Cited by 171Chronic Kidney Disease and DiabetesAcute Kidney Injury ResearchDialysis and Renal Disease Management

Comparing GFR estimating equations using cystatin C and creatinine in elderly individuals

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Fan, Li, Levey, Andrew S., Gudnason, Vilmundur, Eiriksdottir, Gudny, Andresdottir, Margret B., Gudmundsdottir, Hrefna, Indridason, Olafur S., Palsson, Runolfur +2 more·2015·Journal of the American Society of Nephrology

Abstract

Current guidelines recommend reporting eGFR using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations unless other equations are more accurate, and recommend the combination of creatinine and cystatin C (eGFRcr-cys) as more accurate than either eGFRcr or eGFRcys alone. However, preferred equations and filtration markers in elderly individuals are debated. In 805 adults enrolled in the community-based Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study, we measured GFR (mGFR) using plasma clearance of iohexol, standardized creatinine and cystatin C, and eGFR using the CKD-EPI, Japanese, Berlin Initiative Study (BIS), and Caucasian and Asian pediatric and adult subjects (CAPA) equations. We evaluated equation performance using bias, precision, and two measures of accuracy. We first compared the Japanese, BIS, and CAPA equations with the CKD-EPI equations to determine the preferred equations, and then compared eGFRcr and eGFRcys with eGFRcr-cys using the preferred equations. Mean (SD) age was 80.3 (4.0) years. Median (25th, 75th) mGFR was 64 (52, 73) ml/min per 1.73 m(2), and the prevalence of decreased GFR was 39% (95% confidence interval, 35.8 to 42.5). Among 24 comparisons with the other equations, CKD-EPI equations performed better in 9, similar in 13, and worse in 2. Using the CKD-EPI equations, eGFRcr-cys performed better than eGFRcr in four metrics, better than eGFRcys in two metrics, and similar to eGFRcys in two metrics. In conclusion, neither the Japanese, BIS, nor CAPA equations were superior to the CKD-EPI equations in this cohort of community-dwelling elderly individuals. Using the CKD-EPI equations, eGFRcr-cys performed better than eGFRcr or eGFRcys.

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  • The combination of both filtration markers (creatinine and cystatin C) is more accurate and would support better clinical decisions than either marker alone.

    “The combination of both filtration markers (creatinine and cystatin C) is more accurate and would support better clinical decisions than either marker alone (16,19).”

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Authors
Fan, L., Levey, A. S., Gudnason, V., Eiriksdottir, G., Andresdottir, M. B., Gudmundsdottir, H., Indridason, O. S., Palsson, R., Mitchell, G., & Inker, L. A.
Affiliations
  • Tufts Medical Center (US)
  • University of Iceland (IS)
Corresponding author
  • Fan, Li
  • Levey, Andrew S.
  • Inker, Lesley A.
Venue
Journal of the American Society of Nephrology
Published
2015-08
Volume
26
Issue
8
Pages
1982-1989
ISSN
1046-6673 (ISSN-L)
OpenAlex
W2098684703
Cited by
170
References
37
Citations by year
2026: 3 · 2025: 11 · 2024: 14 · 2023: 11 · 2022: 10 · 2021: 12 · 2020: 19 · 2019: 19 · 2018: 21 · 2017: 16 · 2016: 20 · 2015: 14
FWCI
13.17
Type
journal article
Language
en
Open access
Locations
  • Journal of the American Society of Nephrology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Hirsla (Landspítali University Hospital) (submittedVersion)
Funders
  • Tufts Medical Center
  • National Institute on Aging
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK082447)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
glomerular filtration rate estimation, cystatin C, serum creatinine, CKD-EPI equation, older adults, iohexol plasma clearance, equation accuracy, chronic kidney disease
MeSH terms
Aged, Aged, 80 and over, Algorithms, Creatinine, Female, Glomerular Filtration Rate, Humans, Male, Cystatin C

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