GFRs in Chinese CKD: A systematic review

Area of Science:

• Nephrology
• Clinical Chemistry
• Epidemiology

Background:

• Chronic kidney disease (CKD) affects a significant population in China.
• Accurate estimation of glomerular filtration rate (eGFR) is crucial for CKD diagnosis and management.
• Creatinine-based equations are widely used for eGFR estimation, but their accuracy varies across different populations.

Purpose of the Study:

• To evaluate the utility of various creatinine-based equations for estimating glomerular filtration rate (eGFR) in Chinese adults diagnosed with chronic kidney disease (CKD).
• To identify the most accurate eGFR equation for this specific demographic.

Main Methods:

• A systematic review and meta-analysis of studies published between January 2009 and January 2023.
• Inclusion of studies on creatinine-based eGFR equations for Chinese adults with CKD, identified through multiple database searches.
• Quality assessment of included studies using RevMan 5.4 software and extraction of data on equation performance metrics like bias, precision, and P30.

Main Results:

• Twenty-three studies involving six creatinine-based GFR equations (CKD-EPI, Asian modified CKD-EPI, FAS, EKFC, Xiangya, and BSI1) were analyzed.
• The FAS and EKFC equations demonstrated higher accuracy, with P30 values of 72.6% and 73.1%, respectively.
• The BSI1 equation showed acceptable bias and precision in elderly patients (≥60 years) but a relatively low P30 of 69.6%.

Conclusions:

• The FAS and EKFC equations are currently the most accurate for estimating GFR in Chinese adult CKD patients.
• The BSI1 equation's performance in older adults suggests a need for developing more precise eGFR equations for this subgroup.
• Further validation of these findings in large-scale, well-controlled clinical studies is recommended.