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Performance evaluation of estimated glomerular filtration rate (eGFR) equations in Asia: A systematic review
A Siddiqui1, S Lakhani1, F A Khan2
1The Aga Khan University, Medical College, Karachi, Pakistan.
Introduction:
Chronic kidney disease (CKD) poses a global public health challenge, necessitating accurate assessment of renal function for timely intervention. Glomerular filtration rate (GFR) is a crucial indicator, traditionally measured using creatinine-based equations. However, Cystatin C-based equations offer potential advantages. We aim to evaluate the performance of estimated GFR (eGFR) equations for accurate renal function assessment in diverse Asian populations.
Materials And Methods:
Following PRISMA guidelines, the systematic review covered studies from 1991 to 2023 across Asian populations, incorporating equations based on both creatinine and Cystatin C. Eligibility criteria included adults aged 18 or older, either healthy or with CKD. Data extraction included study details, population characteristics, disease conditions, and formulas used. Quality assessment was conducted using the QUADAS-2 tool.
Results:
The study analysed 26 studies focusing on South Asia and 66 on East Asia. In South Asia, the CKD-Epi-Pak equation demonstrated superior accuracy, achieving high percentages of eGFR values within specified ranges of measured GFR (P15: 70.39%, P30: 89.35%) with minimal bias (-1.33). The traditional MDRD equation exhibited poor performance, registering the lowest agreement percentages (P15: 7.8%, P30: 25.4%, P50: 71.1%) and the highest bias (-26.13). In East Asia, the CKD-Epi-2021 formula displayed the best accuracy, with high percentages of eGFR values within specified ranges (P15: 65.4%, P30: 97.6%). The simplified MDRD formula showed suboptimal performance, indicating lower agreement percentages (P15: 15.46%, P50: 56.59%). Variations of the MDRD formula in Japan exhibited bias while modified Gates Method demonstrated inferior precision.
Conclusion:
CKD-Epi-Pak and CKD-Epi-2021 show potential suitability in South and East Asia, respectively. Future research should prioritise ethnicity-specific equation development to enhance accuracy and clinical utility in Asian populations.
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