Measured GFR Does Not Outperform Estimated GFR in Predicting CKD-related Complications
Year: 2011
Type: article
Abstract: Although many assume that measurement of glomerular filtration rate (GFR) using a marker such as iothalamate (iGFR) is superior to equation-estimated GFR (eGFR), each of these methods has distinct disadvantages. Because physicians often use renal function to guide the screening for various CKD-associated complications, one method to compare the clinical utility of iGFR and eGFR is to determine the strength of their association with CKD-associated comorbidities. Using a subset of 1214 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study, we determined the cross-sectional associations between known complications of CKD and iGFR, eGFR estimated from serum creatinine (eGFR_Cr), and eGFR estimated from cystatin C (eGFR_cysC). We found that none of the measures of renal function strongly associated with CKD complications and that the relative strengths of associations varied according to the outcome of interest. For example, iGFR demonstrated better discrimination than eGFR_Cr and eGFR_cysC for outcomes of anemia and hemoglobin concentration; however, both eGFR_Cr and eGFR_cysC demonstrated better discrimination than iGFR for outcomes of hyperphosphatemia and phosphorus level. iGFR and eGFR had similar strengths of association with hyperkalemia/potassium level and with metabolic acidosis/bicarbonate level. In conclusion, iothalamate measurement of GFR is not consistently superior to equation-based estimations of GFR in explaining CKD-related comorbidities. These results raise questions regarding the conventional view that iGFR is the "gold standard" measure of kidney function.
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: University of Pennsylvania, University of Michigan, Johns Hopkins University, Case Western Reserve University, Deutsches Krebsforschungszentrum, Georgia Clinical and Translational Science Alliance, National Institutes of Health, University of Illinois at Chicago, Clinical and Translational Science Collaborative of Cleveland, School of Medicine, Case Western Reserve University, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Research Resources, NIH Clinical Center
Awards: Clinical and Translational Science Institute, G2063336705, G220989761, Case Western Reserve University/Cleveland Clinic CTSA (UL1), G243530825, Institute for Clinical and Translational Research (UL1), Renal and Cardiovascular Events in Patients with Chronic Kidney Disease, Continuation of the Chronic Renal Insufficiency Cohort (CRIC) Study, General Clinical Research Center, Michigan Institute for Clinical and Health Research (MICHR) (UL1), Institutional Clinical and Translational Science Award, Center for Clinical and Translational Science, GENERAL CLINICAL RESEARCH CENTER, CKD the metabolic syndrome & cardiovascular illness, General Clinical Research Center, Prospective renal insufficiency cohort evaluation: PRICE, Chronic Renal Insufficiency Cohort (CRIC) Study Clinical Center, Continuation of the University of Illinois Chicago CRIC Clinical Center, Limited Competition for the Continuation of the Chronic Renal Insufficiency Cohort (CRIC) Hopkins Clinical Center, Tulane Clinical Center for Chronic Renal Insufficiency Cohort Study, Chronic Renal Insufficiency Cohort Limited competition continuation, Chronic Renal Insufficiency Cohort (CRIC) Study
OpenAlex ID: W2146901169