Performance of the estimated glomerular filtration rate creatinine and cystatin C based equations in Thai patients with chronic glomerulonephritis
Authors Satirapoj B, Jirawatsiwaporn K, Tangwonglert T, Choovichian P
Received 6 August 2015
Accepted for publication 14 September 2015
Published 21 October 2015 Volume 2015:8 Pages 145—150
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Narender Goel
Peer reviewer comments 3
Editor who approved publication: Professor Pravin Singhal
Bancha Satirapoj, Ketkan Jirawatsiwaporn, Theerasak Tangwonglert, Panbubpa Choovichian
Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Background: Glomerular filtration rate (GFR) is considered the indicator of overall kidney function, and therefore, its assessment has become an important clinical tool in the daily care of chronic glomerulonephritis (CGN) patients. Currently, practical guidelines recommend using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations to assess GFR in CKD patients.
Methods: A cross-sectional study was performed in CGN patients. Standard GFR was measured using 24-hour urine creatinine clearance. GFR was estimated using the Cockcroft-Gault, Modification of Diet in Renal Disease, CKD-EPI equation based creatinine, cystatin C, and combined creatinine and cystatin C. The performance of GFR estimation equations were examined using bias, precision and accuracy and agreement between standard GFR and estimated GFR by calculating Cohen’s k.
Results: A total of 125 patients (74 male, 59.2%) with mean age 56.1±18.1 years were included. Mean standard GFR was 51.6±32.2 mL/min per 1.73 m2. A significant correlation was found between standard GFR and all estimated GFRs (r=0.573 to 0.660, P<0.001). CKD-EPI-creatinine-cystatin C equation had the smallest absolute bias and the significantly highest accuracy, although it was not significantly different from CKD-EPI-cystatin C equation (P=0.523). CKD-EPI-creatinine-cystatin C equation had the highest accuracy to classify CKD staging (Cohen’s k=0.345), but it underestimated GFR in 32% and overestimated GFR in 18% of the CGN patients.
Conclusion: CKD-EPI-creatinine-cystatin C equation estimated GFR with little bias, and the highest accuracy among CGN patients. This equation gave a better estimate of GFR than the equation based on serum creatinine.
Keywords: serum cystatin C, CKD-EPI cystatin C, glomerulonephritis
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