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Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians
The creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation was calibrated for the general Pakistan population (eGFRcr-PK) to eliminate bias and improve accuracy. Cystatin C–based CKD-EPI equations (eGFRcys and eGFRcr-cys) hav...
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| Published in: | Kidney international reports 2021-04, Vol.6 (4), p.962-975 |
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| creator | Wang, Yeli Levey, Andrew S. Inker, Lesley A. Jessani, Saleem Bux, Rasool Samad, Zainab Khan, Ali Raza Karger, Amy B. Allen, John C. Jafar, Tazeen H. |
| description | The creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation was calibrated for the general Pakistan population (eGFRcr-PK) to eliminate bias and improve accuracy. Cystatin C–based CKD-EPI equations (eGFRcys and eGFRcr-cys) have not been assessed in this population, and non-GFR determinants of cystatin C are unknown.
We assessed eGFRcys, eGFRcr-cys, and non-GFR determinants of cystatin C in a cross-sectional study of 557 participants (≥40 years of age) from Pakistan. We compared bias (median difference in measured GFR [mGFR] and eGFR), precision (interquartile range [IQR] of differences), accuracy (percentage of eGFR within 30% of mGFR), root mean square error (RMSE), and classification of mGFR |
| doi_str_mv | 10.1016/j.ekir.2021.01.005 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_9a4fb308245b4b518ad07639e0b3b2d1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S246802492100005X</els_id><doaj_id>oai_doaj_org_article_9a4fb308245b4b518ad07639e0b3b2d1</doaj_id><sourcerecordid>2519799786</sourcerecordid><originalsourceid>FETCH-LOGICAL-c521t-ebb88faf77c4f8b5fe80ff4b9766701ae53ef5e17c8d4f031755e8ce6bb96eb53</originalsourceid><addsrcrecordid>eNp9kd9qFDEUxgdRbKl9AS8kl97smmQmfwZEqNNtLRQUq9chyZxss-5ktkmm0DvfwTf0Scy4tbQ3woGcnHz55eR8VfWa4CXBhL_bLOGHj0uKKVniEpg9qw5pw-UC06Z9_ig_qI5T2mCMieCsxfJldVDXLaGi4YfV7gtEN8ZBBwtIhx6dQoY4-KBDTmh06AriNKAugs4--LAXdXcpz3vU_f7566NO0KPzs69olbIf5voarW6mkowhoaK6Gqd8jU6S1yG9ql44vU1wfL8eVd_PVt-6T4vLz-cX3cnlwjJK8gKMkdJpJ4RtnDTMgcTONaYVnAtMNLAaHAMirOwbh2siGANpgRvTcjCsPqou9tx-1Bu1i6WxeKdG7dXfwhjXSsfs7RZUqxtnaixpw0xjGJG6x4LXLWBTG9qTwvqwZ-0mM0BvIeSot0-gT0-Cv1br8VZJLAintADe3gPieDNBymrwycJ2qwOMU1KUkVa0rZC8SOleauOYUgT38AzBanZebdTsvJqdV7gEnj_75nGDD1f--VwE7_cCKCO_9RBVsh6K572PYHOZif8f_w8-EsIi</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2519799786</pqid></control><display><type>article</type><title>Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians</title><source>NCBI_PubMed Central（免费）</source><source>ScienceDirect Journals</source><creator>Wang, Yeli ; Levey, Andrew S. ; Inker, Lesley A. ; Jessani, Saleem ; Bux, Rasool ; Samad, Zainab ; Khan, Ali Raza ; Karger, Amy B. ; Allen, John C. ; Jafar, Tazeen H.</creator><creatorcontrib>Wang, Yeli ; Levey, Andrew S. ; Inker, Lesley A. ; Jessani, Saleem ; Bux, Rasool ; Samad, Zainab ; Khan, Ali Raza ; Karger, Amy B. ; Allen, John C. ; Jafar, Tazeen H.</creatorcontrib><description>The creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation was calibrated for the general Pakistan population (eGFRcr-PK) to eliminate bias and improve accuracy. Cystatin C–based CKD-EPI equations (eGFRcys and eGFRcr-cys) have not been assessed in this population, and non-GFR determinants of cystatin C are unknown.
We assessed eGFRcys, eGFRcr-cys, and non-GFR determinants of cystatin C in a cross-sectional study of 557 participants (≥40 years of age) from Pakistan. We compared bias (median difference in measured GFR [mGFR] and eGFR), precision (interquartile range [IQR] of differences), accuracy (percentage of eGFR within 30% of mGFR), root mean square error (RMSE), and classification of mGFR <60 ml/min/1.73 m2 (area under the receiver operating characteristic curve [AUC] and net reclassification index [NRI]) among eGFR equations.
We found that eGFRcys underestimated mGFR (bias, 12.7 ml/min/1.73 m2 [95% confidence interval {CI} 10.7–15.2]). eGFRcr-cys did not improve performance over eGFRcr-PK in precision (P = 0.52), accuracy (P = 0.58), or RMSE (P = 0.49). Results were consistent among subgroups by age, sex, smoking, body mass index (BMI), and eGFR. NRI was 7.31% (95% CI 1.52%–13.1%; P < 0.001) for eGFRcr-cys versus eGFRcr-PK, but AUC was not improved (0.92 [95% CI 0.87–0.96] vs. 0.90 [95% CI 0.86–0.95]; P = 0.056). Non-GFR determinants of higher cystatin C included male sex, smoking, higher BMI and total body fat, and lower lean body mass.
eGFRcys underestimated mGFR in South Asians and eGFRcr-cys did not offer substantial advantage compared with eGFRcr-PK. Future studies are warranted to better understand the large bias in eGFRcys and non-GFR determinants of cystatin C in South Asians.
[Display omitted]</description><identifier>ISSN: 2468-0249</identifier><identifier>EISSN: 2468-0249</identifier><identifier>DOI: 10.1016/j.ekir.2021.01.005</identifier><identifier>PMID: 33912746</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) ; Clinical Research ; cystatin C ; estimating equations ; glomerular filtration rate (GFR) ; kidney function ; South Asian</subject><ispartof>Kidney international reports, 2021-04, Vol.6 (4), p.962-975</ispartof><rights>2021 International Society of Nephrology</rights><rights>2021 International Society of Nephrology. Published by Elsevier Inc.</rights><rights>2021 International Society of Nephrology. Published by Elsevier Inc. 2021 International Society of Nephrology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c521t-ebb88faf77c4f8b5fe80ff4b9766701ae53ef5e17c8d4f031755e8ce6bb96eb53</citedby><cites>FETCH-LOGICAL-c521t-ebb88faf77c4f8b5fe80ff4b9766701ae53ef5e17c8d4f031755e8ce6bb96eb53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071622/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S246802492100005X$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,3536,27901,27902,45756,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33912746$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wang, Yeli</creatorcontrib><creatorcontrib>Levey, Andrew S.</creatorcontrib><creatorcontrib>Inker, Lesley A.</creatorcontrib><creatorcontrib>Jessani, Saleem</creatorcontrib><creatorcontrib>Bux, Rasool</creatorcontrib><creatorcontrib>Samad, Zainab</creatorcontrib><creatorcontrib>Khan, Ali Raza</creatorcontrib><creatorcontrib>Karger, Amy B.</creatorcontrib><creatorcontrib>Allen, John C.</creatorcontrib><creatorcontrib>Jafar, Tazeen H.</creatorcontrib><title>Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians</title><title>Kidney international reports</title><addtitle>Kidney Int Rep</addtitle><description>The creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation was calibrated for the general Pakistan population (eGFRcr-PK) to eliminate bias and improve accuracy. Cystatin C–based CKD-EPI equations (eGFRcys and eGFRcr-cys) have not been assessed in this population, and non-GFR determinants of cystatin C are unknown.
We assessed eGFRcys, eGFRcr-cys, and non-GFR determinants of cystatin C in a cross-sectional study of 557 participants (≥40 years of age) from Pakistan. We compared bias (median difference in measured GFR [mGFR] and eGFR), precision (interquartile range [IQR] of differences), accuracy (percentage of eGFR within 30% of mGFR), root mean square error (RMSE), and classification of mGFR <60 ml/min/1.73 m2 (area under the receiver operating characteristic curve [AUC] and net reclassification index [NRI]) among eGFR equations.
We found that eGFRcys underestimated mGFR (bias, 12.7 ml/min/1.73 m2 [95% confidence interval {CI} 10.7–15.2]). eGFRcr-cys did not improve performance over eGFRcr-PK in precision (P = 0.52), accuracy (P = 0.58), or RMSE (P = 0.49). Results were consistent among subgroups by age, sex, smoking, body mass index (BMI), and eGFR. NRI was 7.31% (95% CI 1.52%–13.1%; P < 0.001) for eGFRcr-cys versus eGFRcr-PK, but AUC was not improved (0.92 [95% CI 0.87–0.96] vs. 0.90 [95% CI 0.86–0.95]; P = 0.056). Non-GFR determinants of higher cystatin C included male sex, smoking, higher BMI and total body fat, and lower lean body mass.
eGFRcys underestimated mGFR in South Asians and eGFRcr-cys did not offer substantial advantage compared with eGFRcr-PK. Future studies are warranted to better understand the large bias in eGFRcys and non-GFR determinants of cystatin C in South Asians.
[Display omitted]</description><subject>Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)</subject><subject>Clinical Research</subject><subject>cystatin C</subject><subject>estimating equations</subject><subject>glomerular filtration rate (GFR)</subject><subject>kidney function</subject><subject>South Asian</subject><issn>2468-0249</issn><issn>2468-0249</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNp9kd9qFDEUxgdRbKl9AS8kl97smmQmfwZEqNNtLRQUq9chyZxss-5ktkmm0DvfwTf0Scy4tbQ3woGcnHz55eR8VfWa4CXBhL_bLOGHj0uKKVniEpg9qw5pw-UC06Z9_ig_qI5T2mCMieCsxfJldVDXLaGi4YfV7gtEN8ZBBwtIhx6dQoY4-KBDTmh06AriNKAugs4--LAXdXcpz3vU_f7566NO0KPzs69olbIf5voarW6mkowhoaK6Gqd8jU6S1yG9ql44vU1wfL8eVd_PVt-6T4vLz-cX3cnlwjJK8gKMkdJpJ4RtnDTMgcTONaYVnAtMNLAaHAMirOwbh2siGANpgRvTcjCsPqou9tx-1Bu1i6WxeKdG7dXfwhjXSsfs7RZUqxtnaixpw0xjGJG6x4LXLWBTG9qTwvqwZ-0mM0BvIeSot0-gT0-Cv1br8VZJLAintADe3gPieDNBymrwycJ2qwOMU1KUkVa0rZC8SOleauOYUgT38AzBanZebdTsvJqdV7gEnj_75nGDD1f--VwE7_cCKCO_9RBVsh6K572PYHOZif8f_w8-EsIi</recordid><startdate>20210401</startdate><enddate>20210401</enddate><creator>Wang, Yeli</creator><creator>Levey, Andrew S.</creator><creator>Inker, Lesley A.</creator><creator>Jessani, Saleem</creator><creator>Bux, Rasool</creator><creator>Samad, Zainab</creator><creator>Khan, Ali Raza</creator><creator>Karger, Amy B.</creator><creator>Allen, John C.</creator><creator>Jafar, Tazeen H.</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20210401</creationdate><title>Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians</title><author>Wang, Yeli ; Levey, Andrew S. ; Inker, Lesley A. ; Jessani, Saleem ; Bux, Rasool ; Samad, Zainab ; Khan, Ali Raza ; Karger, Amy B. ; Allen, John C. ; Jafar, Tazeen H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c521t-ebb88faf77c4f8b5fe80ff4b9766701ae53ef5e17c8d4f031755e8ce6bb96eb53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)</topic><topic>Clinical Research</topic><topic>cystatin C</topic><topic>estimating equations</topic><topic>glomerular filtration rate (GFR)</topic><topic>kidney function</topic><topic>South Asian</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wang, Yeli</creatorcontrib><creatorcontrib>Levey, Andrew S.</creatorcontrib><creatorcontrib>Inker, Lesley A.</creatorcontrib><creatorcontrib>Jessani, Saleem</creatorcontrib><creatorcontrib>Bux, Rasool</creatorcontrib><creatorcontrib>Samad, Zainab</creatorcontrib><creatorcontrib>Khan, Ali Raza</creatorcontrib><creatorcontrib>Karger, Amy B.</creatorcontrib><creatorcontrib>Allen, John C.</creatorcontrib><creatorcontrib>Jafar, Tazeen H.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Kidney international reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wang, Yeli</au><au>Levey, Andrew S.</au><au>Inker, Lesley A.</au><au>Jessani, Saleem</au><au>Bux, Rasool</au><au>Samad, Zainab</au><au>Khan, Ali Raza</au><au>Karger, Amy B.</au><au>Allen, John C.</au><au>Jafar, Tazeen H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians</atitle><jtitle>Kidney international reports</jtitle><addtitle>Kidney Int Rep</addtitle><date>2021-04-01</date><risdate>2021</risdate><volume>6</volume><issue>4</issue><spage>962</spage><epage>975</epage><pages>962-975</pages><issn>2468-0249</issn><eissn>2468-0249</eissn><abstract>The creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation was calibrated for the general Pakistan population (eGFRcr-PK) to eliminate bias and improve accuracy. Cystatin C–based CKD-EPI equations (eGFRcys and eGFRcr-cys) have not been assessed in this population, and non-GFR determinants of cystatin C are unknown.
We assessed eGFRcys, eGFRcr-cys, and non-GFR determinants of cystatin C in a cross-sectional study of 557 participants (≥40 years of age) from Pakistan. We compared bias (median difference in measured GFR [mGFR] and eGFR), precision (interquartile range [IQR] of differences), accuracy (percentage of eGFR within 30% of mGFR), root mean square error (RMSE), and classification of mGFR <60 ml/min/1.73 m2 (area under the receiver operating characteristic curve [AUC] and net reclassification index [NRI]) among eGFR equations.
We found that eGFRcys underestimated mGFR (bias, 12.7 ml/min/1.73 m2 [95% confidence interval {CI} 10.7–15.2]). eGFRcr-cys did not improve performance over eGFRcr-PK in precision (P = 0.52), accuracy (P = 0.58), or RMSE (P = 0.49). Results were consistent among subgroups by age, sex, smoking, body mass index (BMI), and eGFR. NRI was 7.31% (95% CI 1.52%–13.1%; P < 0.001) for eGFRcr-cys versus eGFRcr-PK, but AUC was not improved (0.92 [95% CI 0.87–0.96] vs. 0.90 [95% CI 0.86–0.95]; P = 0.056). Non-GFR determinants of higher cystatin C included male sex, smoking, higher BMI and total body fat, and lower lean body mass.
eGFRcys underestimated mGFR in South Asians and eGFRcr-cys did not offer substantial advantage compared with eGFRcr-PK. Future studies are warranted to better understand the large bias in eGFRcys and non-GFR determinants of cystatin C in South Asians.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33912746</pmid><doi>10.1016/j.ekir.2021.01.005</doi><tpages>14</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Clinical Research cystatin C estimating equations glomerular filtration rate (GFR) kidney function South Asian |
| title | Performance and Determinants of Serum Creatinine and Cystatin C–Based GFR Estimating Equations in South Asians |
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