Estimating GFR among participants in the Chronic Renal Insufficiency Cohort (CRIC) Study

Abstract

Background: Glomerular filtration rate (GFR) is considered the best measure of kidney function, but repeated assessment is not feasible in most research studies.

Study design: Cross-sectional study of 1,433 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study (ie, the GFR subcohort) to derive an internal GFR estimating equation using a split-sample approach.

Setting & participants: Adults from 7 US metropolitan areas with mild to moderate chronic kidney disease; 48% had diabetes and 37% were black.

Index test: CRIC GFR estimating equation.

Reference test or outcome: Urinary (125)I-iothalamate clearance testing (measured GFR [mGFR]).

Other measurements: Laboratory measures, including serum creatinine and cystatin C, and anthropometrics.

Results: In the validation data set, the model that included serum creatinine level, serum cystatin C level, age, sex, and race was the most parsimonious and similarly predictive of mGFR compared with a model additionally including bioelectrical impedance analysis phase angle, CRIC clinical center, and 24-hour urinary creatinine excretion. Specifically, root mean square errors for the separate models were 0.207 versus 0.202, respectively. Performance of the CRIC GFR estimating equation was most accurate for the subgroups of younger participants, men, nonblacks, non-Hispanics, those without diabetes, those with body mass index <30 kg/m(2), those with higher 24-hour urine creatinine excretion, those with lower high-sensitivity C-reactive protein levels, and those with higher mGFRs.

Limitations: Urinary clearance of (125)I-iothalamate is an imperfect measure of true GFR; cystatin C level is not standardized to certified reference material; lack of external validation; small sample sizes limit analyses of subgroup-specific predictors.

Conclusions: The CRIC GFR estimating equation predicts mGFR accurately in the CRIC cohort using serum creatinine and cystatin C levels, age, sex, and race. Its performance was best in younger and healthier participants.

Figure 1

Scat terplots of (A) mGFR with serum creatinine, and (B) mGFR with serum cystatin C within the Chronic Renal Insufficiency Cohort (CRIC) Study GFR subcohort. The solid line is the linear regression line and the dotted line represents the lowess fit. The scatterplots were created in the log scale, but axis labels have been converted back to the original scale.

Figure 2

Performance of the final Chronic Renal Insufficiency Cohort (CRIC) Study glomerular filtration rate (GFR) estimating equation refit in the validation dataset by level of estimated GFR.