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Evaluation of eGFR methods in a sub-Saharan African community-based pediatric population

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Abstract

Background

Accurate assessment of the estimated glomerular filtration rate (eGFR) plays a pivotal role in the early detection, management, and optimal medication dosing for chronic kidney disease (CKD). However, validation of eGFR, utilizing cystatin C-based equations, is limited in African children and adolescents with CKD. We evaluate the agreement of eGFR equations incorporating both cystatin C and creatinine in this specific population.

Methods

This community-based study assessed CKD in children (2–15 years) using cystatin C and serum creatinine. eGFR agreement with the reference was evaluated with Bland–Altman plots, ROC curves, and Lin’s CCC, using the Under-25 serum creatinine–cystatin C equation as the reference standard. Pairwise ROC comparisons assess the statistical differences in estimation equation agreement.

Results

Among 666 children (mean age, 7.8 ± 3.8 years; 48.6% male), CKD prevalence was 11.6% (95% CI, 9.2–14.2%). Notably, the Chehade equation, using combined biomarkers, aligned best with the reference, displaying the lowest mean deviation (− 0.59; 95% CI, − 1.19 to 0.01), superior agreement (P10, 91.0%; P30, 96.70%), and highest discriminatory power (0.989). In contrast, CKD-EPI 2012 cystatin C had the highest mean deviation (− 35.90) and lowest discriminatory power (0.79). Equations combining creatinine and cystatin C (Schwartz, Chehade, Full Age Spectrum) demonstrated strong positive Lin’s CCC with CKiD U25 creatinine–cystatin C, while Bouvet showed a notably weak correlation (Lin’s CCC, 0.22).

Conclusion

In African children with CKD, the Chehade, CKiD Under 25 creatinine-based equations, and the Full Age Spectrum equations show promise for CKD diagnosis. However, a measured GFR is essential to identifying the most accurate eGFR equation in this population.

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Funding

The author(s) received financial support for the work from the ISN Clinical Research Program (https://www.theisn.org/blog/2020/09/02/clinical-research-program-spotlight-alao-michael-abel-studies-community-based-prevalence-of-ckd-in-southwest-nigeria/ISN-CRP2016).

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Authors and Affiliations

  1. College of Medicine, University of Ibadan, CW22+H4W, Queen Elizabeth I I Road, Agodi, Ibadan, 200285, Oyo, Nigeria

    Michael Abel Alao, Adanze Onyenonachi Asinobi & Debo Adebowale Ademola

  2. University of Ilorin Teaching Hospital, Ilorin, 241102, Kwara, Nigeria

    Olayinka Rasheed Ibrahim

  3. Department of Medicine, University of Uyo, Uyo, 520003, Akwa Ibom, Nigeria

    Udeme Ekpenyong Ekrikpo

  4. Paediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Obafemi Awolowo University, PMB 5538, Ile-Ife, 220005, Osun, Nigeria

    Wasiu Adekunle Olowu

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  1. Michael Abel Alao
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Correspondence to Michael Abel Alao.

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Ethical approval

Ethical approval for the study was obtained from the Oyo State Research Ethical Review Committee, Ministry of Health Secretariat, Ibadan, with approval number AD13/479/948. All methods were carried out in accordance with relevant guidelines and regulations.

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Written informed consent was obtained from the parents or caregivers of children younger than 7 years and assent from children over age 7 years.

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Alao, M.A., Ibrahim, O.R., Asinobi, A.O. et al. Evaluation of eGFR methods in a sub-Saharan African community-based pediatric population. Pediatr Nephrol (2024). https://doi.org/10.1007/s00467-024-06323-7

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