Evaluation of renal function: choosing the right equation

Main Article Content

S. V. Kushnirenko
L. M. Savytska
O. V. Kushnirenko
S. O. Rotova

Abstract

The article presents examples of the difference in estimated GFR (eGFR) results obtained using different CKD-EPI creatinine equations (2009) and (2021). In these examples, the results were not reclassified to a higher level of renal function, but the eGFR obtained remained within the same CKD stage despite the different equations. However, it should be borne in mind that a significant reclassification to higher eGFR categories may have undesirable consequences, such as changes in the composition of the CKD population and for initiation of renoprotection measures, dosing and discontinuation of certain medications, timely referral to a nephrologist and RRT planning.
The article presents validated eGFR estimating equations according to the KDIGO 2024 Guidelines for the Evaluation and Management of CKD (CKD-EPI creatinine equation (2009), CKD-EPI creatinine equation (2021), CKD-EPI creatinine-cystatin C equation (2021), EKFC equation et al.), as well as eGFR calculators available on the National Kidney Foundation (NKF) website.

Article Details

Keywords:

renal functional status, glomerular filtration rate, serum creatinine, cystatin C, chronic kidney disease, arterial hypertension, cardiovascular diseases, diabetes mellitus, CKD-EPI creatinine equation (2009), CKD-EPI creatinine equation (2021), CKD-EPI creatinine-cystatin C equation (2021), EKFC equation

References

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024 Apr;105(4S):S117-S314. https://doi.org/10.1016/j.kint.2023.10.018.

Gansevoort RT, Anders HJ, Cozzolino M, Fliser D, Fouque D, Ortiz A, Soler MJ, Wanner C. What should European nephrology do with the new CKD-EPI equation? Nephrology Dialysis Transplantation. 2023;38(1):1-6. https://doi.org/10.1093/ndt/gfac254.

Cockcroft DW, Gault HM. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31-41. http://dx.doi.org/10.1159/000180580.

Michels WM, Grootendorst DC, Verduijn M, Elliott EG, Dekker FW, Krediet RT. Performance of the Cockcroft-Gault, MDRD, and new CKD-EPI formulas in relation to GFR, age, and body size. Clin J Amer Soc Nephrol. 2010; 5(6):1003-9. https://doi.org/10.2215/CJN.06870909.

Fernandez-Prado R, Castillo-Rodriguez E, Velez-Arribas FJ, Gracia-Iguacel C, & Ortiz A. Creatinine clearance is not equal to glomerular filtration rate and Cockcroft-Gault equation is not equal to CKD-EPI collaboration equation. Am J Med. 2016;129(12):1259-63. https://doi.org/10.1016/j.amjmed.2016.08.019.

Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D & Modification of Diet in Renal Disease Study Group. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med. 1999;130(6):461-70. https://doi.org/10.7326/0003-4819-130-6-199903160-00002.

Levey AS, Greene T, Kusek JW & Beck GJ. MDRD Study Group. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol. 2000;11, A0828.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-12. https://doi.org/10.7326/0003-4819-150-9-200905050-00006.

Young BA. Removal of race from estimation of kidney function. Nature Reviews Nephrology. 2022;18(4):201-2. https://doi.org/10.1038/s41581-021-00524-1.

Removing race from estimates of kidney function. 2021. Available from: https://www.kidney.org/news/removing-race-estimates-kidney-function (14 September 2022, last date accessed).

Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, Crews DC, Doria A, Estrella MM, Froissart M, Grams ME, Greene T, Grubb A, Gudnason V, Gutiérrez OM, Kalil R, Karger AB, Mauer M, Navis G, Nelson RG, Poggio ED, Rodby R, Rossing P, Rule AD, Selvin E, Seegmiller JC, Shlipak MG, Torres VE, Yang W, Ballew SH, Couture SJ, Powe NR, Levey AS; Chronic Kidney Disease Epidemiology Collaboration. New creatinine-and cystatin C–based equations to estimate GFR without race. New Engl J Med. 2021;385(19):1737-49. https://doi.org/10.1056/NEJMoa2102953

Worthen G, Vinson A, Tennankore K. New equations for estimating the GFR without race. N Engl J Med. 2022;386:1670-1. https://doi.org/10.1056/NEJMc2119761.

UC Census Bureau releases 2020 census. 2021. Available from: https://eu.usatoday.com/story/news/politics/2021/08/12/how-2020-census-change-how-we-look-america-what-expect/5493043001/ (14 September 2022, last date accessed).

Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, Kusek JW, Manzi J, Van Lente F, Zhang YL, Coresh J, Levey AS; CKD-EPI Investigators. Estimating glomerular filtration rate from serum creatinine and cystatin C. New Engl J Med. 2012;367(1):20-9. https://doi.org/10.1056/NEJMoa1114248

Delgado C, Baweja M, Crews DC, Eneanya ND, Gadegbeku CA, Inker LA, Mendu ML, Miller WG, Moxey-Mims MM, Roberts GV, St Peter WL, Warfield C, Powe NR. A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. Am J Kidney Dis. 2022;79(2):268-88. https://doi.org/10.1053/j.ajkd.2021.08.003.

Delanaye P, Vidal-Petiot E, Björk J, Ebert N, Eriksen BO, Dubourg L, Grubb A, Hansson M, Littmann K, Mariat C, Melsom T, Schaeffner E, Sundin PO, Bökenkamp A, Berg UB, Åsling-Monemi K, Åkesson A, Larsson A, Cavalier E, Dalton RN, Courbebaisse M, Couzi L, Gaillard F, Garrouste C, Jacquemont L, Kamar N, Legendre C, Rostaing L, Stehlé T, Haymann JP, Selistre LDS, Strogoff-de-Matos JP, Bukabau JB, Sumaili EK, Yayo E, Monnet D, Nyman U, Pottel H, Flamant M. Performance of creatinine-based equations to estimate glomerular filtration rate in White and Black populations in Europe, Brazil and Africa. Nephrology Dialysis Transplantation. 2023;38(1):106-18. https://doi.org/10.1093/ndt/gfac241.

Fu EL, Coresh J, Grams ME, Clase CM, Elinder CG, Paik J, Ramspek CL, Inker LA, Levey AS, Dekker FW, Carrero JJ. Removing race from the CKD-EPI equation and its impact on prognosis in a predominantly White European population. Nephrology Dialysis Transplantation. 2023;38(1):119-28. https://doi.org/10.1093/ndt/gfac197.

Pottel H, Björk J, Courbebaisse M, Couzi L, Ebert N, Eriksen BO, Dalton RN, Dubourg L, Gaillard F, Garrouste C, Grubb A, Jacquemont L, Hansson M, Kamar N, Lamb EJ, Legendre C, Littmann K, Mariat C, Melsom T, Rostaing L, Rule AD, Schaeffner E, Sundin PO, Turner S, Bökenkamp A, Berg U, Åsling-Monemi K, Selistre L, Åkesson A, Larsson A, Nyman U, Delanaye P. Development and validation of a modified full age spectrum creatinine-based equation to estimate glomerular filtration rate: a cross-sectional analysis of pooled data. Ann Intern Med. 2021;174(2):183-91. https://doi.org/10.7326/M20-4366.

Shlipak MG, Matsushita K, Ärnlöv J, Inker LA, Katz R, Polkinghorne KR, Rothenbacher D, Sarnak MJ, Astor BC, Coresh J, Levey AS, Gansevoort RT; CKD Prognosis Consortium. Cystatin C versus creatinine in determining risk based on kidney function. New En J Med. 2013;369(10): 932-43. https://doi.org/10.1056/NEJMoa1214234.

National Kidney Foundation. eGFR Calculator. https://www.kidney.org/professionals/gfr_calculator

Most read articles by the same author(s)

<< < 7 8 9 10 11 12 13 14 15 16 > >>