[en] Estimating glomerular filtration rate (GFR) is important in daily practice to assess kidney function and adapting the best clinical care of patients with and without chronic kidney disease. The new creatinine-based European Kidney Function Consortium (EKFC) equation is used to estimate GFR. This equation was developed and validated mainly in European individuals and based on a rescaled creatinine, with the rescaling factor (Q-value) defined as the median normal value of serum creatinine in a given population. The validation was limited in Non-Black Americans and absent in Black Americans. Here, our cross-sectional analysis included 12,854 participants from nine studies encompassing large numbers of both non-Black and Black with measured GFR by clearance of an exogenous marker (reference method), serum creatinine, age, sex, and self-reported race available. Two strategies were considered with population-specific Q-values in Black and non-Black men and women (EKFCPS) or a race-free Q-value (EKFCRF). In the whole population, only the EKFCPS equation showed no statistical median bias (0.14, 95% confidence interval [-0.07; 0.35] mL/min/1.73m2), and the bias for the EKFCRF (0.74, [0.51; 0.94] mL/min/1.73m2) was closer to zero than that for the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI2021) equation (1.22, [0.99; 1.47]) mL/min/1.73m2]. The percentage of estimated GFR within 30% of measured GFR was similar for CKD-EPI2021 (79.2% [78.5%; 79.9%]) and EKFCRF (80.1% [79.4%; 80.7%]), but improved for the EKFCPS equation (81.1% [80.5%; 81.8%]). Thus, our EKFC equations can be used to estimate GFR in the United States incorporating either self-reported race or unknown race at the patient's discretion per hospital registration records.
Disciplines :
Urology & nephrology
Author, co-author :
Delanaye, Pierre ; Université de Liège - ULiège > Département de pharmacie > Chimie médicale
Rule, Andrew D; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
Schaeffner, Elke; Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
Cavalier, Etienne ; Université de Liège - ULiège > Département de pharmacie > Chimie médicale
Shi, Junyan; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
Hoofnagle, Andrew N; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA, Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington, USA, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington, USA, Department of Medicine, University of Washington, Seattle, Washington, USA
Nyman, Ulf; Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
Björk, Jonas; Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden, Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
Pottel, Hans ; Université de Liège - ULiège > Département des sciences cliniques ; Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
Language :
English
Title :
Performance of the European Kidney Function Consortium (EKFC) creatinine-based equation in United States cohorts.
Sverige Vetenskapsrådet [SE] NIDDK - National Institute of Diabetes and Digestive and Kidney Diseases [US-MD]
Funding text :
The Assessing Long Term Outcomes in Living Kidney Donors, Chronic Renal Insufficiency Cohort, Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease, Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications, Preventing Early Renal Loss in Diabetes, African American Study of Kidney Disease and Hypertension, and Modified Diet in Renal Disease studies were performed by respective investigators and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The data from these studies reported here were supplied by the NIDDK Central Repository. This manuscript was not prepared in collaboration with the investigators of the different studies and does not necessarily reflect the opinions or views of these studies, the NIDDK Central Repository, or the NIDDK. This study was supported by the Swedish Research Council (Vetenskapsrådet; grant no. 2019-00198). JB has received funding from the Swedish Research Council (VR) to conduct large-scale epidemiological studies linked with registered data from health care. This funding source was not at all involved in design, analysis, presentation, or interpretation of the results from the present study.This study was supported by the Swedish Research Council (Vetenskapsrådet; grant no. 2019-00198). JB has received funding from the Swedish Research Council (VR) to conduct large-scale epidemiological studies linked with registered data from health care. This funding source was not at all involved in design, analysis, presentation, or interpretation of the results from the present study.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3 (2013), 1–150.
Pottel, H., Björk, J., Rule, A.D., et al. Cystatin C–based equation to estimate GFR without the inclusion of race and sex. N Engl J Med 388 (2023), 333–343.
Inker, L.A., Eneanya, N.D., Coresh, J., et al. New creatinine- and cystatin C–based equations to estimate GFR without race. N Engl J Med 385 (2021), 1737–1749.
Delgado, C., Baweja, M., Crews, D.C., et al. 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 32 (2021), 2994–3015.
Miller, W.G., Kaufman, H.W., Levey, A.S., et al. National Kidney Foundation Laboratory Engagement Working Group recommendations for implementing the CKD-EPI 2021 race-free equations for estimated glomerular filtration rate: practical guidance for clinical laboratories. Clin Chem 68 (2022), 511–520.
Pottel, H., Björk, J., Courbebaisse, M., et al. 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 174 (2021), 183–191.
Delanaye, P., Schaeffner, E., Cozzolino, M., et al. 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). Clin Chem Lab Med 61 (2023), 44–47.
Levey, A.S., Tighiouart, H., Inker, L.A., Improving glomerular filtration rate estimation—across the age and diversity spectrum. Ann Intern Med 174 (2021), 265–267.
Delanaye, P., Vidal-Petiot, E., Björk, J., et al. Performance of creatinine-based equations to estimate glomerular filtration rate in White and Black populations in Europe, Brazil, and Africa. Nephrol Dial Transpl 38 (2023), 106–118.
Kasiske, B.L., Anderson-Haag, T.L., Duprez, D.A., et al. A prospective controlled study of metabolic and physiologic effects of kidney donation suggests that donors retain stable kidney function over the first nine years. Kidney Int 98 (2020), 168–175.
Pottel, H., Cavalier, E., Björk, J., et al. Standardization of serum creatinine is essential for accurate use of unbiased estimated GFR equations: evidence from three cohorts matched on renal function. Clin Kidney J 15 (2022), 2258–2265.
Hsu, C.Y., Yang, W., Parikh, R.V., et al. Race, genetic ancestry, and estimating kidney function in CKD. N Engl J Med 385 (2021), 1750–1760.
Rule, A.D., Torres, V.E., Chapman, A.B., et al. Comparison of methods for determining renal function decline in early autosomal dominant polycystic kidney disease: the consortium of radiologic imaging studies of polycystic kidney disease cohort. J Am Soc Nephrol 17 (2006), 854–862.
Ibrahim, H., Mondress, M., Tello, A., et al. An alternative formula to the Cockcroft-Gault and the modification of diet in renal diseases formulas in predicting GFR in individuals with type 1 diabetes. J Am Soc Nephrol 16 (2005), 1051–1060.
de Boer, I.H., Sun, W., Cleary, P.A., et al. Longitudinal changes in estimated and measured GFR in type 1 diabetes. J Am Soc Nephrol 25 (2014), 810–818.
Doria, A., Galecki, A.T., Spino, C., et al. Serum urate lowering with allopurinol and kidney function in type 1 diabetes. N Engl J Med 382 (2020), 2493–2503.
Lewis, J., Agodoa, L., Cheek, D., et al. Comparison of cross-sectional renal function measurements in African Americans with hypertensive nephrosclerosis and of primary formulas to estimate glomerular filtration rate. Am J Kidney Dis 38 (2001), 744–753.
Levey, A.S., Bosch, J.P., Lewis, J.B., et al. Modification of Diet in Renal Disease Study Group. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130 (1999), 461–470.
Stevens, L.A., Manzi, J., Levey, A.S., et al. Impact of creatinine calibration on performance of GFR estimating equations in a pooled individual patient database. Am J Kidney Dis 50 (2007), 21–35.
Levey, A.S., 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 53 (2007), 766–772.
Afkarian, M., Polsky, S., Parsa, A., et al. Preventing Early Renal Loss in Diabetes (PERL) study: a randomized double-blinded trial of allopurinol—rationale, design, and baseline data. Diabetes Care 42 (2019), 1454–1463.
Rule, A.D., Bailey, K.R., Lieske, J.C., 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 83 (2013), 1169–1176.
Zhang, X., Rule, A.D., McCulloch, C.E., et al. Tubular secretion of creatinine and kidney function: an observational study. BMC Nephrol, 21, 2020, 108.
Björk, J., Nyman, U., Delanaye, P., et al. A novel method for creatinine adjustment makes the revised Lund-Malmö GFR estimating equation applicable in children. Scand J Clin Lab Invest 80 (2020), 456–463.
Shi, J., Lindo, E.G., Baird, G.S., et al. Calculating estimated glomerular filtration rate without the race correction factor: observations at a large academic medical system. Clin Chim Acta 520 (2021), 16–22.
Poggio, E.D., Rule, A.D., Tanchanco, R., et al. Demographic and clinical characteristics associated with glomerular filtration rates in living kidney donors. Kidney Int 75 (2009), 1079–1087.
Delanaye, P., Pottel, H., Botev, R., Con: should we abandon the use of the MDRD equation in favour of the CKD-EPI equation?. Nephrol Dial Transpl 28 (2013), 1396–1403.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:2 suppl 1 (2002), S1–S266.
Björk, J., Grubb, A., Sterner, G., et al. Performance of GFR estimating equations stratified by measured or estimated GFR: implications for interpretation. Am J Kidney Dis 66 (2015), 1107–1108.
Pottel, H., Vrydags, N., Mahieu, B., et al. Establishing age/sex related serum creatinine reference intervals from hospital laboratory data based on different statistical methods. Clin Chim Acta 396 (2008), 49–55.
Delanaye, P., Pottel, H., Glassock, R.J., Americentrism in estimation of GFR equations. Kidney Int 101 (2022), 856–858.
Zhao, L., Li, H.L., Liu, H.J., et al. Validation of the EKFC equation for glomerular filtration rate estimation and comparison with the Asian-modified CKD-EPI equation in Chinese chronic kidney disease patients in an external study. Ren Fail, 45, 2023, 2150217.
Xia, F., Hao, W., Liang, J., et al. Applicability of creatinine-based equations for estimating glomerular filtration rate in elderly Chinese patients. BMC Geriatr 21 (2021), 1–13.
Jeong, T.D., Hong, J., Lee, W., et al. Accuracy of the new creatinine-based equations for estimating glomerular filtration rate in Koreans. Ann Lab Med 43 (2023), 244–252.
Ma, Y., Wei, L., Yong, Z., et al. Validation of the European Kidney Function Consortium (EKFC) equation in Chinese adult population: an equation standing on the shoulders of predecessors. Nephron, 2023, 10.1159/000531030 Published online June 14.
Pottel, H., Björk, J., Bökenkamp, A., et al. Estimating glomerular filtration rate at the transition from pediatric to adult care. Kidney Int 95 (2019), 1234–1243.
Delanaye, P., Mariat, C., Maillard, N., et al. Are the creatinine-based equations accurate to estimate glomerular filtration rate in African American populations?. Clin J Am Soc Nephrol 6 (2011), 906–912.
Delanaye, P., Mariat, C., Cavalier, E., et al. The « race » correction in estimating glomerular filtration rate. Curr Opin Nephrol Hypertens 30 (2021), 525–530.
Jones, C.A., McQuillan, G.M., Kusek, J.W., et al. Serum creatinine levels in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis 32 (1998), 992–999.
Ebert, N., Bevc, S., Bökenkamp, A., et al. Assessment of kidney function: clinical indications for measured GFR. Clin Kidney J 14 (2021), 1861–1870.
Agarwal, R., Delanaye, P., Glomerular filtration rate: when to measure and in which patients?. Nephrol Dial Transpl 34 (2019), 2001–2007.
