Comparison of Various Equations for Estimating GFR in Malawi: How to Determine Renal Function in Resource Limited Settings?

Chronic kidney disease (CKD) is a probably underrated public health problem in Sub-Saharan-Africa, in particular in combination with HIV-infection. Knowledge about the CKD prevalence is scarce and in the available literature different methods to classify CKD are used impeding comparison and general...

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Bibliographic Details
Published in:PloS one 2015-06, Vol.10 (6), p.e0130453-e0130453
Main Authors: Glaser, Nicola, Deckert, Andreas, Phiri, Sam, Rothenbacher, Dietrich, Neuhann, Florian
Format: Article
Language:English
Subjects:
Adult
Adults
Algorithms
Creatinine
Creatinine - blood
Cross-Sectional Studies
Cystatin C
Developing Countries
Disease control
Epidermal growth factor receptors
Female
Glomerular Filtration Rate
Health Services Accessibility
HIV
Human immunodeficiency virus
Humans
Kidney Function Tests
Malawi - epidemiology
Male
Mathematical analysis
Mathematical models
Medical diagnosis
Public health
Renal function
Renal Insufficiency, Chronic - epidemiology
Renal Insufficiency, Chronic - physiopathology
Sexually transmitted diseases
Standardization
STD
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Summary:Chronic kidney disease (CKD) is a probably underrated public health problem in Sub-Saharan-Africa, in particular in combination with HIV-infection. Knowledge about the CKD prevalence is scarce and in the available literature different methods to classify CKD are used impeding comparison and general prevalence estimates. This study assessed different serum-creatinine based equations for glomerular filtration rates (eGFR) and compared them to a cystatin C based equation. The study was conducted in Lilongwe, Malawi enrolling a population of 363 adults of which 32% were HIV-positive. Comparison of formulae based on Bland-Altman-plots and accuracy revealed best performance for the CKD-EPI equation without the correction factor for black Americans. Analyzing the differences between HIV-positive and -negative individuals CKD-EPI systematically overestimated eGFR in comparison to cystatin C and therefore lead to underestimation of CKD in HIV-positives. Our findings underline the importance for standardization of eGFR calculation in a Sub-Saharan African setting, to further investigate the differences with regard to HIV status and to develop potential correction factors as established for age and sex.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0130453