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The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation does not improve the underestimation of Glomerular Filtration Rate (GFR) in people with diabetes and preserved renal function.
BMC Nephrol. 2015 Dec 03; 16:198.BN

Abstract

BACKGROUND

Our hypothesis was that both the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations would underestimate directly measured GFR (mGFR) to a similar extent in people with diabetes and preserved renal function.

METHODS

In a cross-sectional study, bias (eGFR - mGFR) was compared for the CKD-EPI and MDRD equations, after stratification for mGFR levels. We also examined the ability of the CKD-EPI compared with the MDRD equation to correctly classify subjects to various CKD stages. In a longitudinal study of subjects with an early decline in GFR i.e., initial mGFR > 60 ml/min/1.73 m(2) and rate of decline in GFR (ΔmGFR) > 3.3 ml/min/1.73 m(2) per year, ΔmGFR (based on initial and final values) was compared with ΔeGFR by the CKD-EPI and MDRD equations over a mean of 9 years.

RESULTS

In the cross-sectional study, mGFR for the whole group was 80 ± 2.2 ml/min/1.73 m(2) (n = 199, 75 % type 2 diabetes). For subjects with mGFR >90 ml/min/1.73 m(2) (mGFR: 112 ± 2.0, n = 76), both equations significantly underestimated mGFR to a similar extent: bias for CKD-EPI: -12 ± 1.4 ml/min/1.73 m(2) (p < 0.001) and for MDRD: -11 ± 2.1 ml/min/1.73 m(2) (p < 0.001). Using the CKD-EPI compared with the MDRD equation did not improve the number of subjects that were correctly classified to a CKD-stage. No biochemical or clinical patient characteristics were identified to account for the under estimation of mGFR values in the normal to high range by the CKD-EPI equation. In the longitudinal study (n = 30, 66 % type 1 diabetes), initial and final mGFR values were 102.8 ± 6 and 54.6 ± 6.0 ml/min/1.73 m(2), respectively. Mean ΔGFR (ml/min/1.73 m(2) per year) was 6.0 by mGFR compared with only 3.0 by MDRD and 3.2 by CKD-EPI (both p < 0.05 vs mGFR) CONCLUSIONS: Both the CKD-EPI and MDRD equations underestimate reference GFR values > 90 ml/min/1.73 m(2) as well as an early decline in GFR to a similar extent in people with diabetes. There is scope to improve methods for estimating an early decline in GFR.

Authors+Show Affiliations

Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia. r.macisaac@unimelb.edu.au. Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia. r.macisaac@unimelb.edu.au.Endocrine Centre, Austin Health, West Heidelberg, 3081, Victoria, Australia. elif.ekinci@unimelb.edu.au. Menzies School of Health Research, Casuarina, 0811, Northern Territory, Australia. elif.ekinci@unimelb.edu.au. Department of Medicine, Austin Health, University of Melbourne, Heidelberg, 3084, Victoria, Australia. elif.ekinci@unimelb.edu.au.Endocrine Centre, Austin Health, West Heidelberg, 3081, Victoria, Australia. erosha.premaratne@gmail.com.Melbourne Pathology, Collingwood, 3066, Victoria, Australia. Zhong.Lu@mps.com.au.Endocrine Centre, Austin Health, West Heidelberg, 3081, Victoria, Australia. jmseah@gmail.com.Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia. Yue.Lii@svha.org.au. Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia. Yue.Lii@svha.org.au.Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia. drrayboston@yahoo.com. Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia. drrayboston@yahoo.com.Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia. Glenn.Ward@svha.org.au. Clinical Chemistry, St Vincent's Hospital Melbourne, Fitzroy, 3065, Victoria, Australia. Glenn.Ward@svha.org.au. Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia. Glenn.Ward@svha.org.au.Endocrine Centre, Austin Health, West Heidelberg, 3081, Victoria, Australia. g.jerums@unimelb.edu.au. Department of Medicine, Austin Health, University of Melbourne, Heidelberg, 3084, Victoria, Australia. g.jerums@unimelb.edu.au.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26630928

Citation

MacIsaac, Richard J., et al. "The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) Equation Does Not Improve the Underestimation of Glomerular Filtration Rate (GFR) in People With Diabetes and Preserved Renal Function." BMC Nephrology, vol. 16, 2015, p. 198.
MacIsaac RJ, Ekinci EI, Premaratne E, et al. The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation does not improve the underestimation of Glomerular Filtration Rate (GFR) in people with diabetes and preserved renal function. BMC Nephrol. 2015;16:198.
MacIsaac, R. J., Ekinci, E. I., Premaratne, E., Lu, Z. X., Seah, J. M., Li, Y., Boston, R., Ward, G. M., & Jerums, G. (2015). The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation does not improve the underestimation of Glomerular Filtration Rate (GFR) in people with diabetes and preserved renal function. BMC Nephrology, 16, 198. https://doi.org/10.1186/s12882-015-0196-0
MacIsaac RJ, et al. The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) Equation Does Not Improve the Underestimation of Glomerular Filtration Rate (GFR) in People With Diabetes and Preserved Renal Function. BMC Nephrol. 2015 Dec 3;16:198. PubMed PMID: 26630928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation does not improve the underestimation of Glomerular Filtration Rate (GFR) in people with diabetes and preserved renal function. AU - MacIsaac,Richard J, AU - Ekinci,Elif I, AU - Premaratne,Erosha, AU - Lu,Zhong X, AU - Seah,Jas-Mine, AU - Li,Yue, AU - Boston,Ray, AU - Ward,Glenn M, AU - Jerums,George, Y1 - 2015/12/03/ PY - 2015/06/01/received PY - 2015/11/25/accepted PY - 2015/12/4/entrez PY - 2015/12/4/pubmed PY - 2016/6/29/medline SP - 198 EP - 198 JF - BMC nephrology JO - BMC Nephrol VL - 16 N2 - BACKGROUND: Our hypothesis was that both the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations would underestimate directly measured GFR (mGFR) to a similar extent in people with diabetes and preserved renal function. METHODS: In a cross-sectional study, bias (eGFR - mGFR) was compared for the CKD-EPI and MDRD equations, after stratification for mGFR levels. We also examined the ability of the CKD-EPI compared with the MDRD equation to correctly classify subjects to various CKD stages. In a longitudinal study of subjects with an early decline in GFR i.e., initial mGFR > 60 ml/min/1.73 m(2) and rate of decline in GFR (ΔmGFR) > 3.3 ml/min/1.73 m(2) per year, ΔmGFR (based on initial and final values) was compared with ΔeGFR by the CKD-EPI and MDRD equations over a mean of 9 years. RESULTS: In the cross-sectional study, mGFR for the whole group was 80 ± 2.2 ml/min/1.73 m(2) (n = 199, 75 % type 2 diabetes). For subjects with mGFR >90 ml/min/1.73 m(2) (mGFR: 112 ± 2.0, n = 76), both equations significantly underestimated mGFR to a similar extent: bias for CKD-EPI: -12 ± 1.4 ml/min/1.73 m(2) (p < 0.001) and for MDRD: -11 ± 2.1 ml/min/1.73 m(2) (p < 0.001). Using the CKD-EPI compared with the MDRD equation did not improve the number of subjects that were correctly classified to a CKD-stage. No biochemical or clinical patient characteristics were identified to account for the under estimation of mGFR values in the normal to high range by the CKD-EPI equation. In the longitudinal study (n = 30, 66 % type 1 diabetes), initial and final mGFR values were 102.8 ± 6 and 54.6 ± 6.0 ml/min/1.73 m(2), respectively. Mean ΔGFR (ml/min/1.73 m(2) per year) was 6.0 by mGFR compared with only 3.0 by MDRD and 3.2 by CKD-EPI (both p < 0.05 vs mGFR) CONCLUSIONS: Both the CKD-EPI and MDRD equations underestimate reference GFR values > 90 ml/min/1.73 m(2) as well as an early decline in GFR to a similar extent in people with diabetes. There is scope to improve methods for estimating an early decline in GFR. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/26630928/The_Chronic_Kidney_Disease_Epidemiology_Collaboration__CKD_EPI__equation_does_not_improve_the_underestimation_of_Glomerular_Filtration_Rate__GFR__in_people_with_diabetes_and_preserved_renal_function_ DB - PRIME DP - Unbound Medicine ER -