Assessment of creatinine and cystatin C-based eGFR equations in Chinese older adults with chronic kidney disease
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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).
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.
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.
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.
KeywordsGlomerular filtration rate Equation Older adults Chronic kidney disease Creatinine Cystatin-C
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.
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 was obtained from participants included in this study.
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