Cargando…

Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians

INTRODUCTION: The creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation was calibrated for the general Pakistan population (eGFRcr-PK) to eliminate bias and improve accuracy. Cystatin C–based CKD-EPI equations (eGFRcys and e...

Descripción completa

Detalles Bibliográficos
Autores principales: Wang, Yeli, Levey, Andrew S., Inker, Lesley A., Jessani, Saleem, Bux, Rasool, Samad, Zainab, Khan, Ali Raza, Karger, Amy B., Allen, John C., Jafar, Tazeen H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071622/
https://www.ncbi.nlm.nih.gov/pubmed/33912746
http://dx.doi.org/10.1016/j.ekir.2021.01.005
_version_ 1783683749422039040
author Wang, Yeli
Levey, Andrew S.
Inker, Lesley A.
Jessani, Saleem
Bux, Rasool
Samad, Zainab
Khan, Ali Raza
Karger, Amy B.
Allen, John C.
Jafar, Tazeen H.
author_facet Wang, Yeli
Levey, Andrew S.
Inker, Lesley A.
Jessani, Saleem
Bux, Rasool
Samad, Zainab
Khan, Ali Raza
Karger, Amy B.
Allen, John C.
Jafar, Tazeen H.
author_sort Wang, Yeli
collection PubMed
description INTRODUCTION: The creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation was calibrated for the general Pakistan population (eGFRcr-PK) to eliminate bias and improve accuracy. Cystatin C–based CKD-EPI equations (eGFRcys and eGFRcr-cys) have not been assessed in this population, and non-GFR determinants of cystatin C are unknown. METHODS: We assessed eGFRcys, eGFRcr-cys, and non-GFR determinants of cystatin C in a cross-sectional study of 557 participants (≥40 years of age) from Pakistan. We compared bias (median difference in measured GFR [mGFR] and eGFR), precision (interquartile range [IQR] of differences), accuracy (percentage of eGFR within 30% of mGFR), root mean square error (RMSE), and classification of mGFR <60 ml/min/1.73 m(2) (area under the receiver operating characteristic curve [AUC] and net reclassification index [NRI]) among eGFR equations. RESULTS: We found that eGFRcys underestimated mGFR (bias, 12.7 ml/min/1.73 m(2) [95% confidence interval {CI} 10.7–15.2]). eGFRcr-cys did not improve performance over eGFRcr-PK in precision (P = 0.52), accuracy (P = 0.58), or RMSE (P = 0.49). Results were consistent among subgroups by age, sex, smoking, body mass index (BMI), and eGFR. NRI was 7.31% (95% CI 1.52%–13.1%; P < 0.001) for eGFRcr-cys versus eGFRcr-PK, but AUC was not improved (0.92 [95% CI 0.87–0.96] vs. 0.90 [95% CI 0.86–0.95]; P = 0.056). Non-GFR determinants of higher cystatin C included male sex, smoking, higher BMI and total body fat, and lower lean body mass. CONCLUSION: eGFRcys underestimated mGFR in South Asians and eGFRcr-cys did not offer substantial advantage compared with eGFRcr-PK. Future studies are warranted to better understand the large bias in eGFRcys and non-GFR determinants of cystatin C in South Asians.
format Online
Article
Text
id pubmed-8071622
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-80716222021-04-27 Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians Wang, Yeli Levey, Andrew S. Inker, Lesley A. Jessani, Saleem Bux, Rasool Samad, Zainab Khan, Ali Raza Karger, Amy B. Allen, John C. Jafar, Tazeen H. Kidney Int Rep Clinical Research INTRODUCTION: The creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation was calibrated for the general Pakistan population (eGFRcr-PK) to eliminate bias and improve accuracy. Cystatin C–based CKD-EPI equations (eGFRcys and eGFRcr-cys) have not been assessed in this population, and non-GFR determinants of cystatin C are unknown. METHODS: We assessed eGFRcys, eGFRcr-cys, and non-GFR determinants of cystatin C in a cross-sectional study of 557 participants (≥40 years of age) from Pakistan. We compared bias (median difference in measured GFR [mGFR] and eGFR), precision (interquartile range [IQR] of differences), accuracy (percentage of eGFR within 30% of mGFR), root mean square error (RMSE), and classification of mGFR <60 ml/min/1.73 m(2) (area under the receiver operating characteristic curve [AUC] and net reclassification index [NRI]) among eGFR equations. RESULTS: We found that eGFRcys underestimated mGFR (bias, 12.7 ml/min/1.73 m(2) [95% confidence interval {CI} 10.7–15.2]). eGFRcr-cys did not improve performance over eGFRcr-PK in precision (P = 0.52), accuracy (P = 0.58), or RMSE (P = 0.49). Results were consistent among subgroups by age, sex, smoking, body mass index (BMI), and eGFR. NRI was 7.31% (95% CI 1.52%–13.1%; P < 0.001) for eGFRcr-cys versus eGFRcr-PK, but AUC was not improved (0.92 [95% CI 0.87–0.96] vs. 0.90 [95% CI 0.86–0.95]; P = 0.056). Non-GFR determinants of higher cystatin C included male sex, smoking, higher BMI and total body fat, and lower lean body mass. CONCLUSION: eGFRcys underestimated mGFR in South Asians and eGFRcr-cys did not offer substantial advantage compared with eGFRcr-PK. Future studies are warranted to better understand the large bias in eGFRcys and non-GFR determinants of cystatin C in South Asians. Elsevier 2021-01-16 /pmc/articles/PMC8071622/ /pubmed/33912746 http://dx.doi.org/10.1016/j.ekir.2021.01.005 Text en © 2021 International Society of Nephrology. Published by Elsevier Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Research
Wang, Yeli
Levey, Andrew S.
Inker, Lesley A.
Jessani, Saleem
Bux, Rasool
Samad, Zainab
Khan, Ali Raza
Karger, Amy B.
Allen, John C.
Jafar, Tazeen H.
Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians
title Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians
title_full Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians
title_fullStr Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians
title_full_unstemmed Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians
title_short Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians
title_sort performance and determinants of serum creatinine and cystatin c–based gfr estimating equations in south asians
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071622/
https://www.ncbi.nlm.nih.gov/pubmed/33912746
http://dx.doi.org/10.1016/j.ekir.2021.01.005
work_keys_str_mv AT wangyeli performanceanddeterminantsofserumcreatinineandcystatincbasedgfrestimatingequationsinsouthasians
AT leveyandrews performanceanddeterminantsofserumcreatinineandcystatincbasedgfrestimatingequationsinsouthasians
AT inkerlesleya performanceanddeterminantsofserumcreatinineandcystatincbasedgfrestimatingequationsinsouthasians
AT jessanisaleem performanceanddeterminantsofserumcreatinineandcystatincbasedgfrestimatingequationsinsouthasians
AT buxrasool performanceanddeterminantsofserumcreatinineandcystatincbasedgfrestimatingequationsinsouthasians
AT samadzainab performanceanddeterminantsofserumcreatinineandcystatincbasedgfrestimatingequationsinsouthasians
AT khanaliraza performanceanddeterminantsofserumcreatinineandcystatincbasedgfrestimatingequationsinsouthasians
AT kargeramyb performanceanddeterminantsofserumcreatinineandcystatincbasedgfrestimatingequationsinsouthasians
AT allenjohnc performanceanddeterminantsofserumcreatinineandcystatincbasedgfrestimatingequationsinsouthasians
AT jafartazeenh performanceanddeterminantsofserumcreatinineandcystatincbasedgfrestimatingequationsinsouthasians