Pediatric Nephrology

, Volume 34, Issue 6, pp 1087–1098 | Cite as

Validation of standardized creatinine and cystatin C GFR estimating equations in a large multicentre European cohort of children

  • Jonas Björk
  • Ulf NymanEmail author
  • Ulla Berg
  • Pierre Delanaye
  • Laurence Dubourg
  • Karolien Goffin
  • Anders Grubb
  • Magnus Hansson
  • Karin Littmann
  • Kajsa Åsling-Monemi
  • Arend Bökenkamp
  • Hans Pottel
Original Article



Most validations of paediatric glomerular filtration rate (GFR) estimating equations using standardized creatinine (CR) and cystatin C (CYS) assays have comprised relatively small cohorts, which makes accuracy across subgroups of GFR, age, body mass index (BMI) and gender uncertain. To overcome this, a large cohort of children referred for GFR determination has been established from several European medical centres.


Three thousand four hundred eight measurements of GFR (mGFR) using plasma clearance of exogenous substances were performed in 2218 children aged 2–17 years. Validated equations included Schwartz-2009CR/2012CR/CYS/CR+CYS, FASCR/CYS/CR+CYS, LMRCR, Schwartz-LyonCR, BergCYS, CAPACYS, CKD-EPICYS, AndersenCR+CYS and arithmetic means of the best single-marker equations in explorative analysis. Five metrics were used to compare the performance of the GFR equations: bias, precision and three accuracy measures including the percentage of GFR estimates (eGFR) within ± 10% (P10) and ± 30% (P30) of mGFR.


Three of the cystatin C equations, BergCYS, CAPACYS and CKD-EPICYS, exhibited low bias and generally satisfactory accuracy across all levels of mGFR; CKD-EPICYS had more stable performance across gender than the two other equations. Among creatinine equations, Schwartz-LyonCR had the best performance but was inaccurate at mGFR < 30 mL/min/1.73 m2 and in underweight patients. Arithmetic means of the best creatinine and cystatin C equations above improved bias compared to the existing composite creatinine+cystatin C equations.


The present study strongly suggests that cystatin C should be the primary biomarker of choice when estimating GFR in children with decreased GFR. Arithmetic means of well-performing single-marker equations improve accuracy further at most mGFR levels and have practical advantages compared to composite equations.


Children Chronic kidney disease Glomerular filtration rate Kidney function tests Renal failure 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the World Medical Association Declaration of Helsinki of 1975, as revised in 2000.

Informed consent

For this type of retrospective study, all extracted data were fully anonymous without any personal information, why informed consent was not required according to the regional ethical board approval in, Lund, Sweden, which approved the study.

Supplementary material

467_2018_4185_MOESM1_ESM.pdf (482 kb)
ESM 1 (PDF 481 kb)


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Copyright information

© IPNA 2019

Authors and Affiliations

  • Jonas Björk
    • 1
    • 2
  • Ulf Nyman
    • 3
    Email author
  • Ulla Berg
    • 4
  • Pierre Delanaye
    • 5
  • Laurence Dubourg
    • 6
  • Karolien Goffin
    • 7
  • Anders Grubb
    • 8
  • Magnus Hansson
    • 9
  • Karin Littmann
    • 9
  • Kajsa Åsling-Monemi
    • 4
  • Arend Bökenkamp
    • 10
  • Hans Pottel
    • 11
  1. 1.Division of Occupational and Environmental MedicineLund UniversityLundSweden
  2. 2.Clinical Studies Sweden, Forum SouthSkåne University HospitalLundSweden
  3. 3.Department of Translational Medicine, Division of Medical RadiologyLund UniversityMalmöSweden
  4. 4.Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska InstitutetKarolinska University Hospital HuddingeStockholmSweden
  5. 5.Nephrology-Dialysis-TransplantationUniversity of LiègeLiègeBelgium
  6. 6.Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, and Laboratory of Tissue Biology and Therapeutic Engineering, UMR 5305 CNRSUniversité Claude Bernard Lyon 1LyonFrance
  7. 7.Department of Nuclear Medicine & Molecular ImagingUniversity Hospital LeuvenLeuvenBelgium
  8. 8.Department of Clinical Chemistry, Skåne University Hospital, LundLund UniversityLundSweden
  9. 9.Department of Laboratory Medicine, Division of Clinical Chemistry, Karolinska InstitutetKarolinska University Hospital HuddingeStockholmSweden
  10. 10.Emma Children’s Hospital, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
  11. 11.Department of Public Health and Primary CareKU Leuven Campus Kulak KortrijkKortrijkBelgium

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