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Meta-Analysis
. 2021 Aug-Sep;139(5):452-463.
doi: 10.1590/1516-3180.2020.0707.R1.150321.

Performance of the CKD-EPI and MDRD equations for estimating glomerular filtration rate: a systematic review of Latin American studies

Ana Brañez-Condorena  1 , Sergio Goicochea-Lugo  2 , Jessica Hanae Zafra-Tanaka  3 , Naysha Becerra-Chauca  4 , Virgilio Efrain Failoc-Rojas  5 , Percy Herrera-Añazco  6 , Alvaro Taype-Rondan  5
Affiliations
Meta-Analysis

Performance of the CKD-EPI and MDRD equations for estimating glomerular filtration rate: a systematic review of Latin American studies

Ana Brañez-Condorena et al. Sao Paulo Med J. 2021 Aug-Sep.

Abstract

Background: The most-used equations for estimating the glomerular filtration rate (GFR) are the CKD Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations. However, it is unclear which of these shows better performance in Latin America.

Objective: To assess the performance of two equations for estimated GFR (eGFR) in Latin American countries.

Design and setting: Systematic review and meta-analysis in Latin American countries.

Methods: We searched in three databases to identify studies that reported eGFR using both equations and compared them with measured GFR (mGFR) using exogenous filtration markers, among adults in Latin American countries. We performed meta-analyses on P30, bias (using mean difference [MD] and 95% confidence intervals [95% CI]), sensitivity and specificity; and evaluated the certainty of evidence using the GRADE methodology.

Results: We included 12 papers, and meta-analyzed six (five from Brazil and one from Mexico). Meta-analyses that compared CKD-EPI using creatinine measured with calibration traceable to isotope dilution mass spectrometry (CKD-EPI-Cr IDMS) and using MDRD-4 IDMS did not show differences in bias (MD: 0.55 ml/min/1.73m2; 95% CI: -3.34 to 4.43), P30 (MD: 4%; 95% CI: -2% to 11%), sensitivity (76% and 75%) and specificity (91% and 89%), with very low certainty of evidence for bias and P30, and low certainty of evidence for sensitivity and specificity.

Conclusion: We found that the performances of CKD-EPI-Cr IDMS and MDRD-4 IDMS did not differ significantly. However, since most of the meta-analyzed studies were from Brazil, the results cannot be extrapolated to other Latin American countries.

Registration: PROSPERO (CRD42019123434) - https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019123434.

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Conflict of interest statement

Conflicts of interest: None

Figures

Figure 1
Figure 1. Flow diagram summarizing the process of searching the literature and selecting studies.
Figure 2
Figure 2. Risk of bias.
Figure 3
Figure 3. Forest plot for bias and P30.
Figure 4
Figure 4. Forest plot for sensitivity and specificity (cutoff of GFR 60 ml/minute/1.73 m2).
See this image and copyright information in PMC

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