Skip to main content
SpringerLink
Log in

A comparison between 2017 FAS and 2012 CKD-EPI equations: a multi-center validation study in Chinese adult population

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

The recent guidelines recommend using the estimated glomerular filtration rate (eGFR) to evaluate renal function. There are two reported full-age-spectrum (FAS) equations in 2017, which are based on serum cystatin C concentrations with or without accompanying serum creatinine level (FASCr–Cys or FASCys). We compared the performance and assessed the applicability of the new FAS equation with the 2012 CKD-EPI (CKD-EPICys and CKD-EPICr–Cys) equation in Chinese subjects.

Methods

A total of 1184 patients, mean aged 55.06 year who underwent 99mTc-DTPA GFR measurements (rGFR) from four hospitals were enrolled. The bias (eGFR-rGFR), precision (interquartile range of difference [IQR]), and accuracy (the proportion of eGFR within 30% of rGFR [P30]) of eGFR and rGFR calculated by four equations were compared.

Results

Generally, the equation based on the combination of Cys and Scr performed superior to that on the basis of Cys alone, either the CKD-EPICr–Cys or the FASCr–Cys. Detailedly, referred to rGFR (67.33 ml/min/1.73 m2), the CKD-EPICys, CKD-EPICr–Cys, FASCys, and the FASCr–Cys estimated GFR 56.46 ml/min/1.73 m2, 62.79 ml/min/1.73 m2, 56.45 ml/min/1.73 m2, and 61.04 ml/min/1.73 m2, gave ROCAUC0.944, 0.954, 0.943, and 0.953, respectively. Another comparison as to bias, precision, P30, and RMSE with FASCr–Cys were − 2.87 ml/min/1.73 m2, 19.01 ml/min/1.73 m2, 74.16%, and 17.84 ml/min/1.73 m2 showed that FASCr–Cys performed approximately more accurate than other equations, as well as the diagnostic consistency of GFR staging. In the rGFR < 60 ml/min/1.73 m2 subgroup, the FASCr–Cys equation showed the best performance. In older subjects, compared with FASCys, CKD-EPICr–Cys, and CKD-EPICys, the FASCr–Cys equation had relatively less bias (− 8.09 vs. − 9.63, − 7.52, − 11.04, P < 0.05), most precise (15.18 vs. 16.32, 15.22, 16.63), and most accuracy, P30 was statistically different from the other equations, and achieved a ideal value > 70%.

Conclusion

The performance of the FASCr–Cys equation is better than that of the CKD-EPICr–Cys equation in the Chinese population, particularly in the elderly. Yet, further modification of FAS equations from a large-scale study could be more suitable for the Chinese population, particularly in older people.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Murphy D, McCulloch CE, Lin F et al (2016) Trends in prevalence of chronic kidney disease in united states. Ann Intern Med 165(7):473–481

    Article  PubMed  PubMed Central  Google Scholar 

  2. deBoer IH (2012) Chronic kidney disease—a challenge for all ages. JAMA 308(22):2401–2402

    Article  CAS  Google Scholar 

  3. Stevens LA, Coresh J, Levey AS (2008) CKD in the elderly—old questions and new challenges. Am J Kidney Dis 51(3):353–357

    Article  PubMed  Google Scholar 

  4. Zhang L, Wang F, Wang L et al (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379(9818):815–822

    Article  PubMed  Google Scholar 

  5. Levey AS, Inker LA, Coresh J (2014) GFR estimation: from physiology to public health. Am J Kidney Dis 63:820–834

    Article  PubMed  PubMed Central  Google Scholar 

  6. Levey AS, Becker C, Inker LA (2015) Glomerular filtration rate and albuminuria for detection and staging of acute and chronic kidney disease in adults: a systematic review. JAMA 313(8):837–846

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Soveri I, Berg UB, Bjork J et al (2014) Measuring GFR: a systematic review. Am J Kidney Dis 64:411–424

    Article  PubMed  Google Scholar 

  8. Delpassand ES, Homayoon K, Madden T et al (2000) Determination of glomerular filtration rate using a dual-detectorgamma camera and the geometric mean of renal activity: correlation with the Tc-99m DTPA plasma clearance method. Clin Nucl Med 25(4):258–262

    Article  CAS  PubMed  Google Scholar 

  9. Orsal E, Seben B, Subasi ID et al (2013) Vesicoureteral refluxin a nonfunctioning kidney detected by 99mTc-DTPA study. Jpn J Radiol 31(12):823–825

    Article  PubMed  Google Scholar 

  10. Amin A, El-Sayed S, Taher N et al (2012) Tc-99m diethylenetriamine pentaacetic acid (DTPA) renal function reserve estimation: is it a reliable predictive tool for assessment of preclinical renal involvement in scleroderma patients. Clin Rheumatol 31:961–966

    Article  PubMed  Google Scholar 

  11. Inker LA, Schmid CH, Tighiouart H et al (2012) Estimating glomerular fltration rate from serum creatinine and cystatin C. N Engl J Med 367(1):20–29

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Farrington K, Covic A, Aucella F et al (2016) Clinical practice guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR < 45 ml/min/1.73 m2). Nephrol Dial Transplant 31(suppl 2):ii1–ii66

    Article  PubMed  Google Scholar 

  13. Fan L, Inker LA, Rossert J et al (2014) Glomerular filtration rate estimation using cystatin C alone or combined with creatinine as a cofirmatory test. Nephrol Dial Transplant 29:1195–1203

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2013) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3:1–150

    Article  Google Scholar 

  15. Fan L, Levey AS, Gudnason V et al (2015) Comparing GFR estimating equations using cystatin C and creatinine in elderly individuals. J Am Soc Nephrol 26(8):982–1989

    Article  CAS  Google Scholar 

  16. Kong X, Ma Y, Chen J et al (2013) Evaluation of the Chronic Kidney Disease Epidemiology Collaboration equation for estimating glomerular filtration rate in the Chinese population. Nephrol Dial Transplant 28(3):641–651

    Article  CAS  PubMed  Google Scholar 

  17. Barr EL, Maple-Brown LJ, Barzi F et al (2017) Comparison of creatinine and cystatin C based eGFR in the estimation of glomerular filtration rate in Indigenous Australians: the eGFR Study. Clin Biochem 50(6):301–308

    Article  CAS  PubMed  Google Scholar 

  18. Zhu Y, Ye XS, Zhu B et al (2014) Comparisons between the 2012 New CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equations and other four approved equations. PLoS ONE 9(1):e84688

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Li F, Pei XH, Ye XS et al (2017) Modification of the 2012 CKD-EPI equations for the elderly Chinese. Int Urol Nephrol 49(3):467–473

    Article  PubMed  Google Scholar 

  20. Pottel H, Delanaye P, Schaeffner E et al (2017) Estimating glomerular filtration rate for the full age spectrum from serum creatinine and cystatin C. Nephrol Dial Transplant 32(3):497–507

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Pottel H, Hoste L, Yayo E et al (2017) Glomerular filtration rate in healthy living potential kidney donors: a meta-analysis supporting the construction of the full age spectrum equation. Nephron 135(2):105–119

    Article  PubMed  Google Scholar 

  22. Kilbride HS, Stevens PE, Eaglestone G et al (2013) Accuracy of the MDRD (modification of diet in renal disease) study and CKD-EPI (CKD epidemiology collaboration) equations for estimation of GFR in the elderly. Am J Kidney Dis 61:57–66

    Article  PubMed  Google Scholar 

  23. Alshaer IM, Kilbride HS, Stevens PE et al (2014) External validation of the Berlin equations for estimation of GFR in the elderly. Am J Kidney Dis 63:862–865

    Article  PubMed  Google Scholar 

  24. Vidal-Petiot E, Haymann JP, Letavernier E et al (2014) External validation of the BIS (Berlin initiative study)-1 GFR estimating equation in the elderly. Am J Kidney Dis 63:865–867

    Article  PubMed  Google Scholar 

  25. Schaeffner ES, Ebert N, Delanaye P et al (2012) Two novel equations to estimate kidney function in persons aged 70 years or older. Ann Intern Med 157:471–481

    Article  PubMed  Google Scholar 

  26. Stevens LA, Coresh J, Schmid CH et al (2008) Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3418 individuals with CKD. Am J Kidney Dis 51(3):395–406

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Ma YC, Zuo L, Chen L et al (2010) Distribution of measured GFR in apparently healthy Chinese adults. Am J Kidney Dis 56(2):420–421

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the grants from the National Natural Science Foundation of China H0511-81670677, Clinical Medicine Research Special Funds of Chinese Medical Association 15020020590, Jiangsu Provincial Key Discipline of Medicine ZDXKA2016003, Jiangsu Provincial Key Laboratory of Geriatrics, Jiangsu Province’s Key Medical Talents Program ZDRCA2016021, Jiangsu Province 333 Project BRA2017409, Jiangsu Province’s Key Medical Young Talents Program QNRC2016592, and Jiangsu cadres health care research BJ16016, BJ17018.

Author information

Author notes

  1. Zhenzhu Yong, Fen Li, and Xiaohua Pei have contributed equally to this work.

Authors and Affiliations

  1. Department of Geriatric Nephrology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People’s Republic of China

    Zhenzhu Yong, Fen Li, Xiaohua Pei & Weihong Zhao

  2. Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China

    Xun Liu

  3. Department of Nephrology, The Affiliated Wuxi No. 2 Hospital of Nanjing Medical University, Wuxi, People’s Republic of China

    Dan Song

  4. Department of Nephrology, The Fourth Affiliated Hospital of Jilin University, Changchun, People’s Republic of China

    Xiaoxuan Zhang

Authors
  1. Zhenzhu Yong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fen Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaohua Pei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xun Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dan Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaoxuan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Weihong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Weihong Zhao.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethics committee of the First Affiliated Hospital of Nanjing Medical University and conducted in accordance with the Declaration of Helsinki.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yong, Z., Li, F., Pei, X. et al. A comparison between 2017 FAS and 2012 CKD-EPI equations: a multi-center validation study in Chinese adult population. Int Urol Nephrol 51, 139–146 (2019). https://doi.org/10.1007/s11255-018-1997-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-018-1997-4

Keywords

Search

Navigation