The failure of glomerular filtration rate estimating equations among obese population

Autor: Krittaya Tiskajornsiri, Piyawan Kittiskulnam, Pisut Katavetin, Kearkiat Praditpornsilpa, Somchai Eiam-Ong, Tawatchai Chaiwatanarat
Rok vydání: 2020
Předmět:
Male
Physiology
Thai People
medicine.medical_treatment
Estimating equations
Kidney Function Tests
Biochemistry
Body Mass Index
chemistry.chemical_compound
Chronic Kidney Disease
Medicine and Health Sciences
Ethnicities
education.field_of_study
Multidisciplinary
Middle Aged
Concordance correlation coefficient
Physiological Parameters
Nephrology
Creatinine
Medicine
Female
Anatomy
Glomerular Filtration Rate
Research Article
Adult
medicine.medical_specialty
Science
Population
Urology
Renal function
Asian People
Renal Dialysis
medicine
Renal Diseases
Humans
Obesity
Cystatin C
Renal Insufficiency
Chronic
education
Dialysis
Renal Physiology
business.industry
Clinical Laboratory Techniques
Body Weight
Reproducibility of Results
Biology and Life Sciences
Kidneys
Renal System
medicine.disease
chemistry
People and Places
Population Groupings
business
Body mass index
Biomarkers
Kidney disease
Zdroj: PLoS ONE
PLoS ONE, Vol 15, Iss 11, p e0242447 (2020)
ISSN: 1932-6203
Popis: Background Obesity is a major public health with increasing numbers of obese individuals are at risk for kidney disease. However, the validity of serum creatinine-based glomerular filtration rate (GFR) estimating equations in obese population is yet to be determined. Methods We evaluated the performance of the reexpressed Modification of Diet in Renal Disease (MDRD), reexpressed MDRD with Thai racial factor, Thai estimated GFR (eGFR) as well as Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations among obese patients, defined as body mass index (BMI) ≥25 kg/m2 with the reference measured GFR (mGFR) determined by 99mTc-diethylene triamine penta-acetic acid (99mTc-DTPA) plasma clearance method. Serum creatinine levels were measured using standardized enzymatic method simultaneously with GFR measurement. The statistical methods in assessing agreement for continuous data including total deviation index (TDI), concordance correlation coefficient (CCC), and coverage probability (CP) for each estimating equation were compared with the reference mGFR. Accuracy within 10% representing the percentage of estimations falling within the range of ±10% of mGFR values for all equations were also tested. Results A total of 240 Thai obese patients were finally recruited with mean BMI of 31.5 ± 5.8 kg/m2. In the total population, all eGFR equations underestimated the reference mGFR. The average TDI values were 55% indicating that 90% of the estimates falling within the range of -55 to +55% of the reference mGFR. The CP values averaged 0.23 and CCC scores ranged from 0.75 to 0.81, reflecting the low to moderate levels of agreement between each eGFR equation and the reference mGFR. The proportions of patients achieving accuracy 10% ranged from 23% for the reexpressed MDRD equation to 33% for the Thai eGFR formula. Among participants with BMI more than 35 kg/m2 (n = 48), the mean error of all equations was extremely wide and significantly higher for all equations compared with the lower BMI category. Also, the strength of agreement evaluated by TDI, CCC, and CP were low in the subset of patients with BMI ≥35 kg/m2. Conclusion Estimating equations generally underestimated the reference mGFR in subjects with obesity. The overall performance of GFR estimating equations demonstrated poor concordance with the reference mGFR among individuals with high BMI levels. In certain clinical settings such as decision for dialysis initiation, the direct measurements of GFR are required to establish real renal function among obese population.
Databáze: OpenAIRE
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