Advertisement

International Urology and Nephrology

, Volume 50, Issue 12, pp 2229–2238 | Cite as

Assessment of creatinine and cystatin C-based eGFR equations in Chinese older adults with chronic kidney disease

  • Changjie Guan
  • Ming Liang
  • Riguang Liu
  • Shuguang Qin
  • Feng He
  • Jianwen Li
  • Xusheng Zhu
  • Hui Dai
  • Junzhou FuEmail author
Nephrology - Original Paper
  • 86 Downloads

Abstract

Introduction

Glomerular filtration rate (GFR) estimation equations using creatinine and Cystatin-C appear to be superior to those based on creatinine or Cystatin-C in older adults. We sought to compare the performances of those based on creatinine and Cystatin-C in Chinese older adults with chronic kidney disease (CKD).

Methods

A total of 368 Chinese elderly with CKD underwent the dynamic imaging with technetium-99m diethylene-triamine-pentaacetic acid (99mTc-DTPA), and serum creatinine and Cystatin-C were measured on the same day. The comparison of GFR equations which were creatinine and Cystatin-C-based including chronic kidney disease epidemiology collaboration (CKD-EPI) equation (CKD-EPI-Cr-Cys), Berlin Initiative Study (BIS) equation (BIS-Cr-Cys, also known as BIS-2), MA equation (MA-Cr-Cys), and FENG equation (FENG-Cr-Cys) was conducted.

Results

Four equations overestimated GFR except for BIS-2 equation in mGFR ≥ 60 ml/min/1.73 m2 (bias: − 1.40, p = 0.7) and CKD-EPI-Cr-Cys equation in mGFR < 30 ml/min/1.73 m2 (bias: − 1.82, p = 0.2) were unbiased. BIS-2 equation had the smallest interquartile range (IQR, ml/min/1.73 m2) from 12.73 in age < 75 years group to 16.05 in age ≥ 75 years group. BIS-2 equation achieved highest values of 79.1% in overall participants, and 80.77% in age ≥ 75 years group, respectively, and CKD-EPI-Cr-Cys equation 82.26% in age < 75 years group. Lowest values of root-mean-square error (RMSE, ml/min/1.73 m2) were seen in BIS-2 equation from 13.22 in age < 75 years group to 16.18 in age ≥ 75 years group. BIS-2 equation had the lowest misclassification rates of 41.76% in age ≥ 75 years group and 34.41% in age < 75 years group.

Conclusions

BIS-2 equation may be optimal for Chinese older adults with CKD especially in older adults ≥ 75 years and with mGFR ≥ 30 ml/min/1.73 m2, while CKD-EPI-Cr-Cys equation could yield a better performance than BIS-2 equation, especially in those < 75 years and mGFR < 30 ml/min/1.73 m2.

Keywords

Glomerular filtration rate Equation Older adults Chronic kidney disease Creatinine Cystatin-C 

Notes

Funding

This work was supported in part by the National Natural Science Foundation of China (81770677), Science & Technology Planning Project of Guangzhou (201707010290), and Natural Science Foundation of Guangdong Province, China (2017A030313566).

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author declares that there is 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 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from participants included in this study.

References

  1. 1.
    Hill NR, Oho AUID, Fatoba ST et al (2016) Global prevalence of chronic kidney disease: a systematic review and meta-analysis. PLoS ONE 11:e0158765CrossRefGoogle Scholar
  2. 2.
    Zhang L, Wang F, Wang L et al (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379:815–822CrossRefGoogle Scholar
  3. 3.
    Murphy D, McCulloch CE, Lin F et al (2016) Trends in prevalence of chronic kidney disease in the United States. Ann Intern Med 165:473–481CrossRefGoogle Scholar
  4. 4.
    Stevens PE, O’Donoghue DJ, de Lusignan S et al (2007) Chronic kidney disease management in the United Kingdom: NEOERICA project results. Kidney Int 72:92–99CrossRefGoogle Scholar
  5. 5.
    Kurella M, Covinsky KE, Collins AJ et al (2007) Octogenarians and nonagenarians starting dialysis in the United States. Ann Intern Med 146:177–183CrossRefGoogle Scholar
  6. 6.
    Flaherty JH, Liu ML, Ding L et al (2007) China: the aging giant. J Am Geriatr Soc 55:1295–1300CrossRefGoogle Scholar
  7. 7.
    Stevens LA, Coresh J, Greene T et al (2006) Assessing kidney function–measured and estimated glomerular filtration rate. N Engl J Med 354:2473–2483CrossRefGoogle Scholar
  8. 8.
    Changjie G, Xusheng Z, Feng H et al (2017) Evaluation of glomerular filtration rate by different equations in Chinese elderly with chronic kidney disease. Int Urol Nephrol 49:133–141CrossRefGoogle Scholar
  9. 9.
    Lopes MB, Araujo LQ, Passos MT et al (2013) Estimation of glomerular filtration rate from serum creatinine and Cystatin-C in octogenarians and nonagenarians. BMC Nephrol 14:265CrossRefGoogle Scholar
  10. 10.
    Ma YC, Zuo L, Chen JH et al (2007) Improved GFR estimation by combined creatinine and Cystatin-C measurements. Kidney Int 72:1535–1542CrossRefGoogle Scholar
  11. 11.
    Inker LA, Schmid CH, Tighiouart H et al (2012) Estimating glomerular filtration rate from serum creatinine and Cystatin-C. N Engl J Med 367:20–29CrossRefGoogle Scholar
  12. 12.
    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 157:471–481CrossRefGoogle Scholar
  13. 13.
    Feng JF, Qiu L, Zhang L et al (2013) Multicenter study of creatinine- and/or Cystatin-C-based equations for estimation of glomerular filtration rates in Chinese patients with chronic kidney disease. PLoS ONE 8:e57240CrossRefGoogle Scholar
  14. 14.
    Levey AS et al (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266Google Scholar
  15. 15.
    Heikkinen JO, Kuikka JT, Ahonen AK et al (2001) Quality of dynamic radionuclide renal imaging: multicentre evaluation using a functional renal phantom. Nucl Med Commun 22:987–995CrossRefGoogle Scholar
  16. 16.
    Du Bois D, Du Bois EF (1989) A formula to estimate the approximate surface area if height and weight be known: 1916. Nutrition 5:303–311 (discussion 312–313)PubMedGoogle Scholar
  17. 17.
    Knight EL, Verhave JC, Spiegelman D et al (2004) Factors influencing serum Cystatin-C levels other than renal function and the impact on renal function measurement. Kidney Int 65:1416–1421CrossRefGoogle Scholar
  18. 18.
    Teo BW, Xu H, Wang D et al (2012) Estimating glomerular filtration rates by use of both Cystatin-C and standardized serum creatinine avoids ethnicity coefficients in Asian patients with chronic kidney disease. Clin Chem 58:450–457CrossRefGoogle Scholar
  19. 19.
    Liu X, Ma H, Huang H et al (2013) Is the chronic kidney disease epidemiology collaboration creatinine-Cystatin-C equation useful for glomerular filtration rate estimation in the elderly. Clin Interv Aging 8:1387–1391CrossRefGoogle Scholar
  20. 20.
    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 61:57–66CrossRefGoogle Scholar
  21. 21.
    Bevc S, Hojs N, Hojs R et al (2017) Estimation of glomerular filtration rate in elderly chronic kidney disease patients: comparison of three novel sophisticated equations and simple Cystatin-C equation. Ther Apher Dial 21:126–132CrossRefGoogle Scholar
  22. 22.
    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 26:1982–1989CrossRefGoogle Scholar
  23. 23.
    Ye X, Liu X, Song D et al (2016) Estimating glomerular filtration rate by serum creatinine or/and Cystatin-C equations: an analysis of multi-centre Chinese subjects. Nephrology 21:372–378CrossRefGoogle Scholar
  24. 24.
    Ye X, Wei L, Pei X et al (2014) Application of creatinine- and/or Cystatin-C-based glomerular filtration rate estimation equations in elderly Chinese. Clin Interv Aging 9:1539–1549PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Changjie Guan
    • 1
  • Ming Liang
    • 1
  • Riguang Liu
    • 1
  • Shuguang Qin
    • 1
  • Feng He
    • 1
  • Jianwen Li
    • 1
  • Xusheng Zhu
    • 2
  • Hui Dai
    • 3
  • Junzhou Fu
    • 1
    Email author
  1. 1.Department of Nephrology, Guangzhou First People’s HospitalGuangzhou Medical UniversityGuangzhouChina
  2. 2.Department of Nuclear Medicine, Guangzhou First People’s HospitalGuangzhou Medical UniversityGuangzhouChina
  3. 3.Department of Clinical Laboratory Medicine, Guangzhou First People’s HospitalGuangzhou Medical UniversityGuangzhouChina

Personalised recommendations