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Comparison and evaluation of the 2009 and 2021 chronic kidney disease-epidemiological collaboration equations among Jordanian patients with type 2 diabetes mellitus

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Abstract

Aims

This study compared the 2009 versus 2021 chronic kidney disease (CKD) Epidemiological Collaboration (CKD-EPI) equations to calculate estimated glomerular filtration rate (eGFR) among Jordanian patients with T2DM to assess their agreement and impact on CKD staging.

Methods

This cross-sectional study included 2382 adult Jordanian patients with T2DM. The 2009 and 2021 CKD-EPI equations were used to calculate eGFR. Patients were reclassified according to kidney disease-Improving Global Outcomes (KDIGO) categories. Agreement between the equations was assessed using Bland–Altman plots and Lin’s concordance correlation.

Results

The 2021 equation significantly increased eGFR by a median of 2.1 mL/min/1.73 m2 (interquartile range: 0.6–3.6 mL/min/1.73 m2). However, there was significant agreement between equations (Kappa: 0.99; 95% confidence interval: 0.95–1.00), independent of age, sex, and the presence of hypertension. In total, 202 patients (8.5%) were reclassified to higher KDIGO categories using the 2021 equation, with category G3 being most affected. The overall prevalence of patients in the high to highest risk categories decreased (28.0% vs. 26.5%).

Conclusions

Although there was significant agreement with the 2009 equation, the 2021 equation increased eGFR and resulted in the reclassification of a subset of subjects according to KDIGO criteria. The uncertain impact of reducing high-risk category patients raises concerns about potential delays in referral and intervention, while holding the potential to enhance high-risk patient categorization, thus alleviating healthcare burden.

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Data availability

All data generated or analysed during this study are included in this publication article. Raw datasets are available from corresponding author and can be provided upon reasonable request.

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Acknowledgements

The authors cordially thank the participants of this study and all those who supported this project for their valuable time and contributions to this research.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Nephrology Division, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, 11942, Jordan

    Randa I. Farah & Izzat AlAwwa

  2. School of Medicine, University of Jordan, Amman, Jordan

    Abdulrahman Alhajahjeh, Rama Rayyan & Laith Bdier

  3. The National Center for Diabetes, Endocrinology and Genetic (NCDEG), The University of Jordan, Amman, Jordan

    Oraib Al-farahid, Hana Abuzaid, Dana Hiasat & Kamel Ajlouni

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  1. Randa I. Farah
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Correspondence to Randa I. Farah.

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The requirement of obtaining informed consent for publication was waived for this study owing to its retrospective nature.

Ethical approval

This study was approved by the institutional review boards of Jordan University Hospital and the National Centre for Diabetes, Endocrinology and Genetics in Amman, Jordan. All procedures performed during this research were in accordance with the ethical principles outlined in the World Medical Association’s revised Declaration of Helsinki.

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Farah, R.I., Alhajahjeh, A., Al-farahid, O. et al. Comparison and evaluation of the 2009 and 2021 chronic kidney disease-epidemiological collaboration equations among Jordanian patients with type 2 diabetes mellitus. Acta Diabetol 61, 169–180 (2024). https://doi.org/10.1007/s00592-023-02191-z

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