Startseite GFR estimation based on standardized creatinine and cystatin C: a European multicenter analysis in older adults
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GFR estimation based on standardized creatinine and cystatin C: a European multicenter analysis in older adults

  • Jonas Björk , Sten Erik Bäck , Natalie Ebert , Marie Evans , Anders Grubb , Magnus Hansson , Ian Jones , Edmund J. Lamb , Peter Martus , Elke Schaeffner , Per Sjöström und Ulf Nyman EMAIL logo
Veröffentlicht/Copyright: 6. Oktober 2017
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Clinical Chemistry and Laboratory Medicine (CCLM)
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine (CCLM) Band 56 Heft 3

Abstract

Background:

Although recommended by the Kidney Disease Improving Global Outcomes, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICR) creatinine equation was not targeted to estimate glomerular filtration rate (eGFR) among older adults. The Berlin Initiative Study (BIS1CR) equation was specifically developed in older adults, and the Lund-Malmö revised (LMRCR) and the Full Age Spectrum (FASCR) equations have shown promising results in older adults. Our aim was to validate these four creatinine equations, including addition of cystatin C in a large multicenter cohort of Europeans ≥70 years.

Methods:

A total of 3226 individuals (2638 with cystatin C) underwent GFR measurement (mGFR; median, 44 mL/min/1.73 m2) using plasma iohexol clearance. Bias, precision (interquartile range [IQR]), accuracy (percent of estimates ±30% of mGFR, P30), eGFR accuracy diagrams and probability diagrams to classify mGFR<45 mL/min/1.73 m2 were compared.

Results:

The overall results of BIS1CR/CKD-EPICR/FASCR/LMRCR were as follows: median bias, 1.7/3.6/0.6/−0.7 mL/min/1.73 m2; IQR, 11.6/12.3/11.1/10.5 mL/min/1.73 m2; and P30, 77.5%/76.4%/80.9%/83.5% (significantly higher for LMR, p<0.001). Substandard P30 (<75%) was noted for all equations at mGFR<30 mL/min/1.73 m2, and at body mass index values <20 and ≥35 kg/m2. LMRCR had the most stable performance across mGFR subgroups. Only LMRCR and FASCR had a relatively constant small bias across eGFR levels. Probability diagrams exhibited wide eGFR intervals for all equations where mGFR<45 could not be confidently ruled in or out. Adding cystatin C improved P30 accuracy to 85.7/86.8/85.7/88.7 for BIS2CR+CYS/CKD-EPICR+CYS/FASCR+CYS/MEANLMR+CAPA.

Conclusions:

LMRCR and FASCR seem to be attractive alternatives to CKD-EPICR in estimating GFR by creatinine-based equations in older Europeans. Addition of cystatin C leads to important improvement in estimation performance.

Keywords: chronic kidney disease; creatinine; cystatin C; glomerular filtration rate; kidney function tests; renal failure

Acknowledgments

Librarian Elisabeth Sassersson for excellent service regarding literature references.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: UN and JB receive reimbursement for letting GE Healthcare AB, Danderyd, Sweden, distribute the computer program OmniVis in radiology departments for GFR estimation based on various creatinine- and cystatin C-based equations. UN receives lecture fees from GE Healthcare AB, Danderyd, Sweden. None declared by the remaining authors (SEB, NE, ME, AG, MH, IJ, EJL, PM, ES and PS).

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Supplemental Material:

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2017-0563).

Received: 2017-6-28
Accepted: 2017-8-17
Published Online: 2017-10-6
Published in Print: 2018-2-23

©2018 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. Analytical quality: an unfinished journey
  4. Reviews
  5. Update in diagnosis and management of primary aldosteronism
  6. Diagnosis biomarkers in acute intestinal ischemic injury: so close, yet so far
  7. Opinion Papers
  8. Irregular analytical errors in diagnostic testing – a novel concept
  9. A Black Swan in clinical laboratory practice: the analytical error due to interferences in immunoassay methods
  10. General Clinical Chemistry and Laboratory Medicine
  11. Reaching consensus on communication of critical laboratory results using a collective intelligence method
  12. Stability of routine biochemical analytes in whole blood and plasma/serum: focus on potassium stability from lithium heparin
  13. GFR estimation based on standardized creatinine and cystatin C: a European multicenter analysis in older adults
  14. Binding of bromocresol green and bromocresol purple to albumin in hemodialysis patients
  15. Interlaboratory variability of urinary iodine measurements
  16. The venous thromboembolic risk and the clot wave analysis: a useful relationship?
  17. Hematology and Coagulation
  18. Autovalidation and automation of the postanalytical phase of routine hematology and coagulation analyses in a university hospital laboratory
  19. Reference Values and Biological Variations
  20. Indirect method for validating transference of reference intervals
  21. Differences in levels of albumin, ALT, AST, γ-GT and creatinine in frail, moderately healthy and healthy elderly individuals
  22. Cancer Diagnostics
  23. Serum exosomal hnRNPH1 mRNA as a novel marker for hepatocellular carcinoma
  24. Intragenic hypomethylation of DNMT3A in patients with myelodysplastic syndrome
  25. Cardiovascular Diseases
  26. Evaluation of analytical performance of a new high-sensitivity immunoassay for cardiac troponin I
  27. MEF2C loss-of-function mutation associated with familial dilated cardiomyopathy
  28. Letter to the Editor
  29. Hyperuricemia does not seem to be an independent risk factor for coronary heart disease
  30. Reply to: Hyperuricemia does not seem to be an independent risk factor for coronary heart disease
  31. Preanalytics of ammonia: stability, transport and temperature of centrifugation
  32. Influence of delayed separation of plasma from whole blood on Cu, I, Mn, Se, and Zn plasma concentrations
  33. Copeptin as a diagnostic and prognostic biomarker in patients admitted to Emergency Department with syncope, presyncope and vertiginous syndrome
  34. Development of an internally controlled quantitative PCR to measure total cell-associated HIV-1 DNA in blood
  35. Selective changes in cholesterol metabolite levels in plasma of breast cancer patients after tumor removal
  36. Athletes beware before throwing towels to audiences
https://doi.org/10.1515/cclm-2017-0563
Schlagwörter für diesen Artikel
chronic kidney disease; creatinine; cystatin C; glomerular filtration rate; kidney function tests; renal failure

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. Analytical quality: an unfinished journey
  4. Reviews
  5. Update in diagnosis and management of primary aldosteronism
  6. Diagnosis biomarkers in acute intestinal ischemic injury: so close, yet so far
  7. Opinion Papers
  8. Irregular analytical errors in diagnostic testing – a novel concept
  9. A Black Swan in clinical laboratory practice: the analytical error due to interferences in immunoassay methods
  10. General Clinical Chemistry and Laboratory Medicine
  11. Reaching consensus on communication of critical laboratory results using a collective intelligence method
  12. Stability of routine biochemical analytes in whole blood and plasma/serum: focus on potassium stability from lithium heparin
  13. GFR estimation based on standardized creatinine and cystatin C: a European multicenter analysis in older adults
  14. Binding of bromocresol green and bromocresol purple to albumin in hemodialysis patients
  15. Interlaboratory variability of urinary iodine measurements
  16. The venous thromboembolic risk and the clot wave analysis: a useful relationship?
  17. Hematology and Coagulation
  18. Autovalidation and automation of the postanalytical phase of routine hematology and coagulation analyses in a university hospital laboratory
  19. Reference Values and Biological Variations
  20. Indirect method for validating transference of reference intervals
  21. Differences in levels of albumin, ALT, AST, γ-GT and creatinine in frail, moderately healthy and healthy elderly individuals
  22. Cancer Diagnostics
  23. Serum exosomal hnRNPH1 mRNA as a novel marker for hepatocellular carcinoma
  24. Intragenic hypomethylation of DNMT3A in patients with myelodysplastic syndrome
  25. Cardiovascular Diseases
  26. Evaluation of analytical performance of a new high-sensitivity immunoassay for cardiac troponin I
  27. MEF2C loss-of-function mutation associated with familial dilated cardiomyopathy
  28. Letter to the Editor
  29. Hyperuricemia does not seem to be an independent risk factor for coronary heart disease
  30. Reply to: Hyperuricemia does not seem to be an independent risk factor for coronary heart disease
  31. Preanalytics of ammonia: stability, transport and temperature of centrifugation
  32. Influence of delayed separation of plasma from whole blood on Cu, I, Mn, Se, and Zn plasma concentrations
  33. Copeptin as a diagnostic and prognostic biomarker in patients admitted to Emergency Department with syncope, presyncope and vertiginous syndrome
  34. Development of an internally controlled quantitative PCR to measure total cell-associated HIV-1 DNA in blood
  35. Selective changes in cholesterol metabolite levels in plasma of breast cancer patients after tumor removal
  36. Athletes beware before throwing towels to audiences
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