TY - JOUR

T1 - CKD-EPI and EKFC GFR Estimating Equations

T2 - Performance and Other Considerations for Selecting Equations for Implementation in Adults

AU - Inker, Lesley A.

AU - Tighiouart, Hocine

AU - Adingwupu, Ogechi M.

AU - Shlipak, Michael G.

AU - Doria, Alessandro

AU - Estrella, Michelle M.

AU - Froissart, Marc

AU - Gudnason, Vilmundur

AU - Grubb, Anders

AU - Kalil, Roberto

AU - Mauer, Michael

AU - Rossing, Peter

AU - Seegmiller, Jesse

AU - Coresh, Josef

AU - Levey, Andrew S.

N1 - Publisher Copyright: Copyright © 2023 by the American Society of Nephrology.

PY - 2023

Y1 - 2023

N2 - Background New CKD-EPI and EKFC eGFR equations using eGFRcr, eGFRcys, and both (eGFRcr-cys) have sufficient accuracy for use in clinical practice. A better understanding of the equations, including their performance in race, sex and age subgroups, is important for selection of eGFR equations for global implementation. Methods We evaluated performance (bias and P30) of equations and methods used for equation development in an independent study population comprising 4050 adults pooled from 12 studies. The mean (SD) measured GFR was 76.4 (29.6) ml/min per 1.73 m2 and age 57.0 (17.4) years, with 1557 (38%) women and 579 (14%) Black participants. Results Coefficients for creatinine, cystatin C, age, and sex in the CKD-EPI and EKFC equations are similar. Performance of the eGFRcr-cys equations in the overall population (bias,65 ml/min per 1.73 m2 and P30 .90%) was better than the eGFRcr or eGFRcys equations, with fewer differences among race, sex, and age subgroups. Differences in performance across subgroups reflected differences in diversity of source populations and use of variables for race and sex for equation development. Larger differences among eGFRcr equations reflected regional population differences in non-GFR determinants of creatinine. Conclusion CKD-EPI and EKFC equations are approaching convergence. It is not possible to maximize both accuracy and uniformity in selecting one of the currently available eGFRcr equations for implementation across regions. Decisions should consider methods for equation development in addition to performance. Wider use of cystatin C with creatinine could maximize both accuracy and uniformity of GFR estimation using currently available equations.

AB - Background New CKD-EPI and EKFC eGFR equations using eGFRcr, eGFRcys, and both (eGFRcr-cys) have sufficient accuracy for use in clinical practice. A better understanding of the equations, including their performance in race, sex and age subgroups, is important for selection of eGFR equations for global implementation. Methods We evaluated performance (bias and P30) of equations and methods used for equation development in an independent study population comprising 4050 adults pooled from 12 studies. The mean (SD) measured GFR was 76.4 (29.6) ml/min per 1.73 m2 and age 57.0 (17.4) years, with 1557 (38%) women and 579 (14%) Black participants. Results Coefficients for creatinine, cystatin C, age, and sex in the CKD-EPI and EKFC equations are similar. Performance of the eGFRcr-cys equations in the overall population (bias,65 ml/min per 1.73 m2 and P30 .90%) was better than the eGFRcr or eGFRcys equations, with fewer differences among race, sex, and age subgroups. Differences in performance across subgroups reflected differences in diversity of source populations and use of variables for race and sex for equation development. Larger differences among eGFRcr equations reflected regional population differences in non-GFR determinants of creatinine. Conclusion CKD-EPI and EKFC equations are approaching convergence. It is not possible to maximize both accuracy and uniformity in selecting one of the currently available eGFRcr equations for implementation across regions. Decisions should consider methods for equation development in addition to performance. Wider use of cystatin C with creatinine could maximize both accuracy and uniformity of GFR estimation using currently available equations.

U2 - 10.1681/ASN.0000000000000227

DO - 10.1681/ASN.0000000000000227

M3 - Journal article

C2 - 37796982

AN - SCOPUS:85178652052

VL - 34

SP - 1953

EP - 1964

JO - Journal of the American Society of Nephrology : JASN

JF - Journal of the American Society of Nephrology : JASN

SN - 1046-6673

IS - 12

ER -