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Title: The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation does not improve the underestimation of Glomerular Filtration Rate (GFR) in people with diabetes and preserved renal function.
Authors: MacIsaac, Richard J;Ekinci, Elif I;Premaratne, Erosha;Lu, Zhong X;Seah, Jas-Mine;Li, Yue;Boston, Ray;Ward, Glenn M;Jerums, George
Affiliation: Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia
Endocrine Centre, Heidelberg Repatriation Hospital, Austin Health, Heidelberg West, Victoria, Australia
Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia
Menzies School of Health Research, Casuarina, 0811, Northern Territory, Australia
Department of Medicine, Austin Health, University of Melbourne, Heidelberg, 3084, Victoria, Australia
Melbourne Pathology, Collingwood, 3066, Victoria, Australia
Clinical Chemistry, St Vincent's Hospital Melbourne, Fitzroy, 3065, Victoria, Australia
Issue Date: 3-Dec-2015
EDate: 2015-12-03
Citation: BMC nephrology 2015; 16: 198
Abstract: Our hypothesis was that both the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations would underestimate directly measured GFR (mGFR) to a similar extent in people with diabetes and preserved renal function. In a cross-sectional study, bias (eGFR - mGFR) was compared for the CKD-EPI and MDRD equations, after stratification for mGFR levels. We also examined the ability of the CKD-EPI compared with the MDRD equation to correctly classify subjects to various CKD stages. In a longitudinal study of subjects with an early decline in GFR i.e., initial mGFR > 60 ml/min/1.73 m(2) and rate of decline in GFR (ΔmGFR) > 3.3 ml/min/1.73 m(2) per year, ΔmGFR (based on initial and final values) was compared with ΔeGFR by the CKD-EPI and MDRD equations over a mean of 9 years. In the cross-sectional study, mGFR for the whole group was 80 ± 2.2 ml/min/1.73 m(2) (n = 199, 75 % type 2 diabetes). For subjects with mGFR >90 ml/min/1.73 m(2) (mGFR: 112 ± 2.0, n = 76), both equations significantly underestimated mGFR to a similar extent: bias for CKD-EPI: -12 ± 1.4 ml/min/1.73 m(2) (p < 0.001) and for MDRD: -11 ± 2.1 ml/min/1.73 m(2) (p < 0.001). Using the CKD-EPI compared with the MDRD equation did not improve the number of subjects that were correctly classified to a CKD-stage. No biochemical or clinical patient characteristics were identified to account for the under estimation of mGFR values in the normal to high range by the CKD-EPI equation. In the longitudinal study (n = 30, 66 % type 1 diabetes), initial and final mGFR values were 102.8 ± 6 and 54.6 ± 6.0 ml/min/1.73 m(2), respectively. Mean ΔGFR (ml/min/1.73 m(2) per year) was 6.0 by mGFR compared with only 3.0 by MDRD and 3.2 by CKD-EPI (both p < 0.05 vs mGFR) CONCLUSIONS: Both the CKD-EPI and MDRD equations underestimate reference GFR values > 90 ml/min/1.73 m(2) as well as an early decline in GFR to a similar extent in people with diabetes. There is scope to improve methods for estimating an early decline in GFR.
DOI: 10.1186/s12882-015-0196-0
ORCID: 0000-0003-2372-395X
PubMed URL: 26630928
Type: Journal Article
Appears in Collections:Journal articles

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