Comparison of Various Equations for Estimating GFR in Malawi: How to Determine Renal Function in Resource Limited...

Area of Science:

• Nephrology
• Public Health
• Infectious Diseases

Background:

• Chronic kidney disease (CKD) is a significant public health concern in Sub-Saharan Africa, particularly among HIV-infected populations.
• Accurate prevalence data is limited due to varied CKD classification methods in existing literature.

Purpose of the Study:

• To evaluate the performance of various serum creatinine-based equations for estimating glomerular filtration rate (eGFR).
• To compare these equations against a cystatin C-based equation in a Malawian adult population.
• To identify potential discrepancies in eGFR estimation between HIV-positive and HIV-negative individuals.

Main Methods:

• The study involved 363 adults in Lilongwe, Malawi, with 32% being HIV-positive.
• Serum creatinine-based eGFR equations were assessed and compared with a cystatin C-based equation.
• Statistical analyses included Bland-Altman plots and accuracy assessments.

Main Results:

• The CKD-EPI equation, without the black American correction factor, demonstrated the best performance.
• CKD-EPI systematically overestimated eGFR compared to cystatin C in HIV-positive individuals.
• This overestimation led to an underestimation of CKD prevalence in the HIV-positive cohort.

Conclusions:

• Standardization of eGFR calculation is crucial for Sub-Saharan Africa.
• Further research is needed to understand HIV status-specific differences in eGFR.
• Development of localized correction factors for eGFR equations is recommended.