Performance of formulas for estimating glomerular filtration rate in Indigenous Australians with and without Type 2 diabetes

The eGFR Study

Louise Maple-Brown, Elif Ekinci, Jaquelyne Hughes, Mark Chatfield, Paul Lawton, Graham Jones, Andrew G Ellis, A Sinha, Alan Cass, Wendy Hoy, Kerin O'Dea, George Jerums, R MacIsaac

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Aims: It has been proposed that the Chronic Kidney Disease Epidemiology Collaboration formula estimates glomerular filtration rate more accurately than the Modification of Diet in Renal Disease formula. With the very high incidence of diabetes and end-stage kidney disease in Indigenous Australians, accurate estimation of glomerular filtration rate is vital in early detection of kidney disease. We aimed to assess the performance of the Chronic Kidney Disease Epidemiology Collaboration, Modification of Diet in Renal Disease and Cockcroft–Gault formulas in Indigenous Australians with and without diabetes.

Methods: 
Indigenous Australians with (n = 224) or without (n = 340) Type 2 diabetes had a reference glomerular filtration rate measure using plasma disappearance of iohexol (measured glomerular filtration rate) over 4 h. Serum creatinine was measured by an enzymatic method. Performance was assessed by bias (measured glomerular filtration rate – estimated glomerular filtration rate) and accuracy (percentage of estimated glomerular filtration rate within 30% of measured glomerular filtration rate).

Results: 
The median measured glomerular filtration rate (interquartile range) in participants with or without diabetes was 97 (68–119) and 108 (90–122) ml min−1 1.73 m−2, respectively. The Chronic Kidney Disease Epidemiology Collaboration formula had smaller bias and greater accuracy than the Modification of Diet in Renal Disease and Cockcroft–Gault formulas overall, for participants both with and without diabetes. However, for estimated glomerular filtration rate > 90 ml min−1 1.73 m−2, the Chronic Kidney Disease Epidemiology Collaboration formula had greater bias in participants with diabetes, underestimating measured glomerular filtration rate by 7.4 vs. 1.0 ml min−1 1.73 m−2 in those without diabetes. The Chronic Kidney Disease Epidemiology Collaboration formula was less accurate across the whole range of estimated glomerular filtration rates in participants with vs. those without diabetes (87.1% vs. 93.3%).

Conclusions: 
The Chronic Kidney Disease Epidemiology Collaboration formula outperforms the Modification of Diet in Renal Disease and Cockcroft–Gault formulas overall in Indigenous Australians with and without diabetes. However, the Chronic Kidney Disease Epidemiology Collaboration formula has greater bias in people with diabetes compared with those without diabetes, especially in those with normal renal function.
Original languageEnglish
Pages (from-to)829-838
Number of pages10
JournalDiabetic Medicine
Volume31
Issue number7
DOIs
Publication statusPublished - Jul 2014

Fingerprint

Glomerular Filtration Rate
Type 2 Diabetes Mellitus
Chronic Renal Insufficiency
Epidemiology
Diet Therapy
Kidney
Iohexol
Kidney Diseases
Chronic Kidney Failure
Early Diagnosis
Creatinine

Cite this

Maple-Brown, Louise ; Ekinci, Elif ; Hughes, Jaquelyne ; Chatfield, Mark ; Lawton, Paul ; Jones, Graham ; Ellis, Andrew G ; Sinha, A ; Cass, Alan ; Hoy, Wendy ; O'Dea, Kerin ; Jerums, George ; MacIsaac, R. / Performance of formulas for estimating glomerular filtration rate in Indigenous Australians with and without Type 2 diabetes : The eGFR Study. In: Diabetic Medicine. 2014 ; Vol. 31, No. 7. pp. 829-838.
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title = "Performance of formulas for estimating glomerular filtration rate in Indigenous Australians with and without Type 2 diabetes: The eGFR Study",
abstract = "Aims: It has been proposed that the Chronic Kidney Disease Epidemiology Collaboration formula estimates glomerular filtration rate more accurately than the Modification of Diet in Renal Disease formula. With the very high incidence of diabetes and end-stage kidney disease in Indigenous Australians, accurate estimation of glomerular filtration rate is vital in early detection of kidney disease. We aimed to assess the performance of the Chronic Kidney Disease Epidemiology Collaboration, Modification of Diet in Renal Disease and Cockcroft–Gault formulas in Indigenous Australians with and without diabetes.Methods: Indigenous Australians with (n = 224) or without (n = 340) Type 2 diabetes had a reference glomerular filtration rate measure using plasma disappearance of iohexol (measured glomerular filtration rate) over 4 h. Serum creatinine was measured by an enzymatic method. Performance was assessed by bias (measured glomerular filtration rate – estimated glomerular filtration rate) and accuracy (percentage of estimated glomerular filtration rate within 30{\%} of measured glomerular filtration rate).Results: The median measured glomerular filtration rate (interquartile range) in participants with or without diabetes was 97 (68–119) and 108 (90–122) ml min−1 1.73 m−2, respectively. The Chronic Kidney Disease Epidemiology Collaboration formula had smaller bias and greater accuracy than the Modification of Diet in Renal Disease and Cockcroft–Gault formulas overall, for participants both with and without diabetes. However, for estimated glomerular filtration rate > 90 ml min−1 1.73 m−2, the Chronic Kidney Disease Epidemiology Collaboration formula had greater bias in participants with diabetes, underestimating measured glomerular filtration rate by 7.4 vs. 1.0 ml min−1 1.73 m−2 in those without diabetes. The Chronic Kidney Disease Epidemiology Collaboration formula was less accurate across the whole range of estimated glomerular filtration rates in participants with vs. those without diabetes (87.1{\%} vs. 93.3{\%}).Conclusions: The Chronic Kidney Disease Epidemiology Collaboration formula outperforms the Modification of Diet in Renal Disease and Cockcroft–Gault formulas overall in Indigenous Australians with and without diabetes. However, the Chronic Kidney Disease Epidemiology Collaboration formula has greater bias in people with diabetes compared with those without diabetes, especially in those with normal renal function.",
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author = "Louise Maple-Brown and Elif Ekinci and Jaquelyne Hughes and Mark Chatfield and Paul Lawton and Graham Jones and Ellis, {Andrew G} and A Sinha and Alan Cass and Wendy Hoy and Kerin O'Dea and George Jerums and R MacIsaac",
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journal = "Diabetic Medicine",
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Performance of formulas for estimating glomerular filtration rate in Indigenous Australians with and without Type 2 diabetes : The eGFR Study. / Maple-Brown, Louise; Ekinci, Elif; Hughes, Jaquelyne; Chatfield, Mark; Lawton, Paul; Jones, Graham; Ellis, Andrew G; Sinha, A; Cass, Alan; Hoy, Wendy; O'Dea, Kerin; Jerums, George; MacIsaac, R.

In: Diabetic Medicine, Vol. 31, No. 7, 07.2014, p. 829-838.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Performance of formulas for estimating glomerular filtration rate in Indigenous Australians with and without Type 2 diabetes

T2 - The eGFR Study

AU - Maple-Brown, Louise

AU - Ekinci, Elif

AU - Hughes, Jaquelyne

AU - Chatfield, Mark

AU - Lawton, Paul

AU - Jones, Graham

AU - Ellis, Andrew G

AU - Sinha, A

AU - Cass, Alan

AU - Hoy, Wendy

AU - O'Dea, Kerin

AU - Jerums, George

AU - MacIsaac, R

PY - 2014/7

Y1 - 2014/7

N2 - Aims: It has been proposed that the Chronic Kidney Disease Epidemiology Collaboration formula estimates glomerular filtration rate more accurately than the Modification of Diet in Renal Disease formula. With the very high incidence of diabetes and end-stage kidney disease in Indigenous Australians, accurate estimation of glomerular filtration rate is vital in early detection of kidney disease. We aimed to assess the performance of the Chronic Kidney Disease Epidemiology Collaboration, Modification of Diet in Renal Disease and Cockcroft–Gault formulas in Indigenous Australians with and without diabetes.Methods: Indigenous Australians with (n = 224) or without (n = 340) Type 2 diabetes had a reference glomerular filtration rate measure using plasma disappearance of iohexol (measured glomerular filtration rate) over 4 h. Serum creatinine was measured by an enzymatic method. Performance was assessed by bias (measured glomerular filtration rate – estimated glomerular filtration rate) and accuracy (percentage of estimated glomerular filtration rate within 30% of measured glomerular filtration rate).Results: The median measured glomerular filtration rate (interquartile range) in participants with or without diabetes was 97 (68–119) and 108 (90–122) ml min−1 1.73 m−2, respectively. The Chronic Kidney Disease Epidemiology Collaboration formula had smaller bias and greater accuracy than the Modification of Diet in Renal Disease and Cockcroft–Gault formulas overall, for participants both with and without diabetes. However, for estimated glomerular filtration rate > 90 ml min−1 1.73 m−2, the Chronic Kidney Disease Epidemiology Collaboration formula had greater bias in participants with diabetes, underestimating measured glomerular filtration rate by 7.4 vs. 1.0 ml min−1 1.73 m−2 in those without diabetes. The Chronic Kidney Disease Epidemiology Collaboration formula was less accurate across the whole range of estimated glomerular filtration rates in participants with vs. those without diabetes (87.1% vs. 93.3%).Conclusions: The Chronic Kidney Disease Epidemiology Collaboration formula outperforms the Modification of Diet in Renal Disease and Cockcroft–Gault formulas overall in Indigenous Australians with and without diabetes. However, the Chronic Kidney Disease Epidemiology Collaboration formula has greater bias in people with diabetes compared with those without diabetes, especially in those with normal renal function.

AB - Aims: It has been proposed that the Chronic Kidney Disease Epidemiology Collaboration formula estimates glomerular filtration rate more accurately than the Modification of Diet in Renal Disease formula. With the very high incidence of diabetes and end-stage kidney disease in Indigenous Australians, accurate estimation of glomerular filtration rate is vital in early detection of kidney disease. We aimed to assess the performance of the Chronic Kidney Disease Epidemiology Collaboration, Modification of Diet in Renal Disease and Cockcroft–Gault formulas in Indigenous Australians with and without diabetes.Methods: Indigenous Australians with (n = 224) or without (n = 340) Type 2 diabetes had a reference glomerular filtration rate measure using plasma disappearance of iohexol (measured glomerular filtration rate) over 4 h. Serum creatinine was measured by an enzymatic method. Performance was assessed by bias (measured glomerular filtration rate – estimated glomerular filtration rate) and accuracy (percentage of estimated glomerular filtration rate within 30% of measured glomerular filtration rate).Results: The median measured glomerular filtration rate (interquartile range) in participants with or without diabetes was 97 (68–119) and 108 (90–122) ml min−1 1.73 m−2, respectively. The Chronic Kidney Disease Epidemiology Collaboration formula had smaller bias and greater accuracy than the Modification of Diet in Renal Disease and Cockcroft–Gault formulas overall, for participants both with and without diabetes. However, for estimated glomerular filtration rate > 90 ml min−1 1.73 m−2, the Chronic Kidney Disease Epidemiology Collaboration formula had greater bias in participants with diabetes, underestimating measured glomerular filtration rate by 7.4 vs. 1.0 ml min−1 1.73 m−2 in those without diabetes. The Chronic Kidney Disease Epidemiology Collaboration formula was less accurate across the whole range of estimated glomerular filtration rates in participants with vs. those without diabetes (87.1% vs. 93.3%).Conclusions: The Chronic Kidney Disease Epidemiology Collaboration formula outperforms the Modification of Diet in Renal Disease and Cockcroft–Gault formulas overall in Indigenous Australians with and without diabetes. However, the Chronic Kidney Disease Epidemiology Collaboration formula has greater bias in people with diabetes compared with those without diabetes, especially in those with normal renal function.

KW - creatinine

KW - iohexol

KW - adult

KW - Article

KW - blood sampling

KW - calculation

KW - chronic kidney disease

KW - Cockcroft Gault formula

KW - controlled study

KW - creatinine blood level

KW - creatinine clearance

KW - diabetic patient

KW - female

KW - glomerulus filtration rate

KW - human

KW - Indigenous Australian

KW - kidney function

KW - major clinical study

KW - male

KW - measurement accuracy

KW - non insulin dependent diabetes mellitus

KW - Australia

KW - comparative study

KW - Diabetes Mellitus, Type 2

KW - diabetic diet

KW - diagnostic use

KW - early diagnosis

KW - indigenous health care

KW - kidney function test

KW - metabolism

KW - middle aged

KW - Oceanic ancestry group

KW - pathophysiology

KW - predictive value

KW - procedures

KW - Renal Insufficiency, Chronic

KW - reproducibility

KW - Creatinine

KW - Diabetic Diet

KW - Early Diagnosis

KW - Female

KW - Glomerular Filtration Rate

KW - Health Services, Indigenous

KW - Humans

KW - Iohexol

KW - Kidney Function Tests

KW - Male

KW - Middle Aged

KW - Oceanic Ancestry Group

KW - Predictive Value of Tests

KW - Reproducibility of Results

U2 - 10.1111/dme.12426

DO - 10.1111/dme.12426

M3 - Article

VL - 31

SP - 829

EP - 838

JO - Diabetic Medicine

JF - Diabetic Medicine

SN - 0742-3071

IS - 7

ER -