Delanaye Pierre, Derain-Dubourg Laurence, Björk Jonas, Courbebaisse Marie, Couzi Lionel, Gaillard Francois, Garrouste Cyril, Grubb Anders, Jacquemont Lola, Hansson Magnus, Kamar Nassim, Legendre Christophe, Littmann Karin, Mariat Christophe, Rostaing Lionel, Rule Andrew D, Sundin Per-Ola, Bökenkamp Arend, Berg Ulla, Åsling-Monemi Kajsa, Åkesson Anna, Larsson Anders, Nyman Ulf, Pottel Hans
Department of Nephrology-Dialysis-Transplantation, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium.
Department of Nephrology-Dialysis-Apheresis, Hopital Universitaire Caremeau, Nimes, France.
Clin Kidney J. 2024 Aug 28;17(9):sfae261. doi: 10.1093/ckj/sfae261. eCollection 2024 Sep.
Creatinine-based equations are the most used to estimate glomerular filtration rate (eGFR). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), the re-expressed Lund-Malmö Revised (r-LMR) and the European Kidney Function Consortium (EKFC) equations are the most validated. The EKFC and r-LMR equations have been suggested to have better performances in young adults, but this is debated.
We collected data (GFR) measured by clearance of an exogenous marker (reference method), serum creatinine, age and sex from 2366 young adults (aged between 18 and 25 years) both from Europe and the USA.
In the European cohorts ( = 1892), the bias (in mL/min/1.73 m²) was systematically better for the EKFC and r-LMR equations compared with the CKD-EPI equation [2.28, 95% confidence interval (1.59; 2.91), -2.50 (-3.85; -1.76), 17.41 (16.49; 18.47), respectively]. The percentage of estimated GFR within 30% of measured GFR (P30) was also better for EKFC and r-LMR equations compared with the CKD-EPI equation [84.4% (82.8; 86.0), 87.2% (85.7; 88.7) and 65.4% (63.3; 67.6), respectively]. In the US cohorts ( = 474), the bias for the EKFC and r-LMR equations was better than for the CKD-EPI equation in the non-Black population [0.97 (-1.69; 3.06), -2.62 (-5.14; -1.43) and 7.74 (5.97; 9.63), respectively], whereas the bias was similar in Black US individuals. P30 results were not different between the three equations in US cohorts. Analyses in sub-populations confirmed these results, except in individuals with high GFR levels (GFR ≥120 mL/min/1.73 m²) for whom the CKD-EPI equation might have a lower bias.
We demonstrated that both the EKFC and r-LMR creatinine-based equations have a better performance than the CKD-EPI equation in a young population. The only exception might be in patients with hyperfiltration.
基于肌酐的方程是最常用于估算肾小球滤过率（eGFR）的方法。慢性肾脏病流行病学协作组（CKD-EPI）方程、重新表达的隆德-马尔默修订版（r-LMR）方程和欧洲肾功能联盟（EKFC）方程是经过最多验证的方程。有人提出EKFC方程和r-LMR方程在年轻成年人中表现更好，但这一点存在争议。
我们收集了来自欧洲和美国的2366名年轻成年人（年龄在18至25岁之间）通过外源性标志物清除率测量的肾小球滤过率（GFR）数据、血清肌酐、年龄和性别。
在欧洲队列（n = 1892）中，与CKD-EPI方程相比，EKFC方程和r-LMR方程的偏差（单位为mL/min/1.73 m²）系统性地更小[分别为2.28，95%置信区间（1.59；2.91），-2.50（-3.85；-1.76），17.41（16.49；18.47）]。与CKD-EPI方程相比，EKFC方程和r-LMR方程估算的GFR在测量的GFR的30%范围内的百分比（P30）也更高[分别为84.4%（82.8；86.0），87.2%（85.7；88.7）和65.4%（63.3；67.6）]。在美国队列（n = 474）中，在非黑人人群中，EKFC方程和r-LMR方程的偏差比CKD-EPI方程更好[分别为0.97（-1.69；3.06），-2.62（-5.14；-1.43）和7.74（5.97；9.63）]，而在美国黑人个体中偏差相似。在美国队列中，三个方程的P30结果没有差异。亚组分析证实了这些结果，但在高GFR水平（GFR≥120 mL/min/1.73 m²）的个体中除外，对于这些个体，CKD-EPI方程可能偏差更小。
我们证明，在年轻人群中，基于肌酐的EKFC方程和r-LMR方程都比CKD-EPI方程表现更好。唯一的例外可能是在超滤患者中。
