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Comparison of Various Equations for Estimating GFR in Malawi: How to Determine Renal Function in Resource Limited Settings?

Glaser N, Deckert A, Phiri S, Rothenbacher D, Neuhann F - PLoS ONE (2015)

Bottom Line: Comparison of formulae based on Bland-Altman-plots and accuracy revealed best performance for the CKD-EPI equation without the correction factor for black Americans.Analyzing the differences between HIV-positive and -negative individuals CKD-EPI systematically overestimated eGFR in comparison to cystatin C and therefore lead to underestimation of CKD in HIV-positives.Our findings underline the importance for standardization of eGFR calculation in a Sub-Saharan African setting, to further investigate the differences with regard to HIV status and to develop potential correction factors as established for age and sex.

View Article: PubMed Central - PubMed

Affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany.

ABSTRACT

Background: Chronic kidney disease (CKD) is a probably underrated public health problem in Sub-Saharan-Africa, in particular in combination with HIV-infection. Knowledge about the CKD prevalence is scarce and in the available literature different methods to classify CKD are used impeding comparison and general prevalence estimates.

Methods: This study assessed different serum-creatinine based equations for glomerular filtration rates (eGFR) and compared them to a cystatin C based equation. The study was conducted in Lilongwe, Malawi enrolling a population of 363 adults of which 32% were HIV-positive.

Results: Comparison of formulae based on Bland-Altman-plots and accuracy revealed best performance for the CKD-EPI equation without the correction factor for black Americans. Analyzing the differences between HIV-positive and -negative individuals CKD-EPI systematically overestimated eGFR in comparison to cystatin C and therefore lead to underestimation of CKD in HIV-positives.

Conclusions: Our findings underline the importance for standardization of eGFR calculation in a Sub-Saharan African setting, to further investigate the differences with regard to HIV status and to develop potential correction factors as established for age and sex.

No MeSH data available.


Related in: MedlinePlus

CKD-EPI-Cystatin-C versus CKD-EPI without factor for black Americans.
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pone.0130453.g008: CKD-EPI-Cystatin-C versus CKD-EPI without factor for black Americans.

Mentions: To explore whether the difference between formulae with and without factor for black Americans was confounded by the cystatin C equation calculated by van Deventer et al. in black South-Africans, we compared CKD-EPI with and without the factor with the CKD-EPI cystatin C equation by Stevens et al., which has been developed based on results of different pooled cohorts with GFR measured by iothalamate. [20,33] Both figures show similar distribution pattern, with mean differences shifted towards lower numbers for both HIV-negatives and-positives in case the factor is considered (see Figs 7 and 8).


Comparison of Various Equations for Estimating GFR in Malawi: How to Determine Renal Function in Resource Limited Settings?

Glaser N, Deckert A, Phiri S, Rothenbacher D, Neuhann F - PLoS ONE (2015)

CKD-EPI-Cystatin-C versus CKD-EPI without factor for black Americans.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4470826&req=5

pone.0130453.g008: CKD-EPI-Cystatin-C versus CKD-EPI without factor for black Americans.
Mentions: To explore whether the difference between formulae with and without factor for black Americans was confounded by the cystatin C equation calculated by van Deventer et al. in black South-Africans, we compared CKD-EPI with and without the factor with the CKD-EPI cystatin C equation by Stevens et al., which has been developed based on results of different pooled cohorts with GFR measured by iothalamate. [20,33] Both figures show similar distribution pattern, with mean differences shifted towards lower numbers for both HIV-negatives and-positives in case the factor is considered (see Figs 7 and 8).

Bottom Line: Comparison of formulae based on Bland-Altman-plots and accuracy revealed best performance for the CKD-EPI equation without the correction factor for black Americans.Analyzing the differences between HIV-positive and -negative individuals CKD-EPI systematically overestimated eGFR in comparison to cystatin C and therefore lead to underestimation of CKD in HIV-positives.Our findings underline the importance for standardization of eGFR calculation in a Sub-Saharan African setting, to further investigate the differences with regard to HIV status and to develop potential correction factors as established for age and sex.

View Article: PubMed Central - PubMed

Affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany.

ABSTRACT

Background: Chronic kidney disease (CKD) is a probably underrated public health problem in Sub-Saharan-Africa, in particular in combination with HIV-infection. Knowledge about the CKD prevalence is scarce and in the available literature different methods to classify CKD are used impeding comparison and general prevalence estimates.

Methods: This study assessed different serum-creatinine based equations for glomerular filtration rates (eGFR) and compared them to a cystatin C based equation. The study was conducted in Lilongwe, Malawi enrolling a population of 363 adults of which 32% were HIV-positive.

Results: Comparison of formulae based on Bland-Altman-plots and accuracy revealed best performance for the CKD-EPI equation without the correction factor for black Americans. Analyzing the differences between HIV-positive and -negative individuals CKD-EPI systematically overestimated eGFR in comparison to cystatin C and therefore lead to underestimation of CKD in HIV-positives.

Conclusions: Our findings underline the importance for standardization of eGFR calculation in a Sub-Saharan African setting, to further investigate the differences with regard to HIV status and to develop potential correction factors as established for age and sex.

No MeSH data available.


Related in: MedlinePlus