Performance of the CKD-EPI and MDRD equations to estimate the glomerular filtration rate: a systematic review of Latin American studies

2020 ◽  
Author(s):  
Ana Brañez-Condorena ◽  
Sergio Goicochea-Lugo ◽  
Jessica Hanae Zafra-Tanaka ◽  
Naysha Becerra-Chauca ◽  
Virgilio E Failoc-Rojas ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Sensitivity And Specificity ◽  
Latin American ◽  
Filtration Rate ◽  
Data Extraction ◽  
Isotope Dilution Mass Spectrometry ◽  
Grade Methodology ◽  
Meta Analyses ◽  
Latin American Countries

Abstract BackgroundMost commonly used equations to estimate the glomerular filtration rate (GFR) are the CKD-Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD). However, it is not clear which one shows a better performance in Latin America. Objective To assess the performance of both estimated GFR (eGFR) equations in Latin American countries. Methods In January 2019, we performed a systematic search in PubMed, Scopus, and “Biblioteca Regional de Medicina” (BIREME) to identify studies that reported eGFR using CKD-EPI and MDRD equations and compared them with a measured GFR (mGFR) using exogenous filtration markers, among adults from Latin American countries. Study selection, data extraction, and risk of bias evaluation were performed by two reviewers independently. We performed meta-analyses of P30, bias (using mean difference [MD] and its 95% confidence intervals [95% CI]), sensitivity, and specificity; and evaluated certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results We included 12 papers, six of them were meta-analyzed (5 from Brazil and 1 from Mexico). Meta-analyses that compared CKD-EPI using creatinine measured with calibration traceable to isotope dilution mass spectrometry (CKD-EPI-Cr IDMS) and MDRD-4 IDMS did not show statistically significant differences in bias (5 studies, MD: 0.55 mL/min/1.73m 2 , 95% CI: -3.34 to 4.44), P30 (2 studies, MD: 4%, 95% CI: -4% to 13%), sensitivity (2 studies, 76% and 75%), and specificity (2 studies, 91% and 89%), with very low certainty of evidence for bias and P30, and low certainty of evidence for sensitivity and specificity. Conclusions We found that the performance of CKD-EPI-Cr IDMS and MDRD-4 IDMS do not differ significantly, although CKD-EPI-Cr IDMS tends to have a non-significant better performance in terms of P30. However, since most of the meta-analyzed studies were from Brazil, results may not be extrapolated to other Latin American countries. Trial registration CRD42019123434, PROSPERO. Registered 18 February 2019.

scholarly journals Long-term Prognostic Value for Patients with Chronic Heart Failure of Estimated Glomerular Filtration Rate Calculated with the New CKD-EPI Equations Containing Cystatin C

2014 ◽  
Vol 60 (3) ◽  
pp. 481-489 ◽  
Author(s):  
Elisabet Zamora ◽  
Josep Lupón ◽  
Marta de Antonio ◽  
Joan Vila ◽  
Judith Peñafiel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Prognostic Value ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Isotope Dilution Mass Spectrometry ◽  
Intraclass Correlation ◽  
Net Reclassification Improvement

Abstract BACKGROUND Correct estimation of renal function is crucial in assessing prognosis of patients with heart failure (HF). Recently, two new equations have been proposed to calculate estimated glomerular filtration rate (eGFR) with cystatin C alone or both creatinine and cystatin C. We assessed the prognostic value of eGFR estimated by these new equations in outpatients with HF. METHODS The study included 879 patients with median age, 70.4 years; main etiology of HF ischemic heart disease, 52.7%; and median LVEF, 34%. RESULTS eGFR estimates by the new equations correlated significantly with eGFR estimates from previous equations, with the best correlation observed between the 2 equations containing cystatin C [intraclass correlation coefficient 0.95 (95% confidence interval 0.94–0.95)]. During a median follow-up of 3.94 years, 371 patients died. The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equations containing cystatin C were found to be best for predicting death [area under the ROC curve 0.685 for CKD-EPI-cystatin C and 0.672 for CKD-EPI-creatinine-cystatin C vs 0.632 for simplified Modification of Diet in Renal Disease Study traceable to isotope dilution mass spectrometry and 0.643 for CKD-EPI (all P < 0.001)]. The CKD-EPI-cystatin C equations also showed significantly better calibration and reclassification measurements for both integrated discrimination improvement and net reclassification improvement in predicting death (P < 0.001). Reclassification with these new equations was particularly better in the subgroup with intermediate eGFR [45–74 mL · min−1 · (1.73 m2)−1]. CONCLUSIONS The two new CKD-EPI equations containing cystatin C are useful for HF risk stratification and show better prognostic performance than creatinine-only based eGFR equations, mostly in patients with intermediate eGFR. These equations seem appropriate for assessing prognosis of HF patients with moderate renal insufficiency.

scholarly journals Renal Function - Estimation of Glomerular Filtration Rate

2007 ◽  
Vol 26 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Marijana Dajak ◽  
Svetlana Ignjatović ◽  
Nada Majkić-Singh
Keyword(s):  
Mass Spectrometry ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Renal Disease ◽  
Glomerular Filtration ◽  
Isotope Dilution ◽  
Filtration Rate ◽  
Isotope Dilution Mass Spectrometry ◽  
Function Estimation

Funkcija Bubrega - Procena Brzine Glomerularne Filtracije Brzina glomerularne filtracije (GFR) je široko prihvaćena kao najbolja opšta mera funkcije bubrega. Vodiči američke Nacionalne fondacije za bubreg definišu hroničnu bubrežnu bolest (HBB) bilo sa vrednošću GFR koja je manja od 60 mL/min/1,73 m2 ili sa prisustvom oštećenja bubrega, bez obzira na uzrok, u toku 3 ili više meseci i klasifikuju stadijume težine HBB prema GFR. GFR se može meriti kao urinarni ili plazma klirens egzogenih filtracionih markera kao što je inulin. Međutim, zbog teškoća u primeni, troškova i radijacionog izlaganja, ove metode imaju ograničenu upotrebu u rutinskim laboratorijama. Klirens kreatinina može biti korisna alternativa kada egzogeni markeri nisu dostupni, ali sakupljanje urina u vremenskim intervalima nije pogodno za pacijente i osetljivo je na grešku pri sakupljanju. GFR se često procenjuje klinički iz serumskih koncentracija egzogenog kreatinina ili cistatina C. Cistatin C u serumu još uvek nije adekvatno procenjen kao indeks GFR, a na kreatinin u serumu utiču GFR i faktori nezavisni od GFR, uključujući godine, pol, rasu, telesnu veličinu, ishranu, izvesne lekove i laboratorijske analitičke metode. Prema kliničkim vodičima Nacionalne fondacije za bubreg, kliničke laboratorije bi trebalo da izdaju >>procenjenu<< GFR (estimated GFR), izračunatu iz prediktivnih jednačina, kao dodatak izveštavanja vrednosti markera u serumu. Trenutno preporučena jednačina za procenu je razvijena iz MDRD (Modification of Diet in Renal Disease) studije. Ova jednačina koristi godine, pol, rasu (afro-američka prema ne-afro-američkoj) i koncentraciju kreatinina u serumu, a ne zahteva varijablu za telesnu težinu zato što normalizuje GFR za standardnu telesnu površinu od 1,73 m2. Da bi se postigla poboljšana tačnost preračunate GFR sa ovom jednačinom, preporučuje se da komercijalne metode za kreatinin budu kalibrisane prema sertifikovanim referentnim materijalima i sledljive sa IDMS (isotope dilution mass spectrometry) metodologijom. Za MDRD jednačinu je pokazano da je korisna za pacijente sa HBB, ali njena upotreba je još uvek nejasna za ljude sa niskim vrednostima kreatinina u serumu i visokim vrednostima za GFR, uključujući zdrave pojedince, decu i trudnice. Validacione studije su u razvoju kako bi se procenila MDRD jednačina za druge etničke grupe i različita bolesna stanja.

Estimated GFR Derived From Plasma Creatinine by Mass Spectrometry (MSMS) Is A Reliable Measure of Renal Function During the Hyperfiltration Phase In Sickle Cell Disease (SCD)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2649-2649
Author(s):  
Baba Inusa ◽  
Caroline Booth ◽  
Charles Turner ◽  
Helen Appleby ◽  
Giselle Padmore-Penniston ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Glomerular Filtration Rate ◽  
Stable Isotope ◽  
Glomerular Filtration ◽  
Isotope Dilution ◽  
Filtration Rate ◽  
Isotope Dilution Mass Spectrometry ◽  
Plasma Creatinine ◽  
Reliable Measure ◽  
Stable Isotope Dilution

Abstract Abstract 2649 Aim: The hypothesis is that a height based eGFR formula using creatinine measured by mass spectrometry is a reliable measure of GFR in children with SCD. Background: The kidney is a particularly sensitive to hypoxia and renal failure is a major cause of morbidity and mortality in SCD. Children with SCD commonly hyper filtrate, thus making it difficult to establish a reliable Glomerular Filtration Rate (GFR) measure. It is essential to correctly assess the GFR, in order to identify when it begins to fall back towards normal and then starts to decline. Reporting of estimated glomerular filtration rate (eGFR) derived from plasma creatinine (pCr) measurements is now recommended for the classification and monitoring of patients with chronic kidney disease. The new MDRD formula requires the use of pCr methods traceable to stable isotope dilution mass spectrometry (MS). In children the recommendation is to use one of the formulae based on height (Ht), e.g. Schwartz et al1, Morris et al2, both of which were derived using traditional Jaffe creatinine methodology; eGFR = 40 × Ht (cm)/pCr (μmol/l). The introduction of MS traceable creatinine methods requires a review of the k factor. This correlation has never been validated in hyper filtration/or children with SCD. Methods: 43 HbSS patients, age range 5–20yrs, attending the Evelina Children's Hospital were studied, including transfused and non-transfused patients. The plasma samples were also used for the measurement of plasma creatinine by stable isotope dilution mass spectrometry. eGFR was calculated using k=31. Results: Inutest GFR ranged from 70–175 ml/min/1.73m2. There was significant correlation between eGFR and inutest GFR (P<0.01, r=0.68). Conclusions: These preliminary data suggest that eGFR should prove valuable in monitoring GFR in children with SCD, even during hyper filtration, providing the constant is appropriately adjusted for the analytical method of creatinine. Disclosures: Inusa: Novartis: Research Funding.

scholarly journals Performance of the CKD-EPI and MDRD equations for estimating glomerular filtration rate: a systematic review of Latin American studies

2021 ◽  
Vol 139 (5) ◽  
pp. 452-463
Author(s):  
Ana Brañez-Condorena ◽  
Sergio Goicochea-Lugo ◽  
Jessica Hanae Zafra-Tanaka ◽  
Naysha Becerra-Chauca ◽  
Virgilio Efrain Failoc-Rojas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Latin American ◽  
Filtration Rate ◽  
American Studies ◽  
Latin American Studies

scholarly journals Cystatin C: An Improved Estimator of Glomerular Filtration Rate?

2002 ◽  
Vol 48 (5) ◽  
pp. 699-707 ◽  
Author(s):  
Omar F Laterza ◽  
Christopher P Price ◽  
Mitchell G Scott
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Sensitivity And Specificity ◽  
Cystatin C ◽  
Filtration Rate ◽  
Reference Interval ◽  
Interval Data ◽  
Serum Markers ◽  
Reference Intervals ◽  
Specific Patient

Abstract Background: Glomerular filtration rate (GFR) is routinely assessed by measuring the concentrations of endogenous serum markers such as blood urea nitrogen and serum creatinine (SCr). Although widely used, these endogenous markers are not ideal and do not perform optimally in certain clinical settings. The purpose of this review is to critically review the potential utility of cystatin C (CysC), especially in patient populations in which CysC may have an advantage over routinely used endogenous markers of GFR. Approach: In a narrative approach, we extensively review publications, primarily from the last 5 years, that address the development of methods to measure CysC, reference intervals, and the diagnostic accuracy of CysC to assess GFR. Between June 2000 and September 2001 Medline was searched using “cystatin c” as a textword, and articles that examined &gt;75 individuals (except for renal transplant studies) and/or used accepted “gold standards” for assessing GFR were selected for inclusion. A total of 17 studies are reviewed that provide reference interval data for several populations. A total of 24 studies make conclusions about the utility of CysC vs SCr and/or creatinine clearance, with 20 providing data on the sensitivity and specificity of CysC for detecting impaired GFR. These publications are organized into subgroups that deal with specific patient populations or clinical situations. Content: This review focuses on two areas: (a) the evolution of immunoassays used to determine the concentration of CysC in serum, their analytic sensitivity, and reference intervals; and (b) the diagnostic performance of CysC against other renal markers in the general population and in specific subpopulations of patients. Summary: Studies of reference intervals for CysC overwhelmingly demonstrated that CysC values in blood are independent of age and sex. Of the 24 studies that examined clinical utility, 15 concluded that CysC is superior to SCr, whereas 9 concluded that CysC is equivalent but provides no advantage. Summary ROC plot analysis of 20 studies that provide sensitivity and specificity data strongly suggests that CysC will be superior to SCr for detecting impaired GFR. Taken together, it is clear that CysC performs at least as well as SCr in the population at large and that it is likely to be superior to SCr in specific patient populations.

scholarly journals Multicenter Validation of the CamGFR Model for Estimated Glomerular Filtration Rate

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Edward H Williams ◽  
Claire M Connell ◽  
James M J Weaver ◽  
Ian Beh ◽  
Harry Potts ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Mean Squared Error ◽  
Isotope Dilution Mass Spectrometry ◽  
Patients With Cancer ◽  
Squared Error

Abstract Important oncological management decisions rely on kidney function assessed by serum creatinine–based estimated glomerular filtration rate (eGFR). However, no large-scale multicenter comparisons of methods to determine eGFR in patients with cancer are available. To compare the performance of formulas for eGFR based on routine clinical parameters and serum creatinine not calibrated with isotope dilution mass spectrometry, we studied 3620 patients with cancer and 166 without cancer who had their glomerular filtration rate (GFR) measured with an exogenous nuclear tracer at one of seven clinical centers. The mean measured GFR was 86 mL/min. Accuracy of all models was center dependent, reflecting intercenter variability of isotope dilution mass spectrometry–creatinine measurements. CamGFR was the most accurate model for eGFR (root-mean-squared error 17.3 mL/min) followed by the Chronic Kidney Disease Epidemiology Collaboration model (root-mean-squared error 18.2 mL/min).

scholarly journals The Glomerular Filtration Rate: From the Diagnosis of Kidney Function to a Public Health Tool

2021 ◽  
Vol 8 ◽  
Author(s):  
Ana Maria Cusumano ◽  
Carmen Tzanno-Martins ◽  
Guillermo Javier Rosa-Diez
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Urine Analysis ◽  
Demographic Data ◽  
Isotope Dilution Mass Spectrometry ◽  
Laboratory Data ◽  
Renal Physiology ◽  
Estimated Gfr

The prevalence of chronic kidney disease (CKD) continues to increase worldwide, as well as the associated morbidity and mortality and the consequences on the patients' quality of life and countries' economies. CKD often evolves without being recognized by patients and physicians, although the diagnosis is based on two simple laboratory data: the estimated glomerular filtration rate (eGFR) and urine analysis. To measure GFR, the knowledge about the physiologic processes at the nephron level, the concept of clearance, and the identification of creatinine as a suitable endogenous marker for measuring the creatinine clearance (CrCl) had to be previously developed. On those bases, different equations to calculate CrCl (Cockcroft and Gault, 1976), or estimated GFR (four variables MDRD, 1999; CKD-Epi, 2009, among others) were generated. They all include creatinine and some demographic data, such as sex and age. However, to compare results throughout life or among laboratories, the creatinine determination must be standardized. In addition, the accuracy of these equations remains controversial in certain subgroups of patients. For these reasons, other mathematical models to improve CrCl estimation have been developed, such as when urine cannot be collected, in debilitated elderly patients and patients with trauma, diabetes, or obesity. Currently, eGFR in adults can be measured and reported immediately, using isotope dilution mass spectrometry traceable creatinine-based equations. In conclusion, based on knowledge obtained from renal physiology, eGFR can be used in the clinic for the diagnosis and early treatment of CKD, as well as a public instrument to estimate the prevalence.

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