| Two novel equations to estimate kidney function in persons aged 70 years or older. | |
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MedLine Citation:
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PMID: 23027318 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: In older adults, current equations to estimate glomerular filtration rate (GFR) are not validated and may misclassify elderly persons in terms of their stage of chronic kidney disease. OBJECTIVE: To derive the Berlin Initiative Study (BIS) equation, a novel estimator of GFR in elderly participants. DESIGN: Cross-sectional. Data were split for analysis into 2 sets for equation development and internal validation. SETTING: Random community-based population of a large insurance company. PARTICIPANTS: 610 participants aged 70 years or older (mean age, 78.5 years). INTERVENTION: Iohexol plasma clearance measurement as gold standard. MEASUREMENTS: GFR, measured as the plasma clearance of the endogenous marker iohexol, to compare performance of existing equations of estimated GFR with measured GFR of the gold standard; estimation of measured GFR from standardized creatinine and cystatin C levels, sex, and age in the learning sample; and comparison of the BIS equations (BIS1: creatinine-based; BIS2: creatinine- and cystatin C-based) with other estimating equations and determination of bias, precision, and accuracy in the validation sample. RESULTS: The new BIS2 equation yielded the smallest bias followed by the creatinine-based BIS1 and Cockcroft-Gault equations. All other equations considerably overestimated GFR. The BIS equations confirmed a high prevalence of persons older than 70 years with a GFR less than 60 mL/min per 1.73 m2 (BIS1, 50.4%; BIS2, 47.4%; measured GFR, 47.9%). The total misclassification rate for this criterion was smallest for the BIS2 equation (11.6%), followed by the cystatin C equation 2 (15.1%) proposed by the Chronic Kidney Disease Epidemiology Collaboration. Among the creatinine-based equations, BIS1 had the smallest misclassification rate (17.2%), followed by the Chronic Kidney Disease Epidemiology Collaboration equation (20.4%). LIMITATION: There was no validation by an external data set. CONCLUSION: The BIS2 equation should be used to estimate GFR in persons aged 70 years or older with normal or mild to moderately reduced kidney function. If cystatin C is not available, the BIS1 equation is an acceptable alternative. PRIMARY FUNDING SOURCE: Kuratorium für Dialyse und Nierentransplatation (KfH) Foundation of Preventive Medicine. |
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Authors:
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Elke S Schaeffner; Natalie Ebert; Pierre Delanaye; Ulrich Frei; Jens Gaedeke; Olga Jakob; Martin K Kuhlmann; Mirjam Schuchardt; Markus Tölle; Reinhard Ziebig; Markus van der Giet; Peter Martus |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of internal medicine Volume: 157 ISSN: 1539-3704 ISO Abbreviation: Ann. Intern. Med. Publication Date: 2012 Oct |
Date Detail:
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Created Date: 2012-10-02 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 471-81 Citation Subset: AIM; IM |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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