TY - JOUR
T1 - Estimating glomerular filtration rate for the full age spectrum from serum creatinine and cystatin C
AU - Pottel, Hans
AU - Delanaye, Pierre
AU - Schaeffner, Elke
AU - Dubourg, Laurence
AU - Eriksen, Bjørn Odvar
AU - Melsom, Toralf
AU - Lamb, Edmund J.
AU - Rule, Andrew D.
AU - Turner, Stephen T.
AU - Glassock, Richard J.
AU - De Souza, Vandréa
AU - Selistre, Luciano
AU - Goffin, Karolien
AU - Pauwels, Steven
AU - Mariat, Christophe
AU - Flamant, Martin
AU - Ebert, Natalie
N1 - Funding Information:
The Chronic Renal Insufficiency Cohort (CRIC) Study was conducted by the CRIC Investigators and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The data from the CRIC Study reported here were supplied by the NIDDK Central Repositories. This manuscript was not prepared in collaboration with Investigators of the CRIC Study and does not necessarily reflect the opinions or views of the CRIC Study, the NIDDK Central Repositories, or the NIDDK. We would also like to thank all patients and researchers, service users, carers and lay people who contributed to the original datasets and who are not mentioned here as co-authors. No specific funding was obtained for this study. S.T.T. (1 R01 DK073537) was supported by research grants from the National Institutes of Health, US Public Health Service.
Publisher Copyright:
© 2016 The Author.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background. We recently published and validated the new serum creatinine (Scr)-based full-age-spectrum equation (FAScrea) for estimating the glomerular filtration rate (GFR) for healthy and kidney-diseased subjects of all ages. The equation was based on the concept of normalized Scr and shows equivalent to superior prediction performance to the currently recommended equations for children, adolescents, adults and older adults. Methods. Based on an evaluation of the serum cystatin C (ScysC) distribution, we defined normalization constants for ScysC (QcysC = 0.82 mg/L for ages <70 years and QcysC = 0.95 mg/L for ages ≥70 years). By replacing Scr/Qcrea in the FAScrea equation with ScysC/QcysC, or with the average of both normalized biomarkers, we obtained new ScysC-based (FAScysC) and combined Scr-/ScysC-based FAS equations (FAScombi). To validate the new FAScysC and FAScombi we collected data on measured GFR, Scr, ScysC, age, gender, height and weight from 11 different cohorts including n = 6132 unique white subjects (368 children, aged ≤18 years, 4295 adults and 1469 older adults, aged ≥70 years). Results. In children and adolescents, the new FAScysC equation showed significantly better performance [percentage of patients within 30% of mGFR (P30) = 86.1%] than the Caucasian Asian Paediatric Adult Cohort equation (P30 = 76.6%; P < 0.0001), or the ScysC-based Schwartz equation (P30 = 68.8%; P < 0.0001) and the FAScombi equation outperformed all equations with P30 = 92.1% (P < 0.0001). In adults, the FAScysC equation (P30 = 82.6%) performed equally as well as the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPIcysC) (P30 = 80.4%) and the FAScombi equation (P30 = 89.9%) was also equal to the combined CKD-EPI equation (P30 = 88.2%). In older adults, FAScysC was superior (P30 = 88.2%) to CKD-EPIcysC (P30 = 84.4%; P < 0.0001) and the FAScombi equation (P30 = 91.2%) showed significantly higher performance than the combined CKD-EPI equation (P30 = 85.6%) (P < 0.0001). Conclusion. The FAS equation is not only applicable to all ages, but also for all recommended renal biomarkers and their combinations.
AB - Background. We recently published and validated the new serum creatinine (Scr)-based full-age-spectrum equation (FAScrea) for estimating the glomerular filtration rate (GFR) for healthy and kidney-diseased subjects of all ages. The equation was based on the concept of normalized Scr and shows equivalent to superior prediction performance to the currently recommended equations for children, adolescents, adults and older adults. Methods. Based on an evaluation of the serum cystatin C (ScysC) distribution, we defined normalization constants for ScysC (QcysC = 0.82 mg/L for ages <70 years and QcysC = 0.95 mg/L for ages ≥70 years). By replacing Scr/Qcrea in the FAScrea equation with ScysC/QcysC, or with the average of both normalized biomarkers, we obtained new ScysC-based (FAScysC) and combined Scr-/ScysC-based FAS equations (FAScombi). To validate the new FAScysC and FAScombi we collected data on measured GFR, Scr, ScysC, age, gender, height and weight from 11 different cohorts including n = 6132 unique white subjects (368 children, aged ≤18 years, 4295 adults and 1469 older adults, aged ≥70 years). Results. In children and adolescents, the new FAScysC equation showed significantly better performance [percentage of patients within 30% of mGFR (P30) = 86.1%] than the Caucasian Asian Paediatric Adult Cohort equation (P30 = 76.6%; P < 0.0001), or the ScysC-based Schwartz equation (P30 = 68.8%; P < 0.0001) and the FAScombi equation outperformed all equations with P30 = 92.1% (P < 0.0001). In adults, the FAScysC equation (P30 = 82.6%) performed equally as well as the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPIcysC) (P30 = 80.4%) and the FAScombi equation (P30 = 89.9%) was also equal to the combined CKD-EPI equation (P30 = 88.2%). In older adults, FAScysC was superior (P30 = 88.2%) to CKD-EPIcysC (P30 = 84.4%; P < 0.0001) and the FAScombi equation (P30 = 91.2%) showed significantly higher performance than the combined CKD-EPI equation (P30 = 85.6%) (P < 0.0001). Conclusion. The FAS equation is not only applicable to all ages, but also for all recommended renal biomarkers and their combinations.
KW - all ages
KW - all renal biomarkers
KW - combined FAS equation
KW - cystatin C
KW - serum creatinine
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U2 - 10.1093/ndt/gfw425
DO - 10.1093/ndt/gfw425
M3 - Article
C2 - 28089986
AN - SCOPUS:85017224879
SN - 0931-0509
VL - 32
SP - 497
EP - 507
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
IS - 3
ER -