Christine A White1, Céline M Allen2, Ayub Akbari3, Christine P Collier4, David C Holland5, Andrew G Day6, Greg A Knoll7. 1. Division of Nephrology, Department of Medicine, Etherington Hall, Queen's University, 94 Stuart Street, Kingston, Ontario K7L 4N6, Canada. Electronic address: Cw38@queensu.ca. 2. Division of Nephrology, Department of Medicine, Etherington Hall, Queen's University, 94 Stuart Street, Kingston, Ontario K7L 4N6, Canada. Electronic address: callen@qmed.ca. 3. Division of Nephrology, Department of Medicine, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 206, Ottawa, Ontario K1H 8L6, Canada; Kidney Research Centre, Ottawa Health Research Institute, 501 Smyth Road, Box 511, Ottawa, ON K1H 8L6, Canada. Electronic address: aakbari@toh.ca. 4. Department of Pathology and Molecular Medicine, Richardson Laboratory, Queen's University, 88 Stuart Street, Kingston, Ontario K7L 3N6, Canada. Electronic address: Christine.collier@lifelabs.com. 5. Division of Nephrology, Department of Medicine, Etherington Hall, Queen's University, 94 Stuart Street, Kingston, Ontario K7L 4N6, Canada. Electronic address: dh9@queensu.ca. 6. Kingston General Health Research Institute, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada. Electronic address: daya@kgh.kari.net. 7. Division of Nephrology, Department of Medicine, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 206, Ottawa, Ontario K1H 8L6, Canada; Kidney Research Centre, Ottawa Health Research Institute, 501 Smyth Road, Box 511, Ottawa, ON K1H 8L6, Canada. Electronic address: gknoll@toh.ca.
Abstract
BACKGROUND: Diagnosis, prognostication and treatment in chronic kidney disease is often informed by an estimate of the glomerular filtration rate (GFR). Commonly used GFR estimation (eGFR) equations are based on serum creatinine (Cr) concentrations and display suboptimal precision and accuracy. Newer equations incorporating additional endogenous markers such as β-Trace Protein (BTP), β2-Microglobulin (B2M) and cystatin C (cysC) have been developed but require validation. METHODS: This prospective cohort study evaluated the performance of 6 eGFR equations developed by the chronic kidney disease - epidemiology collaboration group (CKD-EPI) against urinary inulin clearance GFR in patients recruited from outpatient nephrology clinics. RESULTS: Mean biases were negligible and similar between equations. The eGFR-EPI Cr/cysC had the best precision and accuracy of all the equations and the best agreement with inulin mGFR when classifying participants into GFR categories. The BTP and B2M equations displayed the worst precisions and accuracies and showed the least consistent performance across levels of GFR. Thus, the eGFR-EPI Cr/cysC is the least biased, most precise and has the highest accuracy as compared to other eGFR-EPI equations. CONCLUSIONS: The BTP and B2M equations are the worst performing of the eGFR-EPI equations, and no benefit is observed with the addition of BTP or B2M to Cr/cysC.
BACKGROUND: Diagnosis, prognostication and treatment in chronic kidney disease is often informed by an estimate of the glomerular filtration rate (GFR). Commonly used GFR estimation (eGFR) equations are based on serum creatinine (Cr) concentrations and display suboptimal precision and accuracy. Newer equations incorporating additional endogenous markers such as β-Trace Protein (BTP), β2-Microglobulin (B2M) and cystatin C (cysC) have been developed but require validation. METHODS: This prospective cohort study evaluated the performance of 6 eGFR equations developed by the chronic kidney disease - epidemiology collaboration group (CKD-EPI) against urinary inulin clearance GFR in patients recruited from outpatient nephrology clinics. RESULTS: Mean biases were negligible and similar between equations. The eGFR-EPI Cr/cysC had the best precision and accuracy of all the equations and the best agreement with inulin mGFR when classifying participants into GFR categories. The BTP and B2M equations displayed the worst precisions and accuracies and showed the least consistent performance across levels of GFR. Thus, the eGFR-EPI Cr/cysC is the least biased, most precise and has the highest accuracy as compared to other eGFR-EPI equations. CONCLUSIONS: The BTP and B2M equations are the worst performing of the eGFR-EPI equations, and no benefit is observed with the addition of BTP or B2M to Cr/cysC.
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