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Agreement between Chronic Kidney Disease Epidemiological Collaboration and Berlin Initiative Study equations for estimating glomerular filtration rate in older people: The Invecchiare in Chianti (Aging in Chianti Region) study.

ABSTRACT: AIM:The aim was to investigate to what extent chronic kidney disease (CKD) can be staged interchangeably by Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) and by Berlin Initiative Study (BIS) equations, and to verify whether cystatin C can improve concordance between formulas. METHODS:Our series consisted of 828 community-dwelling individuals aged 65 years or older enrolled in the Invecchiare in Chianti Study ("Aging in the Chianti Region"). Estimated glomerular filtration rate was calculated using the creatinine-based CKD-EPI, creatinine/cystatin C-based CKD-EPI, creatinine-based BIS and creatinine/cystatin C-based BIS equations. Agreement and sources of discrepancy between equations in identifying people with different degrees of kidney dysfunction was investigated by ? statistic and Bland-Altman plots. RESULTS:Overall, CKD-EPI values were higher than that obtained with BIS equations, especially for eGFR = 30-60 mL/min/1.73 m2 . A total of 191 out of 828 participants were classified in stage 2 by the creatinine-based CKD-EPI and in stage 3a by the creatinine-based BIS equation, whereas 123 participants were classified in stage 2 by creatinine/cystatin C-based CKD-EPI and in stage 3a by the creatinine/cystatin C-based BIS equation. A total of 27 participants were classified in stage 3a by creatinine-based CKD-EPI and in stage 3b by creatinine-based BIS equation, whereas 18 were classified as stage 3a by creatinine/cystatin C-based CKD-EPI and stage 3b by the creatinine/cystatin C-based BIS equation. CONCLUSIONS:Despite a fair overall concordance, the CKD-EPI and BIS equations cannot be considered interchangeable to assess estimated glomerular filtration rate in older people, and using creatinine/cystatin C-based rather than creatinine-based equations only marginally improves the concordance between CKD-EPI and BIS. Disagreement between equations might significantly impact the applications of stage-specific measures for managing CKD among older people. Geriatr Gerontol Int 2017; 17: 1559-1567.

SUBMITTER: Corsonello A

PROVIDER: S-EPMC5804486 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Agreement between Chronic Kidney Disease Epidemiological Collaboration and Berlin Initiative Study equations for estimating glomerular filtration rate in older people: The Invecchiare in Chianti (Aging in Chianti Region) study.

Corsonello Andrea A Pedone Claudio C Bandinelli Stefania S Ferrucci Luigi L Antonelli Incalzi Raffaele R

Geriatrics & gerontology international 20161205 10

<h4>Aim</h4>The aim was to investigate to what extent chronic kidney disease (CKD) can be staged interchangeably by Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) and by Berlin Initiative Study (BIS) equations, and to verify whether cystatin C can improve concordance between formulas.<h4>Methods</h4>Our series consisted of 828 community-dwelling individuals aged 65 years or older enrolled in the Invecchiare in Chianti Study ("Aging in the Chianti Region"). Estimated glomerular fi ...[more]

PMID: 27917582

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Project description:Accurate estimation of glomerular filtration rate (GFR) is important for diagnosis and risk stratification in chronic kidney disease and for selection of living donors. Ethnic differences have required correction factors in the originally developed creatinine-based GFR estimation equations for populations around the world. Existing equations have not been validated in the vegetarian Indian population. We examined the performance of creatinine and cystatin-based GFR estimating equations in Indians.GFR was measured by urinary clearance of inulin. Serum creatinine was measured using IDMS-traceable Jaffe's and enzymatic assays, and cystatin C by colloidal gold immunoassay. Dietary protein intake was calculated by measuring urinary nitrogen appearance. Bias, precision and accuracy were calculated for the eGFR equations.A total of 130 participants (63 healthy kidney donors and 67 with CKD) were studied. About 50% were vegetarians, and the remainder ate meat 3.8 times every month. The average creatinine excretion were 14.7 mg/kg/day (95% CI: 13.5 to 15.9 mg/kg/day) and 12.4 mg/kg/day (95% CI: 11.2 to 13.6 mg/kg/day) in males and females, respectively. The average daily protein intake was 46.1 g/day (95% CI: 43.2 to 48.8 g/day). The mean mGFR in the study population was 51.66?±?31.68 ml/min/1.73m2. All creatinine-based eGFR equations overestimated GFR (p?<?0.01 for each creatinine based eGFR equation). However, eGFR by CKD-EPICys was not significantly different from mGFR (p?=?0.38). The CKD-EPICys exhibited lowest bias [mean bias: -3.53?±?14.70 ml/min/1.73m2 (95% CI: -0.608 to -0.98)] and highest accuracy (P30: 74.6%). The GFR in the healthy population was 79.44 ± 20.19 (range: 41.90-134.50) ml/min/1.73m2.Existing creatinine-based GFR estimating equations overestimate GFR in Indians. An appropriately powered study is needed to develop either a correction factor or a new equation for accurate assessment of kidney function in the Indian population.

Project description:Rationale & objectiveEvaluation of glomerular filtration rate (GFR) is challenging in adults undergoing bariatric surgery because creatinine and cystatin C levels are influenced by changes in muscle and fat mass. Additionally, indexing of GFR by body surface area (BSA) may by affected by decreases in BSA.Study designProspective observational study.Setting & participants27 adults with body mass index (BMI) ≥ 35 kg/m2 who underwent measurement of GFR before and after bariatric surgery.OutcomesIndexed and nonindexed GFRs measured (mGFRs) using plasma iohexol clearance, indexed and nonindexed estimated GFR (eGFR) based on levels of creatinine, cystatin C, or both from Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations.Analytic approachBias and percent of estimates within 20% and 30% of mGFR (P20 and P30) for estimating equations were examined.ResultsMean presurgery BMI was 49.5 (SD, 9.4) kg/m2, BSA was 2.42 (SD, 0.27) m2, nonindexed mGFR was 117.3 (SD, 34.1) mL/min, and indexed mGFR was 84.1 (SD, 22.0) mL/min/1.73 m2. After 6 months, mean BMI changed by -13.8 (95% CI, -15.9 to -11.8) kg/m2, BSA by -0.30 (95% CI, -0.33 to -0.27) m2, and nonindexed mGFR by -9.2 (95% CI, -17.2 to -1.1) mL/min, while indexed mGFR was unchanged at 5.1 (95% CI, -0.1 to 10.4) mL/min/1.73 m2. Nonindexed eGFRcr was unbiased (median bias, 5.0 [95% CI, -4.3 to 11.6] mL/min) before surgery, but overestimated mGFR (8.8 [95% CI, 1.8 to 16.9] mL/min) after surgery. Nonindexed eGFRcys underestimated mGFR before (median bias, -12.1 [95% CI, -21.4 to -1.2] mL/min) and after surgery (-11.2 [95% CI, -21.8 to -7.3] mL/min). Nonindexed eGFRcr-cys was unbiased before (median bias, -6.0 [95% CI, -11.0 to 1.0] mL/min) and after surgery (-2.0 [95% CI, -8.8 to 4.9] mL/min). Findings were similar for indexed eGFR compared with indexed mGFR.LimitationsSmall, mostly white sample.ConclusionsChanges in indexed and nonindexed GFRs may be discordant after bariatric surgery in adults because of decreases in BSA. Indexed and nonindexed eGFRcr-cys may be less biased than indexed or nonindexed eGFRcr or eGFRcys because of opposite biases in estimating mGFR.

Dataset Information

Agreement between Chronic Kidney Disease Epidemiological Collaboration and Berlin Initiative Study equations for estimating glomerular filtration rate in older people: The Invecchiare in Chianti (Aging in Chianti Region) study.

Publications

Agreement between Chronic Kidney Disease Epidemiological Collaboration and Berlin Initiative Study equations for estimating glomerular filtration rate in older people: The Invecchiare in Chianti (Aging in Chianti Region) study.

Similar Datasets

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