. Kidney Med 2022; 4:100444. [PMID: 35402891 PMCID: PMC8988004 DOI: 10.1016/j.xkme.2022.100444] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yeli Wang
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Andrew S. Levey
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Lesley A. Inker
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Saleem Jessani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rasool Bux
- Department of Paediatrics (Division of Women & Child Health), Aga Khan University, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Sonia Yaqub
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Amy B. Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN
| | - John C. Allen
- Center for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Medical School, Singapore
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Medicine, Aga Khan University, Karachi, Pakistan
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke Global Health Institute, Duke University, Durham, NC
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21
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Huisman BJ, Agyemang C, van den Born BJH, Peters RJ, Snijder MB, Vogt L. Discrepancies in estimated glomerular filtration rate and albuminuria levels in ethnic minority groups - The multiethnic HELIUS cohort study. EClinicalMedicine 2022; 45:101324. [PMID: 35284809 PMCID: PMC8904239 DOI: 10.1016/j.eclinm.2022.101324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Classification of chronic kidney disease (CKD) and evaluation of prognosis is based on two components: estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR). In multiethnic populations, ethnic-specific discrepancies in both parameters may exist. It is unknown whether variations in CKD risk factors may explain these discrepancies. METHODS We cross-sectionally analyzed baseline eGFR (CKD-EPI formula) and ACR of 21,421 participants (aged 18-70 years) of the HELIUS cohort who were randomly sampled between 2011 and 2015, stratified by ethnicity, through the municipality register of Amsterdam. Six ethnic groups were distinguished, including participants of Dutch (4539), South-Asian Surinamese (3027), African Surinamese (4114), Ghanaian (2297), Turkish (3576) and Moroccan (3868) descent. Multiple regression analyses to determine ethnic differences were performed, with additional adjustments for age, sex, traditional cardiovascular and renal risk factors, and adjustment for level of education. FINDINGS Mean (SE) eGFR was higher in all ethnic minority groups as compared to Dutch participants (eGFR 94.7 ± 0.3 mL/min/1.73 m2) with age- and sex-adjusted differences ranging from 1.5 ± 0.30 in South-Asian Surinamese to 10.1 ± 0.28 mL/min/1.73 m2 in Moroccan participants. ACR was higher in ethnic minority groups as compared to Dutch participants (ACR 0.64 ± 0.20 mg/mmol), with age- and sex-adjusted differences ranging from 0.46 ± 0.20 in African Surinamese participants to 1.70 ± 0.21 mg/mmol in South-Asian Surinamese participants. Differences in both parameters diminished after multiple adjustments, but remained highly significant. INTERPRETATION Both eGFR and ACR are higher among ethnic minority groups as compared to individuals of Dutch origin-independent of age, sex, prevalence of traditional cardiovascular and renal risk factors, and parameters of socioeconomic status. Future studies should address the potential uncertainty in predicting CKD and CKD-related complications when using both parameters in ethnically diverse populations. Also, identification of driving factors leading to these discrepancies might contribute to improved population screening for CKD. FUNDING The HELIUS study is conducted by the Amsterdam University Medical Center and the Public Health Service of Amsterdam. Both organizations provided core support for HELIUS. The HELIUS study is also funded by the Dutch Heart Foundation (2010T084), the Netherlands Organization for Health Research and Development (ZonMw: 200500003), the European Union (FP7: 278901), and the European Fund for the Integration of non-EU immigrants (EIF: 2013EIF013).
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Affiliation(s)
- Brechje J.M.V. Huisman
- Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Bert-Jan H. van den Born
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ron J.G. Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marieke B. Snijder
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Liffert Vogt
- Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Corresponding author at: Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands.
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