Estimation of glomerular filtration rate from serum creatinine and cystatin C in octogenarians and nonagenarians

Estimation of glomerular filtration rate from serum creatinine and cystatin C in octogenarians and nonagenarians

Author Lopes, Marcelo B. Autor UNIFESP Google Scholar
Araujo, Lara Q. Autor UNIFESP Google Scholar
Passos, Michelle T. Autor UNIFESP Google Scholar
Nishida, Sonia Kiyomi Autor UNIFESP Google Scholar
Kirsztajn, Gianna Mastroianni Autor UNIFESP Google Scholar
Cendoroglo, Maysa Seabra Autor UNIFESP Google Scholar
Sesso, Ricardo de Castro Cintra Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Background: Equations to estimate GFR have not been well validated in the elderly and may misclassify persons with chronic kidney disease (CKD). We measured GFR and compared the performance of the Modification of Diet in Renal Disease (MDRD), the Chronic Kidney Disease-Epidemiology Collaboration (CKD-Epi) and the Berlin Initiative Study (BIS) equations based on creatinine and/or cystatin C in octogenarians and nonagenarians.Methods: Using cross-sectional analysis we assessed 95 very elderly persons (mean 85 years) living in the community. GFR was measured by iohexol (mGFR) and compared with estimates using six equations: MDRD, CKD-Epi_creatinine, CKD-Epi_cystatin, CKD-Epi_creatinine-cystatin, BIS_creatinine and BIS_creatinine-cystatin.Results: Mean mGFR was 55 (range, 19-86) ml/min/1.73 m(2). Bias was smaller with the CKD-Epi_creatinine-cystatin and the CKD-Epi_creatinine equations (-4.0 and 1.7 ml/min/1.73 m2). Accuracy (percentage of estimates within 30% of mGFR) was greater with the CKD-Epi_creatinine-cystatin, BIS_creatinine-cystatin and BIS_creatinine equations (85%, 83% and 80%, respectively). Among the creatinine-based equations, the BIS_creatinine had the greatest accuracy at mGFR < 60 ml/min/1.73 m(2) and the CKD-Epi_creatinine was superior at higher GFRs (79% and 90%, respectively). the CKD-Epi_creatinine-cystatin, BIS_creatinine-cystatin and CKD-Epi_cystatin equations yielded the greatest areas under the receiver operating characteristic curve at GFR threshold = 60 ml/min/1.73 m(2) (0.88, 0.88 and 0.87, respectively). in participants classified based on the BIS_creatinine, CKD-Epi_cystatin, or BIS_creatinine-cystatin equations, the CKD-Epi_creatinine-cystatin equation tended to improve CKD classification (net reclassification index: 12.7%, p = 0.18; 6.7%, p = 0.38; and 15.9%; p = 0.08, respectively).Conclusions: GFR-estimating equations CKD-Epi_creatinine-cystatin and BIS_creatinine-cystatin showed better accuracy than other equations using creatinine or cystatin C alone in very elderly persons. the CKD-Epi_creatinine-cystatin equation appears to be advantageous in CKD classification. If cystatin C is not available, both the BIS_cr equation and the CKD-Epi_cr equation could be used, although at mGFR < 60 ml/min/1.73 m(2), the BIS_cr equation seems to be the best alternative.
Keywords Chronic kidney disease
Creatinine
Cystatin C
Elderly
Glomerular filtration rate
Iohexol
Language English
Sponsor Brazilian Research Council
Grant number Brazilian Research Council: 472115/2010-3
Date 2013-12-02
Published in Bmc Nephrology. London: Biomed Central Ltd, v. 14, 9 p., 2013.
ISSN 1471-2369 (Sherpa/Romeo, impact factor)
Publisher Biomed Central Ltd
Extent 9
Origin http://dx.doi.org/10.1186/1471-2369-14-265
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000329747500001
URI http://repositorio.unifesp.br/handle/11600/37072

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