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Comparing GFR Estimating Equations Using Cystatin C and Creatinine in Elderly Individuals
Open accessAbstract
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 (16,19).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [19]
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Toprak, Ö., Kurt, H., Sarı, Y., Şarkış, C., Us, H., & Kırık, A. (2017) · Kidney & Blood Pressure Research · doi:10.1159/000468530 · Cited by 29,772
A New Equation to Estimate Glomerular Filtration Rate
Levey, A. S., Stevens, L. A., Schmid, C. H., Zhang, Y. (., Castro, A. F., Feldman, H. I., Kusek, J. W., Eggers, P., Van Lente, F., Greene, T., et al. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-150-9-200905050-00006 · Cited by 25,603
Self-citationRevised Equations for Estimated GFR From Serum Creatinine in Japan
Matsuo, S., Imai, E., Horio, M., Yasuda, Y., Tomita, K., Nitta, K., Yamagata, K., Tomino, Y., Yokoyama, H., & Hishida, A. (2009) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2008.12.034 · Cited by 6,440
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Self-citationEstimating glomerular filtration rate from serum creatinine and cystatin C
Inker, L. A., Schmid, C. H., Tighiouart, H., Eckfeldt, J. H., Feldman, H. I., Greene, T., Kusek, J. W., Manzi, J., Van Lente, F., Zhang, Y. L., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1114248 · Cited by 4,102
Self-citation(2012) · Kidney International Supplements · doi:10.1038/kisup.2012.73 · Cited by 3,325
Coresh, J., Astor, B. C., Greene, T., Eknoyan, G., & Levey, A. S. (2002) · American Journal of Kidney Diseases · doi:10.1053/ajkd.2003.50007 · Cited by 2,761
Self-citationPrevalence of obesity in the United States, 2009-2010.
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Self-citationStevens, L. A., Coresh, J., Schmid, C. H., Feldman, H. I., Froissart, M., Kusek, J. W., Rossert, J., Lente, F. V., Bruce, R. D., Zhang, Y., et al. (2008) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2007.11.018 · Cited by 1,043
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Self-citationAn estimated glomerular filtration rate equation for the full age spectrum
Pottel, H., Hoste, L., Dubourg, L. D., Ebert, N., Schäeffner, E., Eriksen, B. O., Melsom, T., Lamb, E. J., Rule, A. D., Turner, S. T., et al. (2016) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfv454 · Cited by 490
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Metadata
- 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)
- PMC
- PMC4520174
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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