Comparison of Pakistani CKD-EPI, new Asian-modified CKD-EPI and revised Lund-Malmö study equations in a South Asian...

Newly proposed estimating glomerular filtration rate equations need to be studied, evaluated and compared for chronic kidney disease staging, diagnosis and medication dosing in South Asians. The objectives of the study were (1) to assess the performance of the CKD-EPI_PK, CKD-EPI_{Asian-Modified,} and LM_Revised equations in the Pakistani chronic kidney disease population, and (2) to investigate prospective implications on chronic kidney disease classification and end-stage kidney disease prevalence.

We conducted a cross-sectional analysis on a chronic kidney disease cohort of 385 participants 18 years of age or above.

CKD-EPI_PK showed the lowest bias (- 1.33 ml/min/1.73 m²), highest precision [IQR, 2.33 (- 2.36, - 0.03)] and enhanced P30 accuracy (89.35%) compared to the CKD-EPI_{Asian-Modified} and LM_Revised equations. The mean difference (ml/min/1.73 m²), 95% limit of agreement (ml/min/1.73 m²) of the equations were; CKD-EPI_{Asian-Modified}: - 5.98, - 13.03, LM_Revised: - 4.06, - 8.13 and CKD-EPI_PK: - 1.18, - 6.14 (P < 0.001). CKD-EPI_{Asian-Modified} and LM_Revised showed upward re-classification of the GFR categories compared to the CKD-EPI_PK equation except in the G5 category where the highest count (217, 56.36%) was noted for the CKD-EPI_PK equation. End-stage kidney disease prevailed in all age groups according to all equations, and the prevalence was high in females in all equations.

CKD-EPI_PK showed the best performance, whereas both CKD-EPI_{Asian-Modified} and LM_Revised showed poor performance and did not offer a sufficient advantage in chronic kidney disease classification and end-stage kidney disease prevalence estimation over CKD-EPI_PK. Hence, CKD-EPI_PK seems ideal for South Asians, thus appropriate measures should be taken for its implementation, at least in Pakistani laboratories.