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Ng DK, Muñoz A. Assessing bias in GFR estimating equations: improper GFR stratification can yield misleading results. Pediatr Nephrol 2024:10.1007/s00467-024-06318-4. [PMID: 38396091 DOI: 10.1007/s00467-024-06318-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Assessing bias (estimated - measured) is key to evaluating glomerular filtration rate (GFR). Stratification by subgroups can indicate where equations perform differently. However, there is a fallacy in the assessment of two instruments (e.g., eGFR and mGFR) when stratifying on the level of only one of those instruments. Here, we present statistical aspects of the problem and a solution for GFR stratification along with an empirical investigation using data from the CKiD study. METHODS Compared and contrasted biases (eGFR relative to mGFR) with 95% confidence intervals within strata of mGFR only, eGFR only, and the average of mGFR and eGFR using data from the Chronic Kidney Disease in Children (CKiD) study. RESULTS A total of 304 participants contributed 843 GFR studies with a mean mGFR of 48.46 (SD = 22.72) and mean eGFR of 48.67 (SD = 22.32) and correlation of 0.904. Despite strong agreement, eGFR significantly overestimated mGFR when mGFR < 30 (+ 6.2%; 95%CI + 2.9%, + 9.7%) and significantly underestimated when mGFR > 90 (-12.2%; 95%CI - 17.3%, - 7.0%). Significant biases in opposite direction were present when stratifying by eGFR only. In contrast, when stratifying by the average of eGFR and mGFR, biases were not significant (+ 1.3% and - 1.0%, respectively) congruent with strong agreement. CONCLUSIONS Stratifying by either mGFR or eGFR only to assess eGFR biases is ubiquitous but can lead to inappropriate inference due to intrinsic statistical issues that we characterize and empirically illustrate using data from the CKiD study. Using the average of eGFR and mGFR is recommended for valid inferences in evaluations of eGFR biases.
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Affiliation(s)
- Derek K Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E7642, Baltimore, MD, 21205, USA.
| | - Alvaro Muñoz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E7642, Baltimore, MD, 21205, USA
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Chen Y, Ma Y, Yong Z, Wei L, Pei X, Zhu B, Zhao W. Assessment of the 2023 European Kidney Function Consortium (EKFC) equations in a Chinese adult population. Clin Chem Lab Med 2024; 0:cclm-2024-0080. [PMID: 38336773 DOI: 10.1515/cclm-2024-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES The European Kidney Function Consortium (EKFC) developed two novel equations in 2023 for estimating glomerular filtration rate (GFR): one sex-free cystatin C-based equation (EKFCCys) and one creatinine-cystatin C combined equation (EKFCCr-Cys). This study compared their performance with the previous creatinine-based EKFC equation (EKFCCr) and commonly used Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Berlin Initiative Study (BIS) equations in Chinese adults. METHODS A total of 2,438 Chinese adults (mean age=53.04 years) who underwent the 99mTc-DTPA renal dynamic imaging for reference GFR (rGFR) were included. Diagnostic value was evaluated using correlation coefficients, sensitivity, specificity, and area under the receiver operating characteristic curve (ROCAUC). Performance was assessed in terms of bias, precision (interquartile range of the median difference [IQR]), accuracy (percentage of estimates ±30 % of rGFR [P30], and root-mean-square error [RMSE]) across age, sex, and rGFR subgroups. Gender differences in bias and P30 were also analyzed. RESULTS Average rGFR was 73.37 mL/min/1.73 m2. EKFC equations showed stronger correlations and larger AUCs compared to the parallel CKD-EPI equations, with EKFCCr-Cys demonstrating the greatest improvement (R=0.771, ROCAUC=0.913). Concerning bias, precision, and accuracy, EKFC equations consistently outperformed CKD-EPI equations. EKFCCr-Cys and EKFCCr performed acceptably well in the entire population and were equivalent to BIS equations in the elderly. All equations, including EKFCCys, showed similar P30 accuracy across sexes. CONCLUSIONS EKFC equations provided a reasonable alternative for estimating GFR in the Chinese adult population. While EKFCCys did not outperform EKFCCr, EKFCCr-Cys improved the accuracy of single-marker equations.
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Affiliation(s)
- Yi Chen
- Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, P.R. China
| | - Yao Ma
- Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, P.R. China
| | - Zhenzhu Yong
- Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, P.R. China
| | - Lu Wei
- Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, P.R. China
| | - Xiaohua Pei
- Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, P.R. China
| | - Bei Zhu
- Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, P.R. China
| | - Weihong Zhao
- Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, P.R. China
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Ma Y, Shen X, Yong Z, Wei L, Zhao W. Comparison of glomerular filtration rate estimating equations in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 114:105107. [PMID: 37379796 DOI: 10.1016/j.archger.2023.105107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/30/2023] [Accepted: 06/16/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Debates persist regarding the performance of existing glomerular filtration rate (GFR) estimating equations in older individuals. We performed this meta-analysis to assess the accuracy and bias of six commonly used equations, including the Chronic Kidney Disease Epidemiology Collaboration creatinine equation (CKD-EPICr) and its combination with cystatin C (CKD-EPICr-Cys), with the corresponding pair of the Berlin Initiative Study equations (BIS1 and BIS2) and the Full Age Spectrum equations (FASCr and FASCr-Cys). METHODS PubMed and the Cochrane Library were searched for studies comparing estimated GFR (eGFR) with measured GFR (mGFR). We analyzed the difference in P30 and bias among the six equations and investigated subgroups based on the area (Asian and non-Asian), mean age (60-74 years and ≥75 years), and levels of mean mGFR (<45 mL/min/1.73m2 and ≥45 mL/min/1.73m2). RESULTS 27 studies with 18,112 participants were included, all reporting P30 and bias. BIS1 and FASCr exhibited significantly higher P30 than CKD-EPICr. While no significant differences were observed between FASCr and BIS1, or among the three combined equations in terms of either P30 or bias. Subgroup analyses revealed FASCr and FASCr-Cys achieved better results in most situations. However, in the subgroup of mGFR<45 mL/min/1.73m2, CKD-EPICr-Cys had relatively higher P30 and significantly smaller bias. CONCLUSIONS Overall, BIS and FAS provided relatively more accurate estimates of GFR than CKD-EPI in older adults. FASCr and FASCr-Cys may be better suited for various conditions, while CKD-EPICr-Cys would be a better option for older individuals with impaired renal function.
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Affiliation(s)
- Yao Ma
- Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, Jiangsu, China
| | - Xue Shen
- Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, Jiangsu, China
| | - Zhenzhu Yong
- Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, Jiangsu, China
| | - Lu Wei
- Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, Jiangsu, China
| | - Weihong Zhao
- Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, Jiangsu, China.
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Shi S, Gao L, Zhang J, Zhang B, Xiao J, Xu W, Tian Y, Ni L, Wu X. The automatic detection of diabetic kidney disease from retinal vascular parameters combined with clinical variables using artificial intelligence in type-2 diabetes patients. BMC Med Inform Decis Mak 2023; 23:241. [PMID: 37904184 PMCID: PMC10617171 DOI: 10.1186/s12911-023-02343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) has become the largest cause of end-stage kidney disease. Early and accurate detection of DKD is beneficial for patients. The present detection depends on the measurement of albuminuria or the estimated glomerular filtration rate, which is invasive and not optimal; therefore, new detection tools are urgently needed. Meanwhile, a close relationship between diabetic retinopathy and DKD has been reported; thus, we aimed to develop a novel detection algorithm for DKD using artificial intelligence technology based on retinal vascular parameters combined with several easily available clinical parameters in patients with type-2 diabetes. METHODS A total of 515 consecutive patients with type-2 diabetes mellitus from Xiangyang Central Hospital were included. Patients were stratified by DKD diagnosis and split randomly into either the training set (70%, N = 360) or the testing set (30%, N = 155) (random seed = 1). Data from the training set were used to develop the machine learning algorithm (MLA), while those from the testing set were used to validate the MLA. Model performances were evaluated. RESULTS The MLA using the random forest classifier presented optimal performance compared with other classifiers. When validated, the accuracy, sensitivity, specificity, F1 score, and AUC for the optimal model were 84.5%(95% CI 83.3-85.7), 84.5%(82.3-86.7), 84.5%(82.7-86.3), 0.845(0.831-0.859), and 0.914(0.903-0.925), respectively. CONCLUSIONS A new machine learning algorithm for DKD diagnosis based on fundus images and 8 easily available clinical parameters was developed, which indicated that retinal vascular changes can assist in DKD screening and detection.
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Affiliation(s)
- Shaomin Shi
- Department of Nephrology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441000, China
| | - Ling Gao
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441000, China
| | - Juan Zhang
- Department of Nephrology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Baifang Zhang
- Department of Biochemistry, Wuhan University TaiKang Medical School (School of Basic Medical Sciences), Wuhan, 430071, Hubei, China
| | - Jing Xiao
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441000, China
| | - Wan Xu
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441000, China
| | - Yuan Tian
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441000, China.
| | - Lihua Ni
- Department of Nephrology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China.
| | - Xiaoyan Wu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China.
- Department of General Practice, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China.
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Safdar A, Akram W, Ahmad Khan M, Muhammad S. Optimal Glomerular Filtration Rate Equations for Various Age Groups, Disease Conditions and Ethnicities in Asia: A Systematic Review. J Clin Med 2023; 12. [PMID: 36902609 DOI: 10.3390/jcm12051822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 03/12/2023] Open
Abstract
(1) Background: The performance of estimated glomerular filtration rate (eGFR) equations in the Asian population has been widely questioned. The primary objective of this study was to gather evidence regarding optimal GFR equations in Asia for various age groups, disease conditions, and ethnicities. The secondary objective was to see whether the equations based on the combination of creatinine and cystatin C biomarkers if employed are satisfactory across different age groups and disease conditions in various ethnicities in Asia compared to those based on either of the single biomarkers. (2) Methods: Validation studies that had both creatinine and cystatin C-based equations either alone or in combination, validated in specific disease conditions, and those which compared the performance of these equations with exogenous markers were eligible only. The bias, precision, and 30% accuracy (P30) of each equation were recorded accordingly. (3) Results: Twenty-one studies consisting of 11,371 participants were included and 54 equations were extracted. The bias, precision, and P30 accuracies of the equations ranged from -14.54 to 9.96 mL/min/1.73 m2, 1.61 to 59.85 mL/min/1.73 m2, and 4.7% to 96.10%. The highest values of P30 accuracies were found for the JSN-CKDI equation (96.10%) in Chinese adult renal transplant recipients, for the BIS-2 equation (94.5%) in Chinese elderly CKD patients, and Filler equation (93.70%) also in Chinese adult renal transplant recipients. (4) Conclusions: Optimal equations were identified accordingly and it was proven that combination biomarker equations are more precise and accurate in most of the age groups and disease conditions. These can be considered equations of choice for the specific age groups, disease conditions, and ethnicities within Asia.
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Shi S, Ni L, Tian Y, Zhang B, Xiao J, Xu W, Gao L, Wu X. Association of Obesity Indices with Diabetic Kidney Disease and Diabetic Retinopathy in Type 2 Diabetes: A Real-World Study. J Diabetes Res 2023; 2023:3819830. [PMID: 37096235 PMCID: PMC10122582 DOI: 10.1155/2023/3819830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/26/2023] [Accepted: 03/16/2023] [Indexed: 04/26/2023] Open
Abstract
Background Diabetic microvascular complications mainly include diabetic kidney disease (DKD) and diabetic retinopathy (DR). Obesity was recognized as a risk factor for DKD, while the reported relationship between obesity and DR was inconsistent. Moreover, whether the associations can be attributed to C-peptide levels is unknown. Methods Data from 1142 sequential inpatients with T2DM at Xiangyang Central Hospital between June 2019 and March 2022 were extracted retrospectively from the electronic medical record system. The associations between four obesity indices (body mass index (BMI), waist-hip circumference ratio (WHR), visceral fat tissue area (VFA), and subcutaneous fat tissue area (SFA)) and DKD and DR were evaluated. Whether the associations can be attributed to C-peptide levels was also explored. Results Obesity was a risk factor for DKD after adjusting for sex, HbA1c, TG, TC, HDL, LDL, smoking history, education, duration of diabetes, and insulin use (obesity indices: BMI (OR 1.050: 95% CI: 1.008-1.094; P = 0.020); WHR (OR 10.97; 95% CI: 1.250-92.267; P = 0.031); VFA (OR 1.005; 95% CI: 1.001-1.008; P = 0.008)), but it became insignificant after further adjusting for fasting C-peptide. The associations between BMI, WHR, VFA, and DKD might be U-shaped. Obesity and FCP tended to protect against DR; however, they became insignificant after adjusting for multiple potential confounders. C2/C0 (the ratio of the postprandial serum C-peptide to fasting C-peptide) was a protective factor for both DKD (OR 0.894, 95% CI: 0.833-0.959, P < 0.05) and DR (OR 0.851, 95% CI: 0.787-0.919; P < 0.05). Conclusions Obesity was a risk factor for DKD, and the effect may be attributable to C-peptide, which represents insulin resistance. The protective effect of obesity or C-peptide on DR was not independent and could be confounded by multiple factors. Higher C2/C0 was associated with both decreased DKD and DR.
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Affiliation(s)
- Shaomin Shi
- Department of Nephrology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei 430071, China
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441000, China
| | - Lihua Ni
- Department of Nephrology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei 430071, China
| | - Yuan Tian
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441000, China
| | - Baifang Zhang
- Department of Biochemistry, Wuhan University TaiKang Medical School (School of Basic Medical Sciences), Wuhan, Hubei 430071, China
| | - Jing Xiao
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441000, China
| | - Wan Xu
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441000, China
| | - Ling Gao
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441000, China
| | - Xiaoyan Wu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei 430071, China
- Department of General Practice, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei 430071, China
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Cui C, Qu Y, Sia JEV, Zhu Z, Wang Y, Ling J, Li H, Jiang Y, Pan J, Liu D. Assessment of Aging-Related Function Variations of P-gp Transporter in Old-Elderly Chinese CHF Patients Based on Modeling and Simulation. Clin Pharmacokinet 2022; 61:1789-800. [PMID: 36378486 DOI: 10.1007/s40262-022-01184-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES P-glycoprotein (P-gp) is one of the most intensely studied transporters owing to its broad tissue distribution and substrate specificity. Existing research suggests that the risk of systemic exposure to dabigatran etexilate (DABE) and digoxin, two P-gp probe substrates in vivo, has significantly increased in elderly patients. We applied a model-based quantitative pharmacological approach to assess aging-related P-gp changes in the Chinese old-elderly population. METHODS Population pharmacokinetic (PopPK) modeling was first performed using clinical pharmacokinetic data to explore the effect of age on the pharmacokinetic characteristics of dabigatran (DAB, the active principle of DABE) and digoxin in elderly Chinese patients. Corresponding physiologically based pharmacokinetic (PBPK) models were established to further explain the elevated systemic exposure to these two drugs. Eventually, standard dosing regimens of DABE and digoxin were assessed in Chinese old-elderly patients with chronic heart failure (CHF) with different stages of renal impairment. RESULTS PopPK analysis suggested that age as a covariate had an additional effect on the apparent clearance of these two drugs after correcting for creatinine clearance. PBPK simulation results suggested that disease-specific pathophysiological changes could explain DAB exposure in the young elderly. In the elderly population, 17.1% of elevated DAB exposure remained unexplained, and 25.5% of the reduced P-gp function associated with aging was ultimately obtained using sensitivity analysis. This value was further validated using digoxin data obtained by PBPK modeling. The simulation results suggest that CHF patients with advanced age and moderate-to-severe renal impairment require heightened vigilance for elevated exposure risk during the use of DABE and digoxin. CONCLUSIONS Aging might be a significant risk factor for elevated systemic exposure to DAB and digoxin by reducing P-gp-mediated efflux in the Chinese old elderly population.
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Noronha IL, Santa-Catharina GP, Andrade L, Coelho VA, Jacob-Filho W, Elias RM. Glomerular filtration in the aging population. Front Med (Lausanne) 2022; 9:769329. [PMID: 36186775 PMCID: PMC9519889 DOI: 10.3389/fmed.2022.769329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 08/24/2022] [Indexed: 12/11/2022] Open
Abstract
In the last decades, improvements in the average life expectancy in the world population have been associated with a significant increase in the proportion of elderly people, in parallel with a higher prevalence of non-communicable diseases, such as hypertension and diabetes. As the kidney is a common target organ of a variety of diseases, an adequate evaluation of renal function in the approach of this population is of special relevance. It is also known that the kidneys undergo aging-related changes expressed by a decline in the glomerular filtration rate (GFR), reflecting the loss of kidney function, either by a natural senescence process associated with healthy aging or by the length of exposure to diseases with potential kidney damage. Accurate assessment of renal function in the older population is of particular importance to evaluate the degree of kidney function loss, enabling tailored therapeutic interventions. The present review addresses a relevant topic, which is the effects of aging on renal function. In order to do that, we analyze and discuss age-related structural and functional changes. The text also examines the different options for evaluating GFR, from the use of direct methods to the implementation of several estimating equations. Finally, this manuscript supports clinicians in the interpretation of GFR changes associated with age and the management of the older patients with decreased kidney function.
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Affiliation(s)
- Irene L. Noronha
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Cellular, Genetic and Molecular Nephrology, University of São Paulo Medical School, São Paulo, Brazil
- *Correspondence: Irene L. Noronha
| | | | - Lucia Andrade
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Venceslau A. Coelho
- Geriatric Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Geriatric Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Rosilene M. Elias
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
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Lin SF, Fan YC, Kuo TT, Pan WH, Bai CH. Quality of life and cognitive assessment in healthy older Asian people with early and moderate chronic kidney disease: The NAHSIT 2013–2016 and validation study. PLoS One 2022; 17:e0264915. [PMID: 35271629 PMCID: PMC8912208 DOI: 10.1371/journal.pone.0264915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background Taiwan has the highest prevalence of chronic kidney disease (CKD). Impaired cognition and quality of life are significant phenomena in the late stages of CKD. We sought to obtain an overview and the attributable effect of impaired glomerular filtration on multiple domains in cognition and dimensions of quality of life for community-based healthy older adults in Taiwan. Methods The study was derived from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013–2016, a nationwide cross-sectional study conducted to sample healthy, community-based older adults aged ≥65 years in Taiwan. Participants were categorized into four CKD groups: CKD stage 1, stage 2, stages 3a and 3b, and stages 4–5. The Mini-Mental State Examination (MMSE) and the QoL questionnaire derived from the 12-item Short Form Health Survey (SF-12) were measured. Generalized linear mixed models (GLMMs) and principal component regressions were employed for the analysis and validation, respectively. Results Participants with moderate CKD (stages 3a and 3b) showed deficits in global MMSE, domain orientation to time, calculation, complex commands, and role-physical and vitality in QoL questionnaires. In GLMMs, impaired eGFR per 30 mL/min/1.73 m² was associated with lower global MMSE scores (β = -0.807, standard error [SE] = 0.235, P = 0.0007), domain orientation to time (β = -0.155, SE = 0.047, P = 0.0011), calculation (β = -0.338, SE = 0.109, P = 0.0020), complex commands (β = -0.156, SE = 0.079, P = 0.0494), and role-physical (β = -2.219, SE = 0.779, P = 0.0046) dimensions of QoL. Conclusions Elderly Han Chinese adults with moderately impaired renal filtration could manifest cognitive deficits in orientation to time, calculation, and impaired quality of life in physical role functioning.
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Affiliation(s)
- Sheng-Feng Lin
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yen-Chun Fan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Tung Kuo
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- * E-mail:
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Xia F, Hao W, Liang J, Wu Y, Yu F, Hu W, Zhao Z, Liu W. Applicability of Creatinine-based equations for estimating glomerular filtration rate in elderly Chinese patients. BMC Geriatr 2021; 21:481. [PMID: 34481470 PMCID: PMC8418712 DOI: 10.1186/s12877-021-02428-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/22/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The accuracy of the estimated glomerular filter rate (eGFR) in elderly patients is debatable. In 2020, a new creatinine-based equation by European Kidney Function Consortium (EKFC) was applied to all age groups. The objective of this study was to assess the appropriateness of the new EKFC equation with Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Lund-Malmö Revised (LMR), Berlin Initiative Study 1 (BIS1), and full age spectrum (FAS) equations based on serum creatinine (SCR) for elderly Chinese patients. METHODS A total of 612 elderly patients with a measured glomerular filtration rate (mGFR) by the dual plasma sample clearance method with Technetium-99 m-diethylenetriamine-pentaacetic acid (Tc-99 m-DTPA) were divided into four subgroups based on age, sex, mGFR, and whether combined with diabetes. The performance of GFR was assessed while considering bias, precision, accuracy, and root-mean-square error (RMSE). Bland-Altman plots, concordance correlation coefficients (CCCs), and correlation coefficients were applied to evaluate the validity of eGFR. RESULTS The median age of the 612 participants was 73 years, and 386 (63.1%) were male. Referring to mGFR (42.1 ml/min/1.73 m2), the CKD-EPI, LMR, BIS1, FAS, and EKFC equations estimated GFR at 44.4, 41.1, 43.6, 41.8 and 41.9 ml/min/1.73 m2, respectively. Overall, the smallest bias was found for the BIS1 equation (- 0.050 vs. range - 3.015 to 0.795, P<0.05, vs. the CKD-EPI equation). Regarding P30, interquartile range (IQR), RMSE, and GFR category misclassification, the BIS1 equation generally performed more accurately than the other eqs. (73.9%, 12.7, 12.9, and 35.3%, respectively). Nevertheless, no equation achieved optimal performance for the mGFR≥60 ml/min/1.73 m2 subgroup. Bland-Altman analysis showed the smallest mean difference (- 0.3 ml/min/1.73 m2) for the BIS1 equation when compared to the other equations. CONCLUSIONS This study suggested that the BIS1 equation was the most applicable for estimating GFR in Chinese elderly patients with moderate to severe renal impairment.
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Affiliation(s)
- Fangxiao Xia
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Wenke Hao
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Jinxiu Liang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Yanhua Wu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Feng Yu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Wenxue Hu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Zhi Zhao
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Wei Liu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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Hu J, Xu X, Zhang K, Li Y, Zheng J, Chen W, Wang X. Comparison of estimated glomerular filtration rates in Chinese patients with chronic kidney disease among serum creatinine-, cystatin-C- and creatinine-cystatin-C-based equations: A retrospective cross-sectional study. Clin Chim Acta 2020; 505:34-42. [DOI: 10.1016/j.cca.2020.01.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/24/2020] [Accepted: 01/31/2020] [Indexed: 12/17/2022]
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Han Q, Zhang D, Zhao Y, Liu L, Li J, Zhang F, Luan F, Duan J, Liu Z, Cai G, Chen X, Zhu H. The practicality of different eGFR equations in centenarians and near-centenarians: which equation should we choose? PeerJ 2020; 8:e8636. [PMID: 32117641 PMCID: PMC7039118 DOI: 10.7717/peerj.8636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/26/2020] [Indexed: 11/20/2022] Open
Abstract
Background No studies have examined the practicality of the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) and Berlin Initiative Study 1 (BIS1) equations for the estimated glomerular filtration rate (eGFR) in a large sample of centenarians. We aim to investigate the differences among the equations and suggest the most suitable equation for centenarians and near-centenarians. Methods A total of 966 centenarians and 787 near-centenarians were enrolled, and the eGFR was calculated using the three equations mentioned above. Agreement among the equations was investigated with the κ statistic and Bland-Altman plots. Sources of discrepancy were investigated using a partial correlation analysis. Results The three equations for assessing eGFR are not considered interchangeable in centenarians and near-centenarians. Δ(MDRD, CKD-EPI) and Δ(MDRD, BIS1) increased with age, but Δ(CKD-EPI, BIS1) was relatively stable with age. Δ(MDRD, CKD-EPI) and Δ(MDRD, BIS1) were considerable in subjects with Scr levels less than 0.7 mg/dL and decreased with the Scr level. A considerable difference between CKD-EPI and BIS1 was observed for participants with Scr levels ranging from 0.5 to 1.5 mg/dL. This difference increased with Scr levels ranging from 0.5 to 0.7 mg/dL, was relatively stable for Scr levels ranging from 0.7 to 0.9 mg/dL, and decreased with Scr levels ranging from 0.9 to 1.5 mg/dL. The differences in the three comparisons were all greater in women than in men (p < 0.05). Conclusions We tend to suggest the MDRD equation to calculate the glomerular filtration rate (GFR) in elderly individuals >95 years old who have no risk factors for cardiovascular disease; the BIS1 equation to calculate the eGFR for elderly individuals younger than 94 years old who have risk factors for cardiovascular disease; the CKD-EPI equation to calculate the eGFR of elderly individuals with Scr levels greater than 1.5 mg/dL; and the BIS1 equation to calculate the eGFR of older women with Scr levels less than 0.7 mg/dL.
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Affiliation(s)
- Qiuxia Han
- Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China.,School of Medicine, Nankai University, Tianjin, China.,The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology of Zhengzhou University, Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Dong Zhang
- Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Yali Zhao
- Central Laboratory, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Liang Liu
- Management Department, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Jing Li
- Management Department, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Fu Zhang
- Management Department, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Fuxin Luan
- Management Department, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Jiayu Duan
- The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology of Zhengzhou University, Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Zhangsuo Liu
- The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology of Zhengzhou University, Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Guangyan Cai
- Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Xiangmei Chen
- Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Hanyu Zhu
- Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
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Chen A, Sun Y, Li W, Yang J, Yao Z, Shi L, Jia J. Application of GFR estimation equations in elderly patients with measured GFR below 60 mL/min/1.73 m 2. Aging Clin Exp Res 2020; 32:415-22. [PMID: 31115878 DOI: 10.1007/s40520-019-01218-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) equations can be inaccurate when applied to elderly patients. Newly, the full-age-spectrum (FAS) equation was developed for use in elderly patients. AIM We compared the available eGFR equations in elderly Chinese patients with mGFRs < 60 mL/min/1.73 m2. METHODS Measured glomerular filtration rates (mGFRs) were obtained using 99mTc-DTPA (diethylene-triamine-pentaacetic acid) scans, 220 patients ≥ 80 years with mGFRs < 60 mL/min/1.73 m2 were enrolled. Serum creatinine (SCr) levels were measured simultaneously, and eGFRs based on SCr were calculated using four formulas: the modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration (CKD-EPI-SCr), Berlin initiative study (BIS1), and the FAS-SCr equations. RESULTS All the equations tended to overestimate GFR. The FAS-SCr equation provided the least bias (1.84), the highest proportion of eGFR within 30% of mGFR (P30, 72.7%), the bias and P30 of the BIS1 equation were 3.45 and 72.3%, respectively. In patients with mGFRs of 30-60 mL/min/1.73 m2, the BIS1 and FAS-SCr equations demonstrated better performances than the MDRD and CKD-EPI-SCr equations. While in patients with mGFR < 30 mL/min/1.73 m2, the accuracy of all equations was poor. DISCUSSION In older patients with mGFRs of 30-60 mL/min/1.73 m2, the BIS1 and the FAS-SCr equations exhibited good performance, none of the equations based on SCr were suitable for older subjects with mGFRs < 30 mL/min/1.73 m2. CONCLUSIONS The BIS1 and FAS-SCr equations may be optimal for older patients with moderately reduced kidney function.
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Porrini E, Ruggenenti P, Luis-Lima S, Carrara F, Jiménez A, de Vries APJ, Torres A, Gaspari F, Remuzzi G. Estimated GFR: time for a critical appraisal. Nat Rev Nephrol 2019; 15:177-90. [PMID: 30518813 DOI: 10.1038/s41581-018-0080-9] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Since 1957, over 70 equations based on creatinine and/or cystatin C levels have been developed to estimate glomerular filtration rate (GFR). However, whether these equations accurately reflect renal function is debated. In this Perspectives article, we discuss >70 studies that compared estimated GFR (eGFR) with measured GFR (mGFR), involving ~40,000 renal transplant recipients and patients with chronic kidney disease (CKD), type 2 diabetes mellitus or polycystic kidney disease. Their results show that eGFR often differed from mGFR by ±30% or more, that eGFR values incorrectly staged CKD in 30-60% of patients, and that eGFR and mGFR gave different rates of GFR decline. Errors were unpredictable, and comparable for equations based on creatinine and/or cystatin C. We argue, therefore, that the persistence of these errors (despite intensive research) suggests that the problem lies with using creatinine and/or cystatin C as markers of renal function, rather than with the mathematical methods used for GFR estimation.
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Cai K, Chai L, Luo Q, Dai Z, Wu L, Hong Y. Full age spectrum equation versus CKD-EPI and MDRD equations to estimate glomerular filtration rate in adults with obstructive nephropathy. J Int Med Res 2019; 47:2394-2403. [PMID: 30991866 PMCID: PMC6567694 DOI: 10.1177/0300060519840564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To compare the full age spectrum (FAS) equation with the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in predicting glomerular filtration rate (GFR) in patients with obstructive nephropathy. Methods Adult patients with obstructive nephropathy who had undergone a GFR measurement using technetium-99m diethylenetriaminepentaacetic acid radioisotope renography were enrolled in the study. The measured GFR was taken as the reference value. Bias, precision and accuracy were compared between the three equations. Kappa test and the Bland–Altman method were used to evaluate the classification and the agreement. Receiver operating characteristic (ROC) curve analysis was used to describe the diagnostic accuracy of each equation. Results A total of 327 patients were enrolled. The P30 value for the FAS equation was 60.2% in the overall study cohort. The FAS equation had the highest diagnostic accuracy (ROCAUC = 0.87, 95% confidence interval [CI] 0.84, 0.91) compared with the MDRD equation (ROCAUC = 0.86, 95% CI 0.82, 0.89). The median bias of the FAS equation was significantly higher than that of the MDRD equation (8.7 versus 7.6 ml/min/1.73 m2, respectively). Conclusions Despite the drawbacks associated with each equation, the FAS equation was probably closer to ideal to estimate GFR in patients with obstructive nephropathy.
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Affiliation(s)
- Kedan Cai
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang Province, China
| | - Lingxiong Chai
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang Province, China
| | - Qun Luo
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang Province, China
| | - Zhiwei Dai
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang Province, China
| | - Lingping Wu
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang Province, China
| | - Yue Hong
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang Province, China
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Han QX, Zhang D, Zhao YL, Liu L, Li J, Zhang F, Luan FX, Duan JY, Liu ZS, Cai GY, Chen XM, Zhu HY. Analysis of chronic kidney disease staging with different estimated glomerular filtration rate equations in Chinese centenarians. Chin Med J (Engl) 2019; 132:512-8. [PMID: 30741827 DOI: 10.1097/CM9.0000000000000079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Accurate estimation of the glomerular filtration rate (GFR) and staging of chronic kidney disease (CKD) are important. Currently, there is no research on the differences in several estimated GFR equations for staging CKD in a large sample of centenarians. Thus, this study aimed to investigate the differences in CKD staging with the most commonly used equations and to analyze sources of discrepancy. Methods: A total of 966 centenarians were enrolled in this study from June 2014 to December 2016 in Hainan province, China. The GFR with the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Berlin Initiative Study 1 (BIS1) equations were estimated. Agreement between these equations was investigated with the κ statistic and Bland-Altman plots. Sources of discrepancy were investigated by partial correlation analysis. Results: The κ values of the MDRD and CKD-EPI equations, MDRD and BIS1 equations, and CKD-EPI and BIS1 equations were 0.610, 0.253, and 0.381, respectively. Serum creatinine (Scr) explained 10.96%, 41.60% and 17.06% of the variability in these three comparisons, respectively. Serum uric acid (SUA) explained 3.65% and 5.43% of the variability in the first 2 comparisons, respectively. Gender was associated with significant differences in these 3 comparisons (P < 0.001). Conclusions: The strengths of agreement between the MDRD and CKD-EPI equations were substantial, but those between the MDRD and BIS1 equations and the CKD-EPI and BIS1 equations were fair. The difference in CKD staging of the first 2 comparisons strongly depended on Scr, SUA and gender, and that of CKD-EPI and BIS1 equations strongly depended on Scr and gender. The incidence at various stages of CKD staging was quite different. Thus, a new equation that is more suitable for the elderly needs to be built in the future.
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Guan C, Liang M, Liu R, Qin S, He F, Li J, Zhu X, Dai H, Fu J. Assessment of creatinine and cystatin C-based eGFR equations in Chinese older adults with chronic kidney disease. Int Urol Nephrol 2018; 50:2229-2238. [DOI: 10.1007/s11255-018-1909-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/06/2018] [Indexed: 11/24/2022]
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Oscanoa TJ, Amado JP, Romero-Ortuno R, Hidalgo JA. Estimation of the glomerular filtration rate in older individuals with serum creatinine-based equations: A systematic comparison between CKD-EPI and BIS1. Arch Gerontol Geriatr 2017; 75:139-145. [PMID: 29304508 DOI: 10.1016/j.archger.2017.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/23/2017] [Accepted: 12/15/2017] [Indexed: 11/17/2022]
Abstract
AIM CKD-EPIcr (Chronic Kidney Disease Epidemiology Collaboration creatinine) and BIS1 (Berlin Initiative Study) are two serum creatinine-based formulae for the estimation of glomerular filtration rate (GFR). However, their comparative accuracy in older people has not been well established. Our aim was to conduct a systematic comparative study of the accuracy of estimation of GFR in older people with these two formulae. METHODS We conducted a systematic search in Pubmed, EMBASE and Central databases on the validity of the CKD-EPIcr and BIS1 formulae in people aged 60 or more years. The search ranged from 2009 and 2012 for CKD-EPIcr and BIS1, respectively, until May 2017. The validity criterion for comparing the formulae was to have a P30 accuracy level equal to or greater than 80%. RESULTS Of 1295 identified studies, 16 met our inclusion criteria. Out of 16 studies reporting the accuracy of the CKD-EPIcr formula, only 5 (31.3%) had P30 scores ≥80% (mean P30 was 77.1 ± 7.711 range 55.5-91.7), and out of 9 studies on accuracy using the BIS1 formula, 6 (66.7%) were ≥80% (mean P30 was 83.88 ± 9.37, range 67.0-95.8). CONCLUSION Our results suggest that for the estimation of the GFR in older people, BIS1 formula may be more accurate than CKD-EPIcr.
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Affiliation(s)
- Teodoro J Oscanoa
- Centro de Investigación de Seguridad de Medicamentos de la Facultad de Medicina de la Universidad de San Martín de Porres, Internal Medicine Department, Hospital Almenara ESSALUD, Lima. Av. Grau 800, La Victoria, Lima -13, Peru.
| | - José P Amado
- Facultad de Medicina de la Universidad Nacional Mayor de San Marcos, Av Grau 755, Distrito de Lima 15001, Lima, Peru.
| | - Roman Romero-Ortuno
- Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom.
| | - José A Hidalgo
- Internal Medicine Department, Hospital Almenara ESSALUD, Lima. Av. Grau 800, La Victoria, Lima -13, Peru.
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Bevc S, Hojs N, Hojs R, Ekart R, Gorenjak M, Puklavec L. Estimation of Glomerular Filtration Rate in Elderly Chronic Kidney Disease Patients: Comparison of Three Novel Sophisticated Equations and Simple Cystatin C Equation. Ther Apher Dial 2017; 21:126-132. [DOI: 10.1111/1744-9987.12523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/07/2016] [Accepted: 12/06/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Sebastjan Bevc
- Department of Nephrology, Clinic for Internal Medicine; University Clinical Centre Maribor; Maribor Slovenia
- Faculty of Medicine; University of Maribor; Maribor Slovenia
| | - Nina Hojs
- Department of Nephrology, Clinic for Internal Medicine; University Clinical Centre Maribor; Maribor Slovenia
| | - Radovan Hojs
- Department of Nephrology, Clinic for Internal Medicine; University Clinical Centre Maribor; Maribor Slovenia
- Faculty of Medicine; University of Maribor; Maribor Slovenia
| | - Robert Ekart
- Department of Dialysis, Clinic for Internal Medicine; University Clinical Centre Maribor; Maribor Slovenia
- Faculty of Medicine; University of Maribor; Maribor Slovenia
| | - Maksimiljan Gorenjak
- Department of Nuclear Medicine, Clinic for Internal Medicine; University Clinical Centre Maribor; Maribor Slovenia
| | - Ludvik Puklavec
- Department of Clinical Chemistry; University Clinical Centre Maribor; Maribor Slovenia
- Faculty of Medicine; University of Maribor; Maribor Slovenia
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