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. 2018 Mar 1;33(3):417-425.
doi: 10.1093/ndt/gfx042.

Performance of glomerular filtration rate estimating equations in a community-based sample of Blacks and Whites: the multiethnic study of atherosclerosis

Lesley A Inker  1 , Andrew S Levey  1 , Hocine Tighiouart  2   3 , Tariq Shafi  4 , John H Eckfeldt  5 , Craig Johnson  6 , Aghogho Okparavero  1 , Wendy S Post  4 , Josef Coresh  4 , Michael G Shlipak  7
Affiliations

Performance of glomerular filtration rate estimating equations in a community-based sample of Blacks and Whites: the multiethnic study of atherosclerosis

Lesley A Inker et al. Nephrol Dial Transplant. .

Abstract

Background: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations are recommended for glomerular filtration rate (GFR) estimation in the general population. They have not been evaluated in community-based populations, including Blacks at higher levels of GFR, but are commonly applied in such populations.

Methods: In an ancillary study of Multi-Ethnic Study of Atherosclerosis conducted at one site, we evaluated the performance of the CKD-EPI equations for creatinine (eGFRcr), cystatin C (eGFRcys) or the combination (eGFRcr-cys) compared with GFR measured as plasma clearance of iohexol.

Results: Among 294 participants, the mean age was 71 (SD 9) years, 47% were Black, 48% were women and the mean measured GFR (mGFR) was 72.6 (SD 18.8) mL/min/1.73 m2. The CKD-EPI equations overestimated mGFR with a larger median bias for eGFRcr and eGFRcr-cys than eGFRcys [-8.3 (95% confidence interval -9.7, -6.5), -7.8 (-9.2, -6.2) and -3.7 (-5.0, -1.8) mL/min/1.73 m2, respectively], with smaller bias for those with lower compared with higher eGFR and by race compared with sex.

Conclusion: The small differential bias of the CKD-EPI equation between races suggests that they can be used in Blacks as well as Whites in older community-based adults. The large differential bias in women versus men in all equations is in contrast to other studies and is unexplained. Further studies are required in multiracial and multiethnic community-based cohorts, taking into account differences in GFR measurement methods.

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Figures

FIGURE 1
FIGURE 1
Bias versus eGFR by race and sex subgroups. (A) CKD-EPI creatinine; (B) CKD-EPI cystatin C and (C) CKD-EPI creatinine–cystatin C. Solid lines indicate the median difference (median bias). Units of difference, ml/min/1.73m2
FIGURE 2
FIGURE 2
Bias by race and sex subgroups assuming 0, 5 and 10% lower mGFR using plasma clearance of iohexol than urinary clearance of iothalamate. CKD-EPI, Chronic Kidney Disease Epidemiology Consortium; cr, creatinine; cys, cystatin C; cr-cys, creatinine-cystatin C. Units of difference, ml/min/1.73m2
FIGURE 3
FIGURE 3
Bias by race and sex subgroups for equations developed using GFR measured using plasma clearance of iohexol. CKD-EPI, Chronic Kidney Disease Epidemiology Consortium; CAPA, Caucasian, Asian, pediatric and adult; BIS, Berlin Initiative Study; cr, creatinine; cys, cystatin C; cr-cys, creatinine-cystatin C. Units of difference, ml/min/1.73m2
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