Quantifying Individual-Level Inaccuracy in Glomerular Filtration Rate Estimation : A Cross-Sectional Study.

Autor: Shafi T; Division of Nephrology, Department of Medicine, Department of Physiology, and Department of Population Health, Bower School of Population Health, The University of Mississippi Medical Center, Jackson, Mississippi (T.S.)., Zhu X; Department of Data Science, Bower School of Population Health, The University of Mississippi Medical Center, Jackson, Mississippi (X.Z., S.T.L.)., Lirette ST; Department of Data Science, Bower School of Population Health, The University of Mississippi Medical Center, Jackson, Mississippi (X.Z., S.T.L.)., Rule AD; Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minnesota (A.D.R.)., Mosley T; The Mind Center, The University of Mississippi Medical Center, Jackson, Mississippi (T.M., K.R.B.)., Butler KR; The Mind Center, The University of Mississippi Medical Center, Jackson, Mississippi (T.M., K.R.B.)., Hall ME; Division of Cardiology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi (M.E.H.)., Vaitla P; Division of Nephrology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi (P.V., M.C.T.)., Wynn JJ; Department of Surgery, The University of Mississippi Medical Center, Jackson, Mississippi (J.J.W.)., Tio MC; Division of Nephrology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi (P.V., M.C.T.)., Dossabhoy NR; Division of Nephrology, Department of Medicine, and Department of Physiology, The University of Mississippi Medical Center, Jackson, Mississippi (N.R.D.)., Guallar E; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (E.G.)., Butler J; Division of Cardiology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi, and Baylor Scott & White Research Institute, Dallas, Texas (J.B.).
Jazyk: angličtina
Zdroj: Annals of internal medicine [Ann Intern Med] 2022 Aug; Vol. 175 (8), pp. 1073-1082. Date of Electronic Publication: 2022 Jul 05.
DOI: 10.7326/M22-0610
Abstrakt: Background: Although the population-level differences between estimated glomerular filtration rate (eGFR) and measured glomerular filtration rate (mGFR) are well recognized, the magnitude and potential clinical implications of individual-level differences are unknown.
Objective: To quantify the magnitude and consequences of the individual-level differences between mGFRs and eGFRs.
Design: Cross-sectional study.
Setting: Four U.S. community-based epidemiologic cohort studies with mGFR.
Patients: 3223 participants in 4 studies.
Measurements: The GFRs were measured using urinary iothalamate and plasma iohexol clearance; the eGFR was calculated from serum creatinine concentration alone (eGFR CR ) and with cystatin C. All GFR results are presented as mL/min/1.73 m 2 .
Results: The participants' mean age was 59 years; 32% were Black, 55% were women, and the mean mGFR was 68. The population-level differences between mGFR and eGFR CR were small; the median difference (mGFR - eGFR) was -0.6 (95% CI, -1.2 to -0.2); however, the individual-level differences were large. At an eGFR CR of 60, 50% of mGFRs ranged from 52 to 67, 80% from 45 to 76, and 95% from 36 to 87. At an eGFR CR of 30, 50% of mGFRs ranged from 27 to 38, 80% from 23 to 44, and 95% from 17 to 54. Substantial disagreement in chronic kidney disease staging by mGFR and eGFR CR was present. Among those with eGFR CR of 45 to 59, 36% had mGFR greater than 60 whereas 20% had mGFR less than 45; among those with eGFR CR of 15 to 29, 30% had mGFR greater than 30 and 5% had mGFR less than 15. The eGFR based on cystatin C did not provide substantial improvement.
Limitation: Single measurement of mGFR and serum markers without short-term replicates.
Conclusion: A substantial individual-level discrepancy exists between the mGFR and the eGFR. Laboratories reporting eGFR should consider including the extent of this uncertainty to avoid misinterpretation of eGFR as an mGFR replacement.
Primary Funding Source: National Institutes of Health.
Databáze: MEDLINE
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