Performance of 4 creatinine-based equations in assessing glomerular filtration rate in adults with diabetes

Zafari, Neda, Lotfaliany, Mojtaba, O’Keefe, Graeme J., Kishore, Kartik, Torkamani, Niloufar, MacIsaac, Richard J., Churilov, Leonid and Ekinci, Elif I. 2021, Performance of 4 creatinine-based equations in assessing glomerular filtration rate in adults with diabetes, The Journal of Clinical Endocrinology & Metabolism, vol. 106, no. 1, pp. e61-e73, doi: 10.1210/clinem/dgaa722.

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Title Performance of 4 creatinine-based equations in assessing glomerular filtration rate in adults with diabetes
Author(s) Zafari, Neda
Lotfaliany, MojtabaORCID iD for Lotfaliany, Mojtaba orcid.org/0000-0001-6594-9004
O’Keefe, Graeme J.
Kishore, Kartik
Torkamani, Niloufar
MacIsaac, Richard J.
Churilov, Leonid
Ekinci, Elif I.
Journal name The Journal of Clinical Endocrinology & Metabolism
Volume number 106
Issue number 1
Start page e61
End page e73
Total pages 13
Publisher Oxford University Press
Place of publication Cary, N.C.
Publication date 2021-01
ISSN 0021-972X
1945-7197
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Endocrinology & Metabolism
CKD-EPI equation
diabetic kidney disease
diagnostic performance
estimated GFR
measure GFR
revised Lund-Malmo equation
SERUM CREATININE
CYSTATIN C
INDIGENOUS AUSTRALIANS
ASSESSING AGREEMENT
HYPERFILTRATION
EPIDEMIOLOGY
PRECISION
DISEASE
IMPACT
GFR
revised Lund–Malmö equation
revised Lund-Malmö equation
Summary Aims
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.
Language eng
DOI 10.1210/clinem/dgaa722
Indigenous content off
Field of Research 1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2020, The Authors
Persistent URL http://hdl.handle.net/10536/DRO/DU:30144637

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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