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Limitations of U25 CKiD and CKD-EPI eGFR formulae in patients 2–20 years of age with measured GFR > 60 mL/min/1.73 m2—a cross-sectional study

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Abstract

Background

When applying Pierce U25 formula for estimating glomerular filtration rate (eGFR), we observed a higher proportion of eGFR < 90 mL/min/1.73 m2 (chronic kidney disease (CKD) stage 2). We compared agreement and accuracy of the Pierce U25 (ages 2–25), Pottel (ages 2–100), and CKD-EPI (ages 18–100) formulae to GFR measurements.

Methods

Post hoc analysis of the three eGFRs compared to 367 99m technetium-diethylene-triamine penta-acetic acid (99Tc DTPA) GFR measurements (240 patients) using 3 sampling points and Brockner/Mørtensen correction (body surface area calculation based on ideal weight) on simultaneous serum creatinine and cystatin C measurements.

Results

Overall, the U25 formula performed well with a Spearman r of 0.8102 (95% confidence interval 0.7706 to 0.8435, p < 0.0001) while diagnostic accuracy was low in patients with normal mGFR. The U25 formula reclassified 29.5% of patients with normal mGFR as CKD stage 2; whereas the average of the modified Schwartz formula based on serum creatinine and the Filler formula based on cystatin C, only over-diagnosed CKD stage 2 in 8.5%, 24.5% within 10% and 62.7% within 30%. We therefore combined both. The average Schwartz/Filler eGFR had 36.5% of results within 10%, 84.7% within 30%, and normal mGFR accuracy was 26.8%, 63.9% for 10% and 30%, respectively, outperforming the CKD-EPI and Pottel formulae.

Conclusions

The Pierce U25 formula results correlated well with mGFR < 75 mL/min/1.73 m2. Over the entire GFR range, accuracy was better for patients with a higher mGFR, when averaging the combined Schwartz/Filler formulae. More work is needed to prospectively confirm our findings in other centers.

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Data availability

Anonymized data are available from the corresponding author upon request.

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Authors and Affiliations

  1. Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A 5W9, Canada

    Guido Filler & Ajay P. Sharma

  2. Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 800 Commissioners Road East, E3-206, London, ON, N6A 5W9, Canada

    Guido Filler

  3. The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, N6A 5W9, Canada

    Guido Filler

  4. Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A 5W9, Canada

    Fateh Ahmad & Vipin Bhayana

  5. Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

    Maria E. Díaz González de Ferris

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Filler, G., Ahmad, F., Bhayana, V. et al. Limitations of U25 CKiD and CKD-EPI eGFR formulae in patients 2–20 years of age with measured GFR > 60 mL/min/1.73 m2—a cross-sectional study. Pediatr Nephrol 39, 1169–1176 (2024). https://doi.org/10.1007/s00467-023-06185-5

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