Standardization of serum creatinine is essential for accurate use of unbiased estimated GFR equations: evidence from three cohorts matched on renal function
[en] ABSTRACT
Background
Differences in the performance of estimated glomerular filtration rate (eGFR) equations have been attributed to the mathematical form of the equations and to differences between patient demographics and measurement methods. We evaluated differences in serum creatinine (SCr) and eGFR in cohorts matched for age, sex, body mass index (BMI) and measured GFR (mGFR).
Methods
White North Americans from Minnesota (n = 1093) and the Chronic Renal Insufficiency Cohort (CRIC) (n = 1548) and White subjects from the European Kidney Function Consortium (EKFC) cohort (n = 7727) were matched for demographic patient characteristics (sex, age ± 3 years, BMI ± 2.5 kg/m2) and renal function (mGFR ± 3 ml/min/1.73 m2). SCr was measured with isotope dilution mass spectrometry (IDMS)-traceable assays in the Minnesota and EKFC cohorts and with non-standardized SCr assays recalculated to IDMS in the CRIC. The Minnesota cohort and CRIC shared a common method to measure GFR (renal clearance of iothalamate), while the EKFC cohort used a variety of exogenous markers and methods, all with recognized sufficient accuracy. We compared the SCr levels and eGFR predictions [for Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and EKFC equations] of patients fulfilling these matching criteria.
Results
For 305 matched individuals, mean SCr (mg/dL) was not different between the Minnesota and EKFC cohorts (females 0.83 ± 0.20 versus 0.86 ± 0.23, males 1.06 ± 0.23 versus 1.12 ± 0.37; P > .05) but significantly different from the CRIC [females 1.13 ± 0.23 (P < .0001), males 1.42 ± 0.31 (P < .0001)]. The CKD-EPI equations performed better than the EKFC equation in the CRIC, while the opposite was true in the Minnesota and EKFC cohorts.
Conclusion
Significant differences in SCr concentrations between the Minnesota and EKFC cohorts versus CRIC were observed in subjects with the same level of mGFR and equal demographic characteristics and can be explained by the difference in SCr calibration.
Disciplines :
Urology & nephrology Laboratory medicine & medical technology
Author, co-author :
Pottel, Hans ; Université de Liège - ULiège > Département des sciences cliniques ; Department of Public Health and Primary Care , KU Leuven Campus Kulak Kortrijk, Kortrijk , Belgium
Cavalier, Etienne ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chimie clinique
Björk, Jonas ; Division of Occupational and Environmental Medicine, Lund University , Lund , Sweden ; Clinical Studies Sweden, Forum South, Skåne University Hospital , Lund , Sweden
Nyman, Ulf; Department of Translational Medicine, Division of Medical Radiology, Lund University , Malmö , Sweden
Grubb, Anders; Department of Clinical Chemistry, Skåne University Hospital , Lund , , Sweden ; Lund University , Lund , , Sweden
Ebert, Natalie ; Charité Universitätsmedizin Berlin, Institute of Public Health , Berlin , Germany
Schaeffner, Elke; Charité Universitätsmedizin Berlin, Institute of Public Health , Berlin , Germany
Eriksen, Björn O; Section of Nephrology, University Hospital of North Norway and Metabolic and Renal Research Group, UiT The Arctic University of Norway , Tromsö , Norway
Melsom, Toralf; Section of Nephrology, University Hospital of North Norway and Metabolic and Renal Research Group, UiT The Arctic University of Norway , Tromsö , Norway
Lamb, Edmund J; Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust , Canterbury , UK
Mariat, Christophe; Service de Néphrologie, Dialyse et Transplantation Rénale , Hôpital Nord, CHU de Saint-Etienne, France
Dubourg, Laurence; Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale , Hôpital Edouard Herriot, Hospices Civils de Lyon, France
Hansson, Magnus; Function area Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital Huddinge and Department of Laboratory Medicine, Karolinska Institute , Stockholm , Sweden
Littmann, Karin; Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institute , Huddinge, Sweden
Sundin, Per-Ola ; Department of Geriatrics, School of Medical Sciences, Örebro University , Örebro, Sweden
Åkesson, Anna; Division of Occupational and Environmental Medicine, Lund University , Lund , Sweden ; Clinical Studies Sweden, Forum South, Skåne University Hospital , Lund , Sweden
Larsson, Anders; Department of Medical Sciences, Clinical Chemistry, Uppsala University , Uppsala , Sweden
Rule, Andrew; Division of Nephrology and Hypertension, Mayo Clinic , Rochester, MN , USA
Delanaye, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie ; Department of Nephrology-Dialysis-Apheresis , Hôpital Universitaire Carémeau, Nîmes, France
Standardization of serum creatinine is essential for accurate use of unbiased estimated GFR equations: evidence from three cohorts matched on renal function
Delanaye P, Mariat C. The applicability of eGFR equations to different populations. Nat Rev Nephrol 2013;9:513 22
Jonsson AJ, Lund SH, Eriksen BO et al. The prevalence of chronic kidney disease in Iceland according to KDIGO criteria and age-Adapted estimated glomerular filtration rate thresholds. Kidney Int 2020;98:1286 95
Levey AS, Stevens LA, Schmid CH et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604 12
Inker LA, Eneanya ND, Coresh J et al. New creatinine-and cystatin C based equations to estimate GFR without race. N Engl J Med 2021;385:1737 49
Pottel H, Björk J, Courbebaisse M et al. Development and validation of a modified full age spectrum creatininebased equation to estimate glomerular filtration rate. A cross-sectional analysis of pooled data. Ann Intern Med 2021;174:183 91
PottelH, Delanaye P, Schaeffner ES et al. Estimating glomerular filtration rate for the full age spectrum from serum creatinine and cystatin C. Nephrol Dial Transplant 2017;32:497 507
White CA, Akbari A, Allen C et al. Simultaneous glomerular filtration rate determination using inulin, iohexol and 99mTc-DTPA demonstrates the need for customized measurement protocols. Kidney Int 2021;99:957 66
Delanaye P, Jouret F, Le Goff C et al. Concordance between iothalamate and iohexol plasma clearance. Am J Kidney Dis 2016;68:329 30
Delanaye P, Ebert N, Melsom T et al. Iohexol plasma clearance for measuring glomerular filtration rate in clinical practice and research: A review. Part 2: why to measure glomerular filtration rate with iohexol? Clin Kidney J 2016;9:682 99
Stolz A, Hoizey G, Toupance O et al. Evaluation of sample bias for measuring plasma iohexol clearance in kidney transplantation. Transplantation 2010;89:440 5
Delanaye P, Vidal-Petiot E, Stehlé T et al. Comparison of plasma clearance with early-compartment correction equations and urinary clearance in high glomerular filtration rate. Kidney Int Rep 2021;6:1622 8
Delanaye P, Cavalier E, Krzesinski J-M et al. Why the MDRD equation should not be used in patients with normal renal function (and normal creatinine values)? Clin Nephrol 2006;66:147 8
Delanaye P, Cavalier E, MaillardNet al. Creatinine calibration in NHANES: is a revised MDRD study formula needed? Am J Kidney Dis 2008;51:709 10
Delanaye P, Cohen E. Formula-based estimates of the GFR: equations variable and uncertain. Nephron Clin Pract 2008;110:c48 53
Delanaye P, Cavalier E, Chapelle JP et al. Importance of the creatinine calibration in the estimation of GFR by MDRD equation. Nephrol Dial Transplant 2006;21:1130
Selvin E, Manzi J, Stevens LA et al. Calibration of serum creatinine in the National Health and Nutrition Examination Surveys (NHANES) 1988 1994, 1999 2004. Am J Kidney Dis 2007;50:918 26
Delanaye P, Cavalier E, Pottel H. Serum creatinine: not so simple! Nephron 2017;136:302 8
Delanaye P, Cavalier E, Cristol J-P et al. Calibration and precision of serum creatinine and plasma cystatin C measurement: impact on the estimation of glomerular filtration rate. J Nephrol 2014;27:467 75
Bargnoux AS, Piéroni L, Cristol JP et al. Multicenter evaluation of cystatin C measurement after assay standardization. Clin Chem 2017;63:833 41
Boutten A, Bargnoux AS, Carlier MC et al. Enzymatic but not compensated Jaffe methods reach the desirable specifications of NKDEP at normal levels of creatinine. Results of the French multicentric evaluation. Clin Chim Acta 2013;419: 132 5
Piéroni L, Delanaye P, Boutten A et al. A multicentric evaluation of IDMS-Traceable creatinine enzymatic assays. Clin Chim Acta 2011;412:2070 5
Hsu C, YangW, Parikh RV et al. Race, genetic ancestry, and estimating kidney function in CKD.NEngl J Med 2021;385:1750 60
Feldman HI, Appel LJ, Chertow GM et al. The Chronic Renal Insufficiency Cohort (CRIC) study: design and methods.J Am Soc Nephrol 2003;14:148 53
Joffe M, Hsu CY, Feldman HI et al. Variability of creatinine measurements in clinical laboratories: results fromthe CRIC study. Am J Nephrol 2010;31:426 34
Levey AS, Bosch JP, Lewis JB et al. Amore accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461 70
Levey AS, Coresh J, Greene T et al. Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007;53:766 72
Anderson AH, Yang W, Hsu C et al. Estimating GFR among participants in the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2012;60:250 61
Ku E, Xie D, Shlipak M et al. Change in measured GFR versus eGFR and CKD outcomes. J Am Soc Nephrol 2016;27:2196 204
Rule AD, Bailey KR, Lieske JC et al. Estimating the glomerular filtration rate from serum creatinine is better than from cystatin C for evaluating risk factors associated with chronic kidney disease. Kidney Int 2013;83:1169 76
Murata K, Baumann NA, Saenger AK et al. Relative performance of the MDRD and CKD-EPI equations for estimating glomerular filtration rate among patients with varied clinical presentations. Clin J Am Soc Nephrol 2011;6: 1963 72
Coresh J, Eknoyan G, Levey AS. Estimating the prevalence of low glomerular filtration rate requires attention to the creatinine assay calibration. J Am Soc Nephrol 2002;13:2811 2
Björk J, Bäck SE, Nordin G et al. How valid are GFR estimation results from the CKD-EPI databases? Am J Kidney Dis 2018;71:446
Soveri I, Berg U, Björk J et al. Measuring GFR: A systematic review. Am J Kidney Dis 2014;64:411 24
Rule AD, Teo BW. GFR estimation in Japan and China: what accounts for the difference? Am J Kidney Dis 2009;53:932 5
Delanaye P, Cavalier E, Mariat C et al. Estimating glomerular filtration rate in Asian subjects: where do we stand? Kidney Int 2011;80:439 40
