Prospects for improved glomerular filtration rate estimation based on creatinine-results from a transnational...

Area of Science:

• Nephrology
• Clinical Chemistry
• Epidemiology

Background:

• The CKD-EPI creatinine equation is standard for assessing renal function but has variable accuracy.
• Patient characteristics and clinical context influence the precision of GFR estimation.
• There is a need to enhance GFR estimation accuracy using creatinine-based methods.

Purpose of the Study:

• To evaluate the accuracy of the CKD-EPI equation for estimating GFR.
• To compare CKD-EPI with other GFR estimation equations, including LMR and Full Age Spectrum.
• To identify potential improvements in creatinine-based GFR estimation.

Main Methods:

• Cross-sectional analysis of data from 2003-2017.
• Validation of CKD-EPI against measured GFR (mGFR) in CKD and community cohorts.
• Comparison with Lund-Malmö revised (LMR) and Full Age Spectrum equations.

Main Results:

• CKD-EPI overestimated GFR in young adults (18-39 years) across both cohort types.
• LMR demonstrated higher accuracy than CKD-EPI in CKD cohorts (P30: 83.5% vs 76.6%).
• All tested equations met the Kidney Disease Outcomes Quality Initiative benchmark (P30 > 90%) in community cohorts.

Conclusions:

• Current creatinine-based GFR estimation equations do not fully optimize data utilization.
• Enhanced GFR estimation procedures are feasible, particularly for young adults.
• Improvements are particularly relevant for patients with suspected or manifest Chronic Kidney Disease (CKD).