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Addition of bioimpedance-derived body cell mass improves performance of serum creatinine-based GFR estimation in a chronic kidney disease cohort

  • Nephrology - Original Paper
  • Published:
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Abstract

Purpose

Serum creatinine-based glomerular filtration rate (GFR) estimating equations are imprecise and systemic overestimate GFR in chronic kidney disease (CKD) populations with low muscle mass. Bioimpedance devices can measure body cell mass (BCM), a surrogate for muscle mass which has been included in a published GFR estimating equation. This BCM GFR equation is validated and compared with MDRD and CKD-EPI 2021 equations in an Indian CKD population.

Methods

Patients with stable CKD stages 1–5 and voluntary kidney donors underwent measurement of serum creatinine, DTPA GFR and bioimpedance on the same day. BCM GFR was tested for consistency, agreement and performance with respect to DTPA GFR.

Results

A total of 125 study participants were enrolled, including 106 patients with CKD (Stage 1: 8; stage 2: 32, stage 3: 42, stage 4: 20 and stage 5: 4 patients) and 19 voluntary kidney donors, with 66% males, and a mean age of 43.3 (± 16.5) years. The median bias of BCM GFR was 5.45 ml/min/1.73 m2 [95% confidence interval (CI) 4.2–8.3], absolute precision was 10.16 ml/min/1.73 m2 [95% CI 4.5–12.6], P30 was 59.1% [95% CI 50.0–67.7] and accuracy was 8.62% [95% CI 6.4–20.0]. Kappa measurement of agreement was the highest for BCM GFR-based staging (0.628 vs 0.545 for MDRD and 0.487 for CKD-EPI).

Conclusion

BCM-based GFR estimating equation performed better than MDRD and CKD-EPI equations in this Indian CKD population, and BCM GFR-based KDIGO staging was associated with lesser misclassification than the MDRD and CKD-EPI equations.

Trial registration (prospective)

Clinical Trials Registry of India (CTRI/2019/11/021850).

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Data availability

Datasets available with the authors and can be made available on request by email address provided.

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Funding

No funding was received for conducting the study. The study did not receive any funding from the institution or other sources

Author information

Authors and Affiliations

  1. Department of Nephrology, Dr Ram Manohar Lohia Institute of Medical Sciences, 4th floor, OPD Block Vibhuti Khand, Lucknow, Uttar Pradesh, 226010, India

    Ranjit Singh, Majibullah Ansari, Namrata Rao & Abhilash Chandra

  2. Department of Nuclear Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India

    Shashwat Verma

  3. Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

    Prabhaker Mishra

  4. Department of Community Medicine, Kalyan Singh Super Specialty Cancer Institute, Lucknow, India

    Ayush Lohiya

Authors
  1. Ranjit Singh
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  2. Majibullah Ansari
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  3. Namrata Rao
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  4. Abhilash Chandra
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  5. Shashwat Verma
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  7. Ayush Lohiya
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Contributions

Conceptualization: NR, AC. Methodology: RS, NR. Formal analysis and investigation: RS, MA, NR, SV, PM, AL. Writing: original draft preparation: RS, MA. Writing: review and editing: NR, AC.

Corresponding author

Correspondence to Namrata Rao.

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The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

The study was performed in line with the principles of the declaration of Helsinki. The approval was granted by the Institutional Ethics Committee of Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India.

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Singh, R., Ansari, M., Rao, N. et al. Addition of bioimpedance-derived body cell mass improves performance of serum creatinine-based GFR estimation in a chronic kidney disease cohort. Int Urol Nephrol 56, 1137–1145 (2024). https://doi.org/10.1007/s11255-023-03758-z

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