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Performance of 4 creatinine-based equations in assessing glomerular filtration rate in adults with diabetes
journal contribution
posted on 2021-01-01, 00:00 authored by Neda Zafari, Mojtaba Lotfaliany Abrand AbadiMojtaba Lotfaliany Abrand Abadi, Graeme J O’Keefe, Kartik Kishore, Niloufar Torkamani, Richard J MacIsaac, Leonid Churilov, Elif I EkinciAims
To evaluate diagnostic performance of glomerular filtration rate (GFR) estimated by modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), full age spectrum (FAS), and revised Lund–Malmö (r-LM) equations in adults with diabetes.
Methods
Individuals were included in this cross-sectional study if they had at least 1 measurement of technetium-99m diethylenetriamine-pentaacetic acid (99mTc-DTPA) GFR (mGFR) and serum creatinine (1487 patients with 2703 measures). GFR calculated by estimation equations was compared with mGFR. Diagnostic performance was assessed using concordance correlation coefficient (CCC), bias, precision, accuracy, reduced major axis regression (RMAR), and Bland–Altman plot. Analysis was repeated in subgroups based on sex, diabetes type, Hemoglobin A1C, and GFR level.
Results
Of all patients, 1189 (86%) had type 2 diabetes. Mean mGFR, MDRD, CKD-EPI, FAS, and revised Lund-Malmö eGFR were 66, 72, 74, 71, and 67 mL/min/1.73m2, respectively. Overall, the r-LM had the highest CCC (0.83), lowest bias (–1.4 mL/min/1.73 m2), highest precision (16.2 mL/min/1.73 m2), and highest accuracy (P10 = 39%). The RMAR (slope, intercept) in r-LM, FAS, MDRD, and CKD-EPI was 1.18, –13.35; 0.97, –2.9; 1, -6.4, and 1.04, –11.3, respectively. The Bland–Altman plot showed that r-LM had the lowest mean difference and the narrowest 95% limit of agreement (–1.0, 54.1 mL/min/1.73 m2), while mean difference was more than 5-fold higher in FAS, MDRD, and CKD-EPI (–5.2, –6.3, and –8.2, respectively).
Conclusions
In adults with diabetes the revised Lund-Malmö performs better than MDRD, CKD-EPI, and FAS in calculating point estimates of GFR.
To evaluate diagnostic performance of glomerular filtration rate (GFR) estimated by modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), full age spectrum (FAS), and revised Lund–Malmö (r-LM) equations in adults with diabetes.
Methods
Individuals were included in this cross-sectional study if they had at least 1 measurement of technetium-99m diethylenetriamine-pentaacetic acid (99mTc-DTPA) GFR (mGFR) and serum creatinine (1487 patients with 2703 measures). GFR calculated by estimation equations was compared with mGFR. Diagnostic performance was assessed using concordance correlation coefficient (CCC), bias, precision, accuracy, reduced major axis regression (RMAR), and Bland–Altman plot. Analysis was repeated in subgroups based on sex, diabetes type, Hemoglobin A1C, and GFR level.
Results
Of all patients, 1189 (86%) had type 2 diabetes. Mean mGFR, MDRD, CKD-EPI, FAS, and revised Lund-Malmö eGFR were 66, 72, 74, 71, and 67 mL/min/1.73m2, respectively. Overall, the r-LM had the highest CCC (0.83), lowest bias (–1.4 mL/min/1.73 m2), highest precision (16.2 mL/min/1.73 m2), and highest accuracy (P10 = 39%). The RMAR (slope, intercept) in r-LM, FAS, MDRD, and CKD-EPI was 1.18, –13.35; 0.97, –2.9; 1, -6.4, and 1.04, –11.3, respectively. The Bland–Altman plot showed that r-LM had the lowest mean difference and the narrowest 95% limit of agreement (–1.0, 54.1 mL/min/1.73 m2), while mean difference was more than 5-fold higher in FAS, MDRD, and CKD-EPI (–5.2, –6.3, and –8.2, respectively).
Conclusions
In adults with diabetes the revised Lund-Malmö performs better than MDRD, CKD-EPI, and FAS in calculating point estimates of GFR.
History
Journal
The Journal of Clinical Endocrinology & MetabolismVolume
106Issue
1Pagination
e61 - e73Publisher
Oxford University PressLocation
Cary, N.C.Publisher DOI
ISSN
0021-972XeISSN
1945-7197Language
engPublication classification
C1 Refereed article in a scholarly journalCopyright notice
2020, The AuthorsUsage metrics
Categories
No categories selectedKeywords
CKD-EPI equationdiabetic kidney diseasediagnostic performanceestimated GFRmeasure GFRrevised Lund-Malmö equationScience & TechnologyLife Sciences & BiomedicineEndocrinology & Metabolismrevised Lund-Malmo equationSERUM CREATININECYSTATIN CINDIGENOUS AUSTRALIANSASSESSING AGREEMENTHYPERFILTRATIONEPIDEMIOLOGYPRECISIONDISEASEIMPACTGFRrevised Lund–Malmö equation