Hans Pottel1, Jonas Björk2, Marie Courbebaisse3, Lionel Couzi4, Natalie Ebert5, Björn O Eriksen6, R Neil Dalton7, Laurence Dubourg8, François Gaillard9, Cyril Garrouste10, Anders Grubb11, Lola Jacquemont12, Magnus Hansson13, Nassim Kamar14, Edmund J Lamb15, Christophe Legendre16, Karin Littmann17, Christophe Mariat18, Toralf Melsom6, Lionel Rostaing19, Andrew D Rule20, Elke Schaeffner5, Per-Ola Sundin21, Stephen Turner20, Arend Bökenkamp22, Ulla Berg23, Kajsa Åsling-Monemi23, Luciano Selistre24, Anna Åkesson2, Anders Larsson25, Ulf Nyman26, Pierre Delanaye27. 1. KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium (H.P.). 2. Lund University and Skåne University Hospital, Lund, Sweden (J.B., A.Å.). 3. Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Paris Descartes University, INSERM U1151-CNRS UMR8253, Paris, France (M.C.). 4. CHU de Bordeaux, Université de Bordeaux, CNRS-UMR 5164 Immuno ConcEpT, Bordeaux, France (L.C.). 5. Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany (N.E., E.S.). 6. UiT The Arctic University of Norway, Tromsö, Norway (B.O.E., T.M.). 7. Evelina London Children's Hospital, London, United Kingdom (R.N.D.). 8. Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France (L.D.). 9. Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France (F.G.). 10. Clermont-Ferrand University Hospital, Clermont-Ferrand, France (C.G.). 11. Skåne University Hospital and Lund University, Lund, Sweden (A.G.). 12. CHU Nantes, Nantes University, Nantes, France (L.J.). 13. Karolinska University Hospital Huddinge and Karolinska Institute, Stockholm, Sweden (M.H.). 14. CHU Rangueil, INSERM U1043, IFR-BMT, University Paul Sabatier, Toulouse, France (N.K.). 15. East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom (E.J.L.). 16. Hôpital Necker, Assistance Publique Hôpitaux de Paris (AP-HP)and Université Paris Descartes, Paris, France (C.L.). 17. Karolinska Institute, Huddinge, Sweden (K.L.). 18. Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France (C.M.). 19. Hôpital Michallon, CHU Grenoble-Alpes, La Tronche, France (L.R.). 20. Mayo Clinic, Rochester, Minnesota (A.D.R., S.T.). 21. Örebro University, Örebro, Sweden (P.S.). 22. Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (A.B.). 23. Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden (U.B., K.Å.). 24. Mestrado em Ciências da Saúde-Universidade Caxias do Sul Foundation CAPES, Caxias do Sul, Brazil (L.S.). 25. Skåne University Hospital, Lund, Sweden; Uppsala University, Uppsala, Sweden (A.L.). 26. Lund University, Malmö, Sweden (U.N.). 27. University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium, and Hôpital Universitaire Carémeau, Nîmes, France (P.D.).
Abstract
BACKGROUND: The Chronic Kidney Disease in Children Study (CKiD) equation for children and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for adults are recommended serum creatinine (SCr)-based calculations for estimating glomerular filtration rate (GFR). However, these equations, as well as their combination, have limitations, notably the problem of implausible changes in GFR during the transition from adolescence to adulthood and overestimation of GFR in young adults. The full age spectrum (FAS) equation addresses these issues but overestimates GFR when SCr levels are low. OBJECTIVE: To develop and validate a modified FAS SCr-based equation combining design features of the FAS and CKD-EPI equations. DESIGN: Cross-sectional analysis with separate pooled data sets for development and validation. SETTING: Research and clinical studies (n = 13) with measured GFR available. PATIENTS: 11 251 participants in 7 studies (development and internal validation data sets) and 8378 participants in 6 studies (external validation data set). MEASUREMENTS: Clearance of an exogenous marker (reference method), SCr level, age, sex, and height were used to develop a new equation to estimate GFR. RESULTS: The new European Kidney Function Consortium (EKFC) equation is a FAS equation with low bias (-1.2 mL/min/1.73 m2 [95% CI, -2.7 to 0.0 mL/min/1.73 m2] in children and -0.9 mL/min/1.73 m2 [CI, -1.2 to -0.5 mL/min/1.73 m2] in adults) across the FAS (2 to 90 years) and SCr range (40 to 490 µmol/L [0.45 to 5.54 mg/dL]) and with fewer estimation errors exceeding 30% (6.5% [CI, 3.8% to 9.1%] in children and 3.1% [CI, 2.5% to 3.6%] in adults) compared with the CKiD and CKD-EPI equations. LIMITATION: No Black patients were included. CONCLUSION: The new EKFC equation shows improved accuracy and precision compared with commonly used equations for estimating GFR from SCr levels. PRIMARY FUNDING SOURCE: Swedish Research Council (Vetenskapsrådet).
BACKGROUND: The Chronic Kidney Disease in Children Study (CKiD) equation for children and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for adults are recommended serum creatinine (SCr)-based calculations for estimating glomerular filtration rate (GFR). However, these equations, as well as their combination, have limitations, notably the problem of implausible changes in GFR during the transition from adolescence to adulthood and overestimation of GFR in young adults. The full age spectrum (FAS) equation addresses these issues but overestimates GFR when SCr levels are low. OBJECTIVE: To develop and validate a modified FAS SCr-based equation combining design features of the FAS and CKD-EPI equations. DESIGN: Cross-sectional analysis with separate pooled data sets for development and validation. SETTING: Research and clinical studies (n = 13) with measured GFR available. PATIENTS: 11 251 participants in 7 studies (development and internal validation data sets) and 8378 participants in 6 studies (external validation data set). MEASUREMENTS: Clearance of an exogenous marker (reference method), SCr level, age, sex, and height were used to develop a new equation to estimate GFR. RESULTS: The new European Kidney Function Consortium (EKFC) equation is a FAS equation with low bias (-1.2 mL/min/1.73 m2 [95% CI, -2.7 to 0.0 mL/min/1.73 m2] in children and -0.9 mL/min/1.73 m2 [CI, -1.2 to -0.5 mL/min/1.73 m2] in adults) across the FAS (2 to 90 years) and SCr range (40 to 490 µmol/L [0.45 to 5.54 mg/dL]) and with fewer estimation errors exceeding 30% (6.5% [CI, 3.8% to 9.1%] in children and 3.1% [CI, 2.5% to 3.6%] in adults) compared with the CKiD and CKD-EPI equations. LIMITATION: No Black patients were included. CONCLUSION: The new EKFC equation shows improved accuracy and precision compared with commonly used equations for estimating GFR from SCr levels. PRIMARY FUNDING SOURCE: Swedish Research Council (Vetenskapsrådet).
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