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Comparison of the Schwartz and CKD-EPI Equations for Estimating Glomerular Filtration Rate in Children, Adolescents, and Adults: A Retrospective Cross-Sectional Study

Selistre, Luciano ; Rabilloud, Muriel ; Cochat, Pierre ; de Souza, Vandréa ; Iwaz, Jean ; Lemoine, Sandrine ; Beyerle, Françoise ; Poli-de-Figueiredo, Carlos E ; Dubourg, Laurence Remuzzi, Giuseppe

PLoS medicine, 2016-03, Vol.13 (3), p.e1001979-e1001979 [Periódico revisado por pares]

United States: Public Library of Science

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  • Título:
    Comparison of the Schwartz and CKD-EPI Equations for Estimating Glomerular Filtration Rate in Children, Adolescents, and Adults: A Retrospective Cross-Sectional Study
  • Autor: Selistre, Luciano ; Rabilloud, Muriel ; Cochat, Pierre ; de Souza, Vandréa ; Iwaz, Jean ; Lemoine, Sandrine ; Beyerle, Françoise ; Poli-de-Figueiredo, Carlos E ; Dubourg, Laurence
  • Remuzzi, Giuseppe
  • Assuntos: Accuracy ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analysis ; Bias ; Biology and Life Sciences ; Child ; Child, Preschool ; Chronic kidney failure ; Clinical medicine ; Collaboration ; Creatinine - metabolism ; Cross-Sectional Studies ; Diagnosis ; Female ; Fructans - metabolism ; Glomerular Filtration Rate ; Humans ; Inulin - urine ; Kidney - metabolism ; Kidney diseases ; Laboratories ; Life Sciences ; Male ; Mass Spectrometry ; Medicine and Health Sciences ; Middle Aged ; Models, Theoretical ; Mortality ; People and Places ; Physiological aspects ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - metabolism ; Reproducibility of Results ; Researchers ; Retrospective Studies ; Studies ; Teenagers ; Urine ; Young Adult
  • É parte de: PLoS medicine, 2016-03, Vol.13 (3), p.e1001979-e1001979
  • Notas: ObjectType-Article-2
    SourceType-Scholarly Journals-1
    ObjectType-Feature-1
    content type line 23
    PMCID: PMC4811544
    Conceived and designed the experiments: LS MR PC LD. Performed the experiments: SL LD. Analyzed the data: LS MR. Contributed reagents/materials/analysis tools: LS MR PC VS JI SL FB CPF LD. Wrote the first draft of the manuscript: LS MR PC VS JI SL FB CPF LD. Contributed to the writing of the manuscript: LS MR PC VS JI SL FB CPF LD. Enrolled patients: LS LD. Agree with the manuscript’s results and conclusions: LS MR PC VS JI SL FB CPF LD. All authors have read, and confirm that they meet, ICMJE criteria for authorship.
    The authors have declared that no competing interests exist.
  • Descrição: Estimating kidney glomerular filtration rate (GFR) is of utmost importance in many clinical conditions. However, very few studies have evaluated the performance of GFR estimating equations over all ages and degrees of kidney impairment. We evaluated the reliability of two major equations for GFR estimation, the CKD-EPI and Schwartz equations, with urinary clearance of inulin as gold standard. The study included 10,610 participants referred to the Renal and Metabolic Function Exploration Unit of Edouard Herriot Hospital (Lyon, France). GFR was measured by urinary inulin clearance (only first measurement kept for analysis) then estimated with isotope dilution mass spectrometry (IDMS)-traceable CKD-EPI and Schwartz equations. The participants' ages ranged from 3 to 90 y, and the measured GFRs from 3 to 160 ml/min/1.73 m2. A linear mixed-effects model was used to model the bias (mean ratio of estimated GFR to measured GFR). Equation reliability was also assessed using precision (interquartile range [IQR] of the ratio) and accuracy (percentage of estimated GFRs within the 10% [P10] and 30% [P30] limits above and below the measured GFR). In the whole sample, the mean ratio with the CKD-EPI equation was significantly higher than that with the Schwartz equation (1.17 [95% CI 1.16; 1.18] versus 1.08 [95% CI 1.07; 1.09], p < 0.001, t-test). At GFR values of 60-89 ml/min/1.73 m2, the mean ratios with the Schwartz equation were closer to 1 than the mean ratios with the CKD-EPI equation whatever the age class (1.02 [95% CI 1.01; 1.03] versus 1.15 [95% CI 1.13; 1.16], p < 0.001, t-test). In young adults (18-40 y), the Schwartz equation had a better precision and was also more accurate than the CKD-EPI equation at GFR values under 60 ml/min/1.73 m2 (IQR: 0.32 [95% CI 0.28; 0.33] versus 0.40 [95% CI 0.36; 0.44]; P30: 81.4 [95% CI 78.1; 84.7] versus 63.8 [95% CI 59.7; 68.0]) and also at GFR values of 60-89 ml/min/1.73 m2. In all patients aged ≥65 y, the CKD-EPI equation performed better than the Schwartz equation (IQR: 0.33 [95% CI 0.31; 0.34] versus 0.40 [95% CI 0.38; 0.41]; P30: 77.6 [95% CI 75.7; 79.5] versus 67.5 [95% CI 65.4; 69.7], respectively). In children and adolescents (2-17 y), the Schwartz equation was superior to the CKD-EPI equation (IQR: 0.23 [95% CI 0.21; 0.24] versus 0.33 [95% CI 0.31; 0.34]; P30: 88.6 [95% CI 86.7; 90.4] versus 29.4 [95% CI 26.8; 32.0]). This study is limited by its retrospective design, single-center setting with few non-white patients, and small number of patients with severe chronic kidney disease. The results from this study suggest that the Schwartz equation may be more reliable than the CKD-EPI equation for estimating GFR in children and adolescents and in adults with mild to moderate kidney impairment up to age 40 y.
  • Editor: United States: Public Library of Science
  • Idioma: Inglês
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