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Comparative Prognostic Assessment of European Kidney Function Consortium Equations for Mortality Prediction: A
Sitong Chen1, Jinjing Shi1,2, Iokfai Cheang1
1State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Cardiorenal Medicine
|June 9, 2026
Summary
The cystatin C-based European Kidney Function Consortium (EKFC) equation (EKFC-eGFRcys) better predicts long-term mortality than creatinine-based (EKFC-eGFRcr) or combined models. Cystatin C alone offers superior prognostic value for all-cause and cardiovascular mortality risk stratification.
Area of Science:
- Nephrology
- Epidemiology
- Biomarkers
Background:
- The European Kidney Function Consortium (EKFC) developed equations for estimating glomerular filtration rate (eGFR) using creatinine (Cr) and cystatin C (Cys).
- While diagnostic accuracy is known, the comparative prognostic value of these eGFR equations for long-term mortality in the general population remains unclear.
Purpose of the Study:
- To compare the prognostic performance of three EKFC eGFR equations (creatinine-based, cystatin C-based, and combined) for predicting all-cause and cardiovascular mortality.
- To evaluate the incremental prognostic value of cystatin C and creatinine in predicting mortality.
Main Methods:
- Analysis of a population-based cohort (n=4519) from the National Health and Nutrition Examination Survey (NHANES) 1999-2002.
- Calculation of eGFR using EKFC-eGFRcr, EKFC-eGFRcys, and EKFC-eGFRcrcys equations.
- Assessment of all-cause and cardiovascular mortality through December 31, 2019, using integrated discrimination improvement (IDI), net reclassification improvement (NRI), and number needed to measure (NNM).
Main Results:
- All three EKFC eGFR models independently predicted mortality (P <0.001) over a median follow-up of 211 months.
- EKFC-eGFRcys significantly improved risk reclassification for all-cause mortality compared to EKFC-eGFRcr (NRI = 15.9%).
- EKFC-eGFRcys showed modestly better performance than the combined EKFC-eGFRcrcys model (NRI = 7.0%), indicating limited added value of creatinine when cystatin C is used.
Conclusions:
- The EKFC-eGFRcys equation demonstrates superior prognostic value for all-cause and cardiovascular mortality compared to creatinine-based and combined EKFC equations.
- The combined EKFC-eGFRcrcys model provided no significant prognostic advantage over cystatin C alone.
- Cystatin C-based eGFR is clinically important for accurate mortality risk stratification in the general population.
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