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Trends in the prevalence of reduced GFR in the United States: a comparison of creatinine- and cystatin C-based estimates.
Am J Kidney Dis. 2013 Aug; 62(2):253-60.AJ

Abstract

BACKGROUND

The US prevalence of reduced estimated glomerular filtration rate (eGFR) based on serum creatinine level increased during the decade ending in 2002. National Health and Nutrition Examination Survey (NHANES) cystatin C measurements recently were calibrated to the international standard, allowing for an independent test of the trend in prevalence of reduced eGFR using cystatin C level.

STUDY DESIGN

Cross-sectional surveys performed during 2 periods.

SETTING & PARTICIPANTS

Nationally representative subsamples of adult participants from NHANES III (1988-1994) and the NHANES 1999-2002 surveys.

PREDICTOR

Survey period.

OUTCOMES

Prevalence of reduced GFR, defined as eGFR <60 mL/min/1.73 m² based on levels of serum creatinine, cystatin C, or both (eGFRcr, eGFRcys, and eGFRcr-cys), using estimating equations developed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI).

MEASUREMENTS

Serum cystatin C level, measured from stored samples in 2006, calibrated to the international standard in 2012.

RESULTS

Between 1988-1994 and 1999-2002, the prevalence of reduced eGFRcr, eGFRcys, and eGFRcr-cys increased from 4.7% (95% CI, 4.1%-5.3%) to 6.5% (95% CI, 5.9%-7.1%) (P < 0.001), from 5.5% (95% CI, 4.6%-6.5%) to 8.7% (95% CI, 7.5%-10.0%) (P < 0.001), and from 4.4% (95% CI, 3.7%-5.2%) to 7.1% (95% CI, 6.2%-8.0%) (P < 0.001), respectively. The higher prevalence of reduced GFR in the later period was observed in all subgroups of age, race, sex, and GFR categories. After adjusting for changes in the US population by age, sex, race, diabetes, hypertension, and body mass index, prevalence ratios of reduced GFR in the later versus earlier survey were 1.24 (95% CI, 1.09-1.45), 1.34 (95% CI, 1.15-1.67), and 1.33 (95% CI, 1.17-1.65) using eGFRcr, eGFRcys, and eGFRcr-cys, respectively.

LIMITATIONS

Likely underascertainment of persons with GFR <15 mL/min/1.73 m²; GFR was estimated and not measured; comparability of laboratory assays based on a calibration subsample.

CONCLUSIONS

The prevalence of reduced eGFRcys in the US civilian noninstitutionalized population increased between 1988-1994 and 1999-2002, confirming the increase observed in the prevalence of reduced eGFRcr.

Authors+Show Affiliations

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. mgrams2@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

23619125

Citation

Grams, Morgan E., et al. "Trends in the Prevalence of Reduced GFR in the United States: a Comparison of Creatinine- and Cystatin C-based Estimates." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 62, no. 2, 2013, pp. 253-60.
Grams ME, Juraschek SP, Selvin E, et al. Trends in the prevalence of reduced GFR in the United States: a comparison of creatinine- and cystatin C-based estimates. Am J Kidney Dis. 2013;62(2):253-60.
Grams, M. E., Juraschek, S. P., Selvin, E., Foster, M. C., Inker, L. A., Eckfeldt, J. H., Levey, A. S., & Coresh, J. (2013). Trends in the prevalence of reduced GFR in the United States: a comparison of creatinine- and cystatin C-based estimates. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 62(2), 253-60. https://doi.org/10.1053/j.ajkd.2013.03.013
Grams ME, et al. Trends in the Prevalence of Reduced GFR in the United States: a Comparison of Creatinine- and Cystatin C-based Estimates. Am J Kidney Dis. 2013;62(2):253-60. PubMed PMID: 23619125.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in the prevalence of reduced GFR in the United States: a comparison of creatinine- and cystatin C-based estimates. AU - Grams,Morgan E, AU - Juraschek,Stephen P, AU - Selvin,Elizabeth, AU - Foster,Meredith C, AU - Inker,Lesley A, AU - Eckfeldt,John H, AU - Levey,Andrew S, AU - Coresh,Josef, Y1 - 2013/04/22/ PY - 2012/10/29/received PY - 2013/03/15/accepted PY - 2013/4/27/entrez PY - 2013/4/27/pubmed PY - 2013/10/1/medline KW - Cystatin C KW - chronic kidney disease KW - estimating equations KW - prevalence SP - 253 EP - 60 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 62 IS - 2 N2 - BACKGROUND: The US prevalence of reduced estimated glomerular filtration rate (eGFR) based on serum creatinine level increased during the decade ending in 2002. National Health and Nutrition Examination Survey (NHANES) cystatin C measurements recently were calibrated to the international standard, allowing for an independent test of the trend in prevalence of reduced eGFR using cystatin C level. STUDY DESIGN: Cross-sectional surveys performed during 2 periods. SETTING & PARTICIPANTS: Nationally representative subsamples of adult participants from NHANES III (1988-1994) and the NHANES 1999-2002 surveys. PREDICTOR: Survey period. OUTCOMES: Prevalence of reduced GFR, defined as eGFR <60 mL/min/1.73 m² based on levels of serum creatinine, cystatin C, or both (eGFRcr, eGFRcys, and eGFRcr-cys), using estimating equations developed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). MEASUREMENTS: Serum cystatin C level, measured from stored samples in 2006, calibrated to the international standard in 2012. RESULTS: Between 1988-1994 and 1999-2002, the prevalence of reduced eGFRcr, eGFRcys, and eGFRcr-cys increased from 4.7% (95% CI, 4.1%-5.3%) to 6.5% (95% CI, 5.9%-7.1%) (P < 0.001), from 5.5% (95% CI, 4.6%-6.5%) to 8.7% (95% CI, 7.5%-10.0%) (P < 0.001), and from 4.4% (95% CI, 3.7%-5.2%) to 7.1% (95% CI, 6.2%-8.0%) (P < 0.001), respectively. The higher prevalence of reduced GFR in the later period was observed in all subgroups of age, race, sex, and GFR categories. After adjusting for changes in the US population by age, sex, race, diabetes, hypertension, and body mass index, prevalence ratios of reduced GFR in the later versus earlier survey were 1.24 (95% CI, 1.09-1.45), 1.34 (95% CI, 1.15-1.67), and 1.33 (95% CI, 1.17-1.65) using eGFRcr, eGFRcys, and eGFRcr-cys, respectively. LIMITATIONS: Likely underascertainment of persons with GFR <15 mL/min/1.73 m²; GFR was estimated and not measured; comparability of laboratory assays based on a calibration subsample. CONCLUSIONS: The prevalence of reduced eGFRcys in the US civilian noninstitutionalized population increased between 1988-1994 and 1999-2002, confirming the increase observed in the prevalence of reduced eGFRcr. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/23619125/Trends_in_the_prevalence_of_reduced_GFR_in_the_United_States:_a_comparison_of_creatinine__and_cystatin_C_based_estimates_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(13)00669-0 DB - PRIME DP - Unbound Medicine ER -