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Data mining of reference intervals for serum creatinine: an improvement in glomerular filtration rate estimating equations based on Q-values

  • Yao Ma , Zhenzhu Yong , Lu Wei , Haichuan Yuan , Lihong Wan , Xiaohua Pei , Feng Zhang , Guohua Wen , Cheng Jin , Yan Gu , Qun Zhang EMAIL logo , Weihong Zhao EMAIL logo and Bei Zhu EMAIL logo
Published/Copyright: January 12, 2024
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 62 Issue 6

Abstract

Objectives

Glomerular filtration rate (GFR) estimating equations based on rescaled serum creatinine (SCr/Q) have shown better performance, where Q represents the median SCr for age- and sex-specific healthy populations. However, there remains a scarcity of investigations in China to determine this value. We aimed to develop Chinese age- and sex-specific reference intervals (RIs) and Q-values for SCr and to validate the equations incorporating new Q-values.

Methods

We included 117,345 adults from five centers for establishing RIs and Q-values, and 3,692 participants with reference GFR (rGFR, 99mTc-DTPA renal dynamic imaging measurement) for validation. Appropriate age partitioning was determined using the decision tree method. Lower and upper reference limits and medians were calculated using the refineR algorithm, and Q-values were determined accordingly. We evaluated the full age spectrum (FAS) and European Kidney Function Consortium (EKFC) equations incorporating different Q-values considering bias, precision (interquartile range, IQR), and accuracy (percentage of estimates within ±20 % [P20] and ±30 % [P30] of rGFR).

Results

RIs for males were: 18–79 years, 55.53–92.50 μmol/L; ≥80 years, 54.41–96.43 μmol/L. RIs for females were: 18–59 years, 40.42–69.73 μmol/L; 60–79 years, 41.16–73.69 μmol/L; ≥80 years, 46.50–73.20 μmol/L. Q-values were set at 73.82 μmol/L (0.84 mg/dL) for males and 53.80 μmol/L (0.61 mg/dL) for females. After validation, we found that the adjusted equations exhibit less bias, improved precision and accuracy, and increased agreement of GFR categories.

Conclusions

We determined Chinese age- and sex-specific RIs and Q-values for SCr. The adjustable Q-values provide an effective alternative to obtain valid equations for estimating GFR.

Keywords: creatinine; reference interval; glomerular filtration rate (GFR); kidney function tests
Corresponding authors: Qun Zhang, MD, Health Management Center, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, P.R. China, E-mail: ; and Weihong Zhao, MD, PhD and Bei Zhu, MD, Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, P.R. China, E-mail: (W. Zhao), (B. Zhu)
Qun Zhang, Weihong Zhao, and Bei Zhu share senior authorship.

Funding source: National Natural Science Foundation of China

Award Identifier / Grant number: 82171585

Funding source: Jiangsu Province Graduate Training Innovation Project

Award Identifier / Grant number: SJCX21_0620

Funding source: Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital

Award Identifier / Grant number: JSPH-MC-2022-22

Funding source: Jiangsu Commission of Health

Award Identifier / Grant number: BJ17018

Award Identifier / Grant number: LX2021003

  1. Research ethics: The study was approved by the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University and conducted in accordance with the Declaration of Helsinki, registration number 2021-SR-508.

  2. Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.

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

  4. Competing interests: Authors state no conflict of interest.

  5. Research funding: This study was supported by the grants from the National Key R&D Program of China (2018YFC2002100, 2018YFC2002102), National Natural Science Foundation of China (82171585), Jiangsu Province Older Adults Health Introduction New Technique Project (LX2021003), Jiangsu Province Hospital Clinical Ability Improvement Project (JSPH-MC-2022-22), Jiangsu Province Graduate Training Innovation Project (SJCX21_0620), Jiangsu Province Cadres Health Care Project (BJ17018).

  6. Data availability: The data underlying this article will be shared on reasonable request to the corresponding author.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2023-1421).

Received: 2023-12-11
Accepted: 2024-01-02
Published Online: 2024-01-12
Published in Print: 2024-05-27

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2023-1421
Keywords for this article
creatinine; reference interval; glomerular filtration rate (GFR); kidney function tests

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  1. Frontmatter
  2. Editorial
  3. SARS-CoV-2 is here to stay: do not lower our guard
  4. Reviews
  5. SARS-CoV-2 subgenomic RNA: formation process and rapid molecular diagnostic methods
  6. Prognostic value of anti-SARS-CoV-2 antibodies: a systematic review
  7. Presence of SARS-CoV-2 RNA in COVID-19 survivors with post-COVID symptoms: a systematic review of the literature
  8. Opinion Papers
  9. Harmonizing the post-analytical phase: focus on the laboratory report
  10. Blood-based biomarkers in Alzheimer’s disease – moving towards a new era of diagnostics
  11. A comprehensive review on PFAS including survey results from the EFLM Member Societies
  12. General Clinical Chemistry and Laboratory Medicine
  13. Report from the HarmoSter study: different LC-MS/MS androstenedione, DHEAS and testosterone methods compare well; however, unifying calibration is a double-edged sword
  14. An LC–MS/MS method for serum cystatin C quantification and its comparison with two commercial immunoassays
  15. CX3CL1/Fractalkine as a biomarker for early pregnancy prediction of preterm premature rupture of membranes
  16. Elevated S100B urine levels predict seizures in infants complicated by perinatal asphyxia and undergoing therapeutic hypothermia
  17. The correlation of urea and creatinine concentrations in sweat and saliva with plasma during hemodialysis: an observational cohort study
  18. Tubular phosphate transport: a comparison between different methods of urine sample collection in FGF23-dependent hypophosphatemic syndromes
  19. Reference Values and Biological Variations
  20. Monocyte distribution width (MDW): study of reference values in blood donors
  21. Data mining of reference intervals for serum creatinine: an improvement in glomerular filtration rate estimating equations based on Q-values
  22. Hematology and Coagulation
  23. MALDI-MS in first-line screening of newborns for sickle cell disease: results from a prospective study in comparison to HPLC
  24. Cardiovascular Diseases
  25. To rule-in, or not to falsely rule-out, that is the question: evaluation of hs-cTnT EQA performance in light of the ESC-2020 guideline
  26. Temporal biomarker concentration patterns during the early course of acute coronary syndrome
  27. Diabetes
  28. Proteomic analysis of diabetic retinopathy identifies potential plasma-protein biomarkers for diagnosis and prognosis
  29. Infectious Diseases
  30. Serum biomarkers of inflammation and vascular damage upon SARS-Cov-2 mRNA vaccine in patients with thymic epithelial tumors
  31. A high throughput immuno-affinity mass spectrometry method for detection and quantitation of SARS-CoV-2 nucleoprotein in human saliva and its comparison with RT-PCR, RT-LAMP, and lateral flow rapid antigen test
  32. Evaluation of inflammatory biomarkers and vitamins in hospitalized patients with SARS-CoV-2 infection and post-COVID syndrome
  33. The CoLab score is associated with SARS-CoV-2 viral load during admission in individuals admitted to the intensive care unit: the CoLaIC cohort study
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  35. Letters to the Editor
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