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Improved glomerular filtration rate estimation using new equations combined with standardized cystatin C and creatinine in Chinese adult chronic kidney disease patients.
Clin Biochem. 2014 Sep; 47(13-14):1220-6.CB

Abstract

OBJECTIVES

The newly developed glomerular filtration rate (GFR)-estimating equations developed by the CKD-EPI Collaboration and Feng et al. (2013) that are based on standardized serum cystatin C (ScysC), combined/not combined with serum creatinine (Scr), require further validation in China. We compared the performance of four new equations (CKD-EPIcys, CKD-EPIcr-cys, Fengcys, and Fengcr-cys equations) with the CKD-EPI creatinine equation (CKD-EPIcr) in adult Chinese chronic kidney disease (CKD) patients to clarify their clinical application.

DESIGN AND METHODS

GFR was measured using the dual plasma sampling (99m)Tc-DTPA method (mGFR) in 252 adult CKD patients enrolled from four centres. Scr and ScysC were measured by standardized assays in a central laboratory. Each equation's performance was assessed using bias, precision, accuracy, agreement, and correct classification of the CKD stage.

RESULTS

The measured GFR was 46 [25-83] mL/min per 1.73 m(2). The CKD-EPIcys, CKD-EPIcr-cys and Fengcys equations provided significantly higher accuracy (P15: 38.9%, 39.7%, and 38.9%) than the CKD-EPIcr equation (29.8%). The CKD-EPIcr-cys and Fengcr-cys equations presented higher precision (IQR of the difference, 16.4 and 17.3 mL/min per 1.73 m(2), respectively) and narrower acceptable limits in Bland-Altman analysis (56.6 and 50.8 mL/min per 1.73 m(2), respectively) than single marker-based equations. The CKD-EPIcr-cys equation achieved the highest overall correct proportion (61.5%) in classification of CKD stages.

CONCLUSIONS

Combining ScysC and Scr measurements for GFR estimation improves diagnostic performance. The Scr-ScysC equation showed better performance than equations based on either marker alone. The CKD-EPIcr-cys equation showed the best performance for GFR estimation in Chinese adult CKD patients.

Authors+Show Affiliations

Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academic Medical Science and Peking Union Medical College, Beijing, P. R. China.Department of Nephrology, Peking Union Medical College Hospital, Chinese Academic Medical Science and Peking Union Medical College, Beijing, P. R. China.Department of Nephrology, Peking Union Medical College Hospital, Chinese Academic Medical Science and Peking Union Medical College, Beijing, P. R. China.Department of Nephrology, Peking Union Medical College Hospital, Chinese Academic Medical Science and Peking Union Medical College, Beijing, P. R. China.Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academic Medical Science and Peking Union Medical College, Beijing, P. R. China.Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academic Medical Science and Peking Union Medical College, Beijing, P. R. China.Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academic Medical Science and Peking Union Medical College, Beijing, P. R. China.Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academic Medical Science and Peking Union Medical College, Beijing, P. R. China.Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academic Medical Science and Peking Union Medical College, Beijing, P. R. China.Department of Nephrology, Peking Union Medical College Hospital, Chinese Academic Medical Science and Peking Union Medical College, Beijing, P. R. China. Electronic address: 0605.mei@gmail.com.Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academic Medical Science and Peking Union Medical College, Beijing, P. R. China. Electronic address: lingqiubj@aliyun.com.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24886770

Citation

Guo, Xiuzhi, et al. "Improved Glomerular Filtration Rate Estimation Using New Equations Combined With Standardized Cystatin C and Creatinine in Chinese Adult Chronic Kidney Disease Patients." Clinical Biochemistry, vol. 47, no. 13-14, 2014, pp. 1220-6.
Guo X, Qin Y, Zheng K, et al. Improved glomerular filtration rate estimation using new equations combined with standardized cystatin C and creatinine in Chinese adult chronic kidney disease patients. Clin Biochem. 2014;47(13-14):1220-6.
Guo, X., Qin, Y., Zheng, K., Gong, M., Wu, J., Shou, W., Cheng, X., Xia, L., Xu, E., Li, X., & Qiu, L. (2014). Improved glomerular filtration rate estimation using new equations combined with standardized cystatin C and creatinine in Chinese adult chronic kidney disease patients. Clinical Biochemistry, 47(13-14), 1220-6. https://doi.org/10.1016/j.clinbiochem.2014.05.060
Guo X, et al. Improved Glomerular Filtration Rate Estimation Using New Equations Combined With Standardized Cystatin C and Creatinine in Chinese Adult Chronic Kidney Disease Patients. Clin Biochem. 2014;47(13-14):1220-6. PubMed PMID: 24886770.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved glomerular filtration rate estimation using new equations combined with standardized cystatin C and creatinine in Chinese adult chronic kidney disease patients. AU - Guo,Xiuzhi, AU - Qin,Yan, AU - Zheng,Ke, AU - Gong,Mengchun, AU - Wu,Jie, AU - Shou,Weiling, AU - Cheng,Xinqi, AU - Xia,Liangyu, AU - Xu,Ermu, AU - Li,Xuemei, AU - Qiu,Ling, Y1 - 2014/06/02/ PY - 2014/02/08/received PY - 2014/05/20/revised PY - 2014/05/21/accepted PY - 2014/6/3/entrez PY - 2014/6/3/pubmed PY - 2015/5/13/medline KW - Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) KW - Chronic kidney disease KW - Creatinine KW - Cystatin C KW - Glomerular filtration rate SP - 1220 EP - 6 JF - Clinical biochemistry JO - Clin Biochem VL - 47 IS - 13-14 N2 - OBJECTIVES: The newly developed glomerular filtration rate (GFR)-estimating equations developed by the CKD-EPI Collaboration and Feng et al. (2013) that are based on standardized serum cystatin C (ScysC), combined/not combined with serum creatinine (Scr), require further validation in China. We compared the performance of four new equations (CKD-EPIcys, CKD-EPIcr-cys, Fengcys, and Fengcr-cys equations) with the CKD-EPI creatinine equation (CKD-EPIcr) in adult Chinese chronic kidney disease (CKD) patients to clarify their clinical application. DESIGN AND METHODS: GFR was measured using the dual plasma sampling (99m)Tc-DTPA method (mGFR) in 252 adult CKD patients enrolled from four centres. Scr and ScysC were measured by standardized assays in a central laboratory. Each equation's performance was assessed using bias, precision, accuracy, agreement, and correct classification of the CKD stage. RESULTS: The measured GFR was 46 [25-83] mL/min per 1.73 m(2). The CKD-EPIcys, CKD-EPIcr-cys and Fengcys equations provided significantly higher accuracy (P15: 38.9%, 39.7%, and 38.9%) than the CKD-EPIcr equation (29.8%). The CKD-EPIcr-cys and Fengcr-cys equations presented higher precision (IQR of the difference, 16.4 and 17.3 mL/min per 1.73 m(2), respectively) and narrower acceptable limits in Bland-Altman analysis (56.6 and 50.8 mL/min per 1.73 m(2), respectively) than single marker-based equations. The CKD-EPIcr-cys equation achieved the highest overall correct proportion (61.5%) in classification of CKD stages. CONCLUSIONS: Combining ScysC and Scr measurements for GFR estimation improves diagnostic performance. The Scr-ScysC equation showed better performance than equations based on either marker alone. The CKD-EPIcr-cys equation showed the best performance for GFR estimation in Chinese adult CKD patients. SN - 1873-2933 UR - https://www.unboundmedicine.com/medline/citation/24886770/Improved_glomerular_filtration_rate_estimation_using_new_equations_combined_with_standardized_cystatin_C_and_creatinine_in_Chinese_adult_chronic_kidney_disease_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0009-9120(14)00288-4 DB - PRIME DP - Unbound Medicine ER -