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Background: The Modification of Diet in Renal Disease (MDRD) Study equation underestimates measured glomerular filtration rate (GFR) at levels>60 mL/min/1.73 m2, with variable accuracy among subgroups; consequently, estimated GFR (eGFR)>or=60 mL/min/1.73 m2 is not reported by clinical laboratories. Here, performance of a more accurate GFR-estimating equation, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, is reported by level of GFR and clinical characteristics.Study Design: Test of diagnostic accuracy.Setting& Participants: Pooled data set of 3,896 people from 16 studies with measured GFR (not used for the development of either equation). Subgroups were defined by eGFR, age, sex, race, diabetes, prior solid-organ transplant, and body mass index.Index Tests: eGFR from the CKD-EPI and MDRD Study equations and standardized serum creatinine.Reference Test: Measured GFR using urinary or plasma clearance of exogenous filtration markers.Results: Mean measured GFR was 68+/-36 (SD) mL/min/1.73 m2. For eGFR<30 mL/min/1.73 m2, both equations have similar bias (median difference compared with measured GFR). For eGFR of 30-59 mL/min/1.73 m2, bias was decreased from 4.9 to 2.1 mL/min/1.73 m2 (57% improvement). For eGFR of 60-89 mL/min/1.73 m2, bias was decreased from 11.9 to 4.2 mL/min/1.73 m2 (61% improvement). For eGFR of 90-119 mL/min/1.73 m2, bias was decreased from 10.0 to 1.9 mL/min/1.73 m2 (75% improvement). Similar or improved performance was noted for most subgroups with eGFR<90 mL/min/1.73 m2, other than body mass index<20 kg/m2, with greater variation noted for some subgroups with eGFR>or=90 mL/min/1.73 m2.Limitations: Limited number of elderly people and racial and ethnic minorities with measured GFR.Conclusions: The CKD-EPI equation is more accurate than the MDRD Study equation overall and across most subgroups. In contrast to the MDRD Study equation, eGFR>or=60 mL/min/1.73 m2 can be reported using the CKD-EPI equation. [ABSTRACT FROM AUTHOR]

Background: Serum cystatin C was proposed as a potential replacement for serum creatinine in glomerular filtration rate (GFR) estimation. We report the development and evaluation of GFR-estimating equations using serum cystatin C alone and serum cystatin C, serum creatinine, or both with demographic variables.Study Design: Test of diagnostic accuracy.Setting& Participants: Participants screened for 3 chronic kidney disease (CKD) studies in the United States (n = 2,980) and a clinical population in Paris, France (n = 438).Reference Test: Measured GFR (mGFR).Index Test: Estimated GFR using the 4 new equations based on serum cystatin C alone, serum cystatin C, serum creatinine, or both with age, sex, and race. New equations were developed by using linear regression with log GFR as the outcome in two thirds of data from US studies. Internal validation was performed in the remaining one third of data from US CKD studies; external validation was performed in the Paris study.Measurements: GFR was measured by using urinary clearance of iodine-125-iothalamate in the US studies and chromium-51-EDTA in the Paris study. Serum cystatin C was measured by using Dade-Behring assay, standardized serum creatinine values were used.Results: Mean mGFR, serum creatinine, and serum cystatin C values were 48 mL/min/1.73 m(2) (5th to 95th percentile, 15 to 95), 2.1 mg/dL, and 1.8 mg/L, respectively. For the new equations, coefficients for age, sex, and race were significant in the equation with serum cystatin C, but 2- to 4-fold smaller than in the equation with serum creatinine. Measures of performance in new equations were consistent across the development and internal and external validation data sets. Percentages of estimated GFR within 30% of mGFR for equations based on serum cystatin C alone, serum cystatin C, serum creatinine, or both levels with age, sex, and race were 81%, 83%, 85%, and 89%, respectively. The equation using serum cystatin C level alone yields estimates with small biases in age, sex, and race subgroups, which are improved in equations including these variables.Limitations: Study population composed mainly of patients with CKD.Conclusions: Serum cystatin C level alone provides GFR estimates that are nearly as accurate as serum creatinine level adjusted for age, sex, and race, thus providing an alternative GFR estimate that is not linked to muscle mass. An equation including serum cystatin C level in combination with serum creatinine level, age, sex, and race provides the most accurate estimates. [ABSTRACT FROM AUTHOR]

Introduction L’évaluation du débit de filtration glomérulaire (DFG) est essentielle pour la prise en charge des patients atteints d’une tumeur de vessie infiltrant le muscle. Cependant, l’évolution du DFG mesuré après cystectomie radicale, ainsi que la meilleure méthode pour estimer le DFG chez ces patients est inconnue. Notre objectif était d’étudier l’évolution du DFG mesuré après une cystectomie radicale et d’évaluer la meilleure méthode pour estimer le DFG avant et après une chirurgie. Patients/matériels et méthodes Les patients atteints d’une tumeur de vessie infiltrant le muscle, sélectionnés pour une cystectomie radicale et une dérivation urinaire ont été inclus prospectivement. L’évaluation du DFG isotopique mesurée (iDFG) par 51Cr-EDTA, et le calcul du DFG estimée (eDFG) par 4 modèles publiés ont étés réalisés avant et 6 mois après chirurgie. Le biais et la concordance du eDFG par rapport à l’iDFG ont été calculés avant et après chirurgie. Résultats Vingt-sept patients (âge médian 66 ans) ont été inclus. Le iDFG médian est passé de 84,1 mL/min/1,73 m2 à 69,9 mL/min/1,73 m2 6 mois après chirurgie (p = 0,01). Douze patients sur 22 (54,5 %) ayant une fonction rénale préopératoire normale ont développé une IRC (< 60 mL/min par 1,73 m2). L’équation CKD-EPI BSA ajustée était le modèle le plus précis pour estimer le DFG (médiane résiduelle −5,4 ; IQR [−13,4 ; 0,8]), avec la meilleure concordance avant et après chirurgie (respectivement, moyenne −5,4 ± écart-type 16,3 ; moyenne −7,0 ± écart-type 7,9). Conclusion Dans notre série prospective, nous avons démontré une diminution précoce du DFG mesuré après cystectomie radicale. L’équation CKD-EPI était le meilleur modèle pour surveiller le DFG avant et après cystectomie radicale et dérivation urinaire. [ABSTRACT FROM AUTHOR]

The article presents a study on Chronic kidney disease (CKD) characterized by arterial stiffness and enlargement to determine the link between between arterial phenotype and mineral metabolism parameters.