The new, race-free, Chronic Kidney Disease Epidemiology Consortium (CKD-EPI) equation to estimate glomerular filtration rate: is it applicable in Europe? A position statement by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM).
chronic kidney disease epidemiology consortium (CKD-EPI); creatinine; equation; estimated glomerular filtration rate (eGFR); european kidney function consortium (EKFC); Cystatin C; Creatinine; Humans; Glomerular Filtration Rate; Chemistry, Clinical; Laboratories; Renal Insufficiency, Chronic/diagnosis; Renal Insufficiency, Chronic/epidemiology; Clinical Biochemistry; Biochemistry (medical); General Medicine
Abstract :
[en] The EFLM recommends not to implement the race-free Chronic Kidney Disease Epidemiology Consortium (CKD-EPI) equation in European laboratories and to keep the 2009 version of the CKD-EPI equation, without applying a race correction factor. This recommendation is completely in line with a recent Editorial published by the European Renal Association who has also proposed to change to a novel equation only when it has considerably better performance, trying to reach global consensus before implementing such a new glomerular filtration rate (GFR) estimation equation. In Europe, this equation could be for instance the new European Kidney Function Consortium (EKFC) equation, which is population-specific, developed from European cohorts and accurate from infants to the older old. Beyond serum creatinine, the estimating equations based on cystatin C will probably gain in popularity, especially because cystatin C seems independent of race. Finally, we must keep in mind that all GFR equations remain an estimation of GFR, especially rough at the individual level. Measuring GFR with a reference method, such as iohexol clearance, remains indicated in specific patients and/or specific situations, and here also, the role of the clinical laboratories is central and should still evolve positively in the future.
Disciplines :
Urology & nephrology Laboratory medicine & medical technology
Author, co-author :
Delanaye, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie
Schaeffner, Elke; Chair of the EKFC Consortium, Charité University Medicine, Institute of Public Health, Berlin, Germany
Cozzolino, Mario; Renal Division, Department of Health Sciences, University of Milan, Milan, Italy
Langlois, Michel; Chair of EFLM Science Committee, Department of Laboratory Medicine, AZ St. Jan Hospital, Bruges, Belgium
Plebani, Mario ; Department of Laboratory Medicine, University of Padova, Padova, Italy
Ozben, Tomris; Department of Clinical Biochemistry, Medical Faculty, Akdeniz University, Antalya, Turkey
Cavalier, Etienne ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chimie clinique
Language :
English
Title :
The new, race-free, Chronic Kidney Disease Epidemiology Consortium (CKD-EPI) equation to estimate glomerular filtration rate: is it applicable in Europe? A position statement by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM).
Levey AS, Stevens LA, Hostetter T, Automatic reporting of estimated glomerular filtration rate - just what the doctor ordered Clin Chem 2006 52 2188 93 https://doi.org/10.1373/clinchem.2006.078733
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, A new equation to estimate glomerular filtration rate Ann Intern Med 2009 150 604 12 https://doi.org/10.7326/0003-4819-150-9-200905050-00006
KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease Kidney Int Suppl 2013 3 1 150
Björk J, Grubb A, Larsson A, Hansson L-O, Flodin M, Sterner G, Accuracy of GFR estimating equations combining standardized cystatin C and creatinine assays: a cross-sectional study in Sweden Clin Chem Lab Med 2015 53 403 14
Pottel H, Björk J, Courbebaisse M, Couzi L, Ebert N, Eriksen BO, Development and validation of a modified full age spectrum creatinine-based equation to estimate glomerular filtration rate. A cross-sectional analysis of pooled data Ann Intern Med 2021 174 183 91 https://doi.org/10.7326/m20-4366
Pottel H, Björk J, Bökenkamp A, Berg U, Asling-Monemi K, Selistre L, Estimating glomerular filtration rate at the transition from pediatric to adult care Kidney Int 2019 95 1234 43 https://doi.org/10.1016/j.kint.2018.12.020
Delanaye P, Vidal-Petiot E, Björk J, Ebert N, Eriksen BO, Dubourg L, Performance of creatinine-based equations to estimate glomerular filtration rate in white and black populations in Europe, Brazil, and Africa Nephrol Dial Transplant 2022 https://doi.org/10.1093/ndt/gfac241
Hsu C, Yang W, Parikh RV, Anderson AH, Chen TK, Cohen DL, Race, genetic ancestry, and estimating kidney function in CKD N Engl J Med 2021 385 1750 60 https://doi.org/10.1056/nejmoa2103753
Levey AS, Tighiouart H, Titan SM, Inker LA, Estimation of glomerular filtration rate with vs without including patient race JAMA Intern Med 2020 180 793 5 https://doi.org/10.1001/jamainternmed.2020.0045
Delanaye P, Mariat C, Cavalier E, Glassock RJ, Gemenne F, Pottel H, The « race » correction in estimating glomerular filtration rate: an European point of view Curr Opin Nephrol Hypertens 2021 30 525 30 https://doi.org/10.1097/mnh.0000000000000739
Eneanya ND, Boulware LE, Tsai J, Bruce MA, Ford CL, Harris C, Health inequities and the inappropriate use of race in nephrology Nat Rev Nephrol 2022 18 84 94 https://doi.org/10.1038/s41581-021-00501-8
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D, A more 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 https://doi.org/10.7326/0003-4819-130-6-199903160-00002
Delanaye P, Pottel H, Glassock RJ, Americentrism in estimation of glomerular filtration rate equations Kidney Int 2022 101 856 8 https://doi.org/10.1016/j.kint.2022.02.022
Shi J, Lindo EG, Baird GS, Young B, Ryan M, Jefferson JA, Calculating estimated glomerular filtration rate without the race correction factor: observations at a large academic medical system Clin Chim Acta 2021 520 16 22 https://doi.org/10.1016/j.cca.2021.05.022
Delanaye P, Mariat C, Maillard N, Krzesinski J-M, Cavalier E, Are the creatinine-based equations accurate to estimate glomerular filtration rate in african american populations? Clin J Am Soc Nephrol 2011 6 906 12 https://doi.org/10.2215/cjn.10931210
Bukabau JB, Yayo E, Gnionsahé A, Monnet D, Pottel H, Cavalier E, Performance of creatinine-or cystatin C-based equations to estimate glomerular filtration rate in sub-Saharan African populations Kidney Int 2019 95 1181 9 https://doi.org/10.1016/j.kint.2018.11.045
Flamant M, Vidal-Petiot E, Metzger M, Haymann J-P, Letavernier E, Delatour V, Performance of GFR estimating equations in African Europeans: basis for a lower race-ethnicity factor than in African Americans Am J Kidney Dis 2013 62 182 4 https://doi.org/10.1053/j.ajkd.2013.03.015
van Deventer HE, George JA, Paiker JE, Becker PJ, Katz IJ, Estimating glomerular filtration rate in black South Africans by use of the modification of diet in renal disease and Cockcroft-Gault equations Clin Chem 2008 54 1197 202 https://doi.org/10.1373/clinchem.2007.099085
Rocha AD, Garcia S, Santos AB, Eduardo JCC, Mesquita CT, Lugon JR, No race-ethnicity adjustment in CKD-EPI equations is required for estimating glomerular filtration rate in the Brazilian population Internet J Nephrol 2020 2020 2141038 https://doi.org/10.1155/2020/2141038
Zanocco JA, Nishida SK, Passos MT, Pereira AR, Silva MS, Pereira AB, Race adjustment for estimating glomerular filtration rate is not always necessary Nephron Extra 2012 2 293 302 https://doi.org/10.1159/000343899
Eneanya ND, Yang W, Reese PP, Reconsidering the consequences of using race to estimate kidney function JAMA 2019 322 113 4 https://doi.org/10.1001/jama.2019.5774
Delgado C, Baweja M, Crews DC, Eneanya ND, Gadegbeku CA, Inker LA, A unifying approach for GFR estimation: recommendations of the NKF-ASN Task force on reassessing the inclusion of race in diagnosing kidney disease J Am Soc Nephrol 2021 32 2994 3015 https://doi.org/10.1681/asn.2021070988
Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, New creatinine-and cystatin C-based equations to estimate GFR without race N Engl J Med 2021 385 1737 49 https://doi.org/10.1056/nejmoa2102953
Walther CP, Winkelmayer WC, Navaneethan SD, Black race coefficient in GFR estimation and diabetes medications in CKD: national estimates J Am Soc Nephrol 2021 32 1319 21 https://doi.org/10.1681/asn.2020121724
Walther CP, Winkelmayer WC, Navaneethan SD, Updated US prevalence estimates for chronic kidney disease stage and complications using the new race-free equation to estimate glomerular filtration rate JAMA Netw Open 2022 5 e220460 https://doi.org/10.1001/jamanetworkopen.2022.0460
Diao JA, Powe NR, Manrai AK, Race-free equations for eGFR: comparing effects on CKD classification J Am Soc Nephrol 2021 32 1868 70 https://doi.org/10.1681/asn.2021020224
Vestergaard SV, Heide-Jørgensen U, Birn H, Christiansen CF, Effect of the refitted race-free eGFR formula on the CKD prevalence and mortality in the Danish population Clin J Am Soc Nephrol 2022 17 426 8 https://doi.org/10.2215/cjn.14491121
Delanaye P, Masson I, Maillard N, Pottel H, Mariat C, The new 2021 CKD-EPI equation without race in an European cohort of renal transplanted patients Transplantation 2022 https://doi.org/10.1097/TP.0000000000004234
Fu EL, Coresh J, Grams ME, Clase CM, Elinder C-G, Paik Paik, Removing race from the CKD-EPI equation and its impact on prognosis in a predominantly White European population Nephrol Dial Transplant 2022 https://doi.org/10.1093/ndt/gfac197
Gansevoort RT, Anders H-J, Cozzolino M, Filser D, Fouque D, Ortiz A, What should European nephrology do with the new CKD-EPI equation? Nephrol Dial Transplant 2022 https://doi.org/10.1093/ndt/gfac254
Grubb A, Nyman U, Björk J, Lindström V, Rippe B, Sterner B, Simple cystatin C-based prediction equations for glomerular filtration rate compared with the modification of diet in renal disease prediction equation for adults and the Schwartz and the Counahan-Barratt prediction equations for children Clin Chem 2005 51 1420 31 https://doi.org/10.1373/clinchem.2005.051557
Ottosson Frost C, Gille-Johnson P, Blomstrand E, St-Aubin V, Leion F, Grubb A, Cystatin C-based equations for estimating glomerular filtration rate do not require race or sex coefficients Scand J Clin Lab Invest 2022 82 162 6 https://doi.org/10.1080/00365513.2022.2031279
Shafi T, Zhu X, Lirette ST, Rule AD, Mosley T, Butler KR, Quantifying individual-level inaccuracy in glomerular filtration rate estimation. A cross-sectional study Ann Intern Med 2022 175 1073 82 https://doi.org/10.7326/m22-0610
Luis-Lima S, Escamilla-Cabrera B, Negrín-Mena N, Estupinan S, Delgado-Mallen P, Cobo-Caso MA, CKD staging with cystatin C or creatinine-based formulas: flipping the coin Nephrol Dial Transplant 2019 34 287 94 https://doi.org/10.1093/ndt/gfy086
Porrini E, Ruggenenti P, Luis-Lima S, Carrara F, Jiménez A, de Vries APJ, Estimated GFR: time for a critical appraisal Nat Rev Nephrol 2019 15 177 90 https://doi.org/10.1038/s41581-018-0080-9
Miller WG, Perspective on new equations for estimating glomerular filtration rate Clin Chem 2021 67 820 2 https://doi.org/10.1093/clinchem/hvab029
Agarwal R, Delanaye P, Glomerular filtration rate: when to measure and in which patients? Nephrol Dial Transplant 2019 34 2001 7 https://doi.org/10.1093/ndt/gfy363
Ebert N, Bevc S, Bökenkamp A, Gaillard F, Hornum M, Jager KJ, Assessment of kidney function: clinical indications for measured GFR Clin Kidney J 2021 14 1861 70 https://doi.org/10.1093/ckj/sfab042
Delanaye P, Ebert N, Melsom T, Gaspari F, Mariat C, Cavalier E, Iohexol plasma clearance for measuring glomerular filtration rate in clinical practice and research: a review. Part 1: how to measure glomerular filtration rate with iohexol Clin Kidney J 2016 9 682 99 https://doi.org/10.1093/ckj/sfw070
Nyssen L, Delanaye P, Le Goff C, Peeters S, Cavalier E, A simple LC-MS method for the determination of iohexol and iothalamate in serum, using ioversol as an internal standard Clin Chim Acta 2016 463 96 102 https://doi.org/10.1016/j.cca.2016.10.021
