Abstract
Introduction:The guidelines recommend estimating the glomerular filtration rate using serum creatinine-based equations as a predictor of kidney disease, preferably adjusted for local population groups.Methods:Cross-sectional study that evaluated the performance of four equations used for estimating GFR compared to endogenous creatinine clearance (ClCr) in 1,281 participants. Modification of Diet equations in Renal Disease Study Group (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), CKD-EPI with adjustment for local population (CKD-EPI local) and Full Age Spectrum (FAS) in comparison with endogenous creatinine clearance (ClCr). We used the Quantile Regression to calculate the median bias, interquartile range (IQR), Bland-Altman agreement analysis and 30% margin of error (P30).Results:The mean age of participants was 52.5 ± 16.5 years with 466 women (38%), median ClCr[IQR] of 92.0 [58.0; 122.0] mL/min/1.73 m2, with 320 (25%) participants presenting ClCr < 60 mL/min/1.73 m2. The performance of the local CKD-EPI and FAS equations were superior to MDRD and CKD-EPI in relation to variability (0.92 [0.89; 0.94]) and P30 (90.5% [88.7; 92, 0]). In the group with ClCr < 60 mL/min/1.73 m2, the local CKD-EPI and FAS equations showed less variability than the CKD-EPI and MDRD (0.90 [0.86; 0.98] and 1.05 [0.97; 1.09] vs. 0.63 [0.61; 0.68] and 0.65 [0.62; 0.70], P < 0.01) and best P30 (85.5) % [81.0; 90.0], 88.0% [84.0; 92.0] vs. 52.0% (46.0; 58.0) and 53.0% [47.0; 58 .5], P < 0.01).Conclusion:Local CKD-EPI and FAS equations performed better than CKD-EPI and MDRD when compared to ClCr.
Highlights
The guidelines recommend estimating the glomerular filtration rate using serum creatinine-based equations as a predictor of kidney disease, preferably adjusted for local population groups
The present study evaluated the performance of four equations for estimating Glomerular filtration rate (GFR): MDRD, chronic kidney disease (CKD)-EPI, CKD-EPI with adjustment for the local population and Full Age Spectrum (FAS) using ClCr as reference standard, in adults from the northeast of Rio Grande do Sul
Variability In the general population, the best median ratio was observed with the FAS equation, with a median estimate GFR (eGFR)/ClCr of 0.92 (0.89; 0.94) (Table 3, p < 0.01)
Summary
The guidelines recommend estimating the glomerular filtration rate using serum creatinine-based equations as a predictor of kidney disease, preferably adjusted for local population groups. Modification of Diet equations in Renal Disease Study Group (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), CKD-EPI with adjustment for local population (CKDEPI local) and Full Age Spectrum (FAS) in comparison with endogenous creatinine clearance (ClCr). The most commonly used marker of renal function is serum creatinine (SCr), but it can be affected by several biological factors, such as muscle metabolism, tubular secretion and laboratory dosage method To minimize these variations, CKD management guidelines recommend the use of SCr-based mathematical equations as a non-invasive method to estimate GFR (eGFR)[1]. Recommended equations for adults are the Modification of Diet in Renal Disease Study Group (MDRD); and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)[2,3] Both use SCr, gender, age and ethnicity (African-American or not) to calculate eGFR (Table 1). Another recently described equation is the Full Age Spectrum (FAS), based on the concept of median SCr normalized for the local population[4]
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