GFR Estimation Using a Panel of Filtration Markers in Shanghai and Beijing

Nan Chen; Hao Shi; Luxia Zhang; Li Zuo; Jingyuan Xie; Danshu Xie; Amy B. Karger; Shiyuan Miao; Hong Ren; Wen Zhang; Weiming Wang; Yujing Pan; Wei Minji; Zhun Sui; Aghogho Okparavero; Andrew Simon; Juhi Chaudhari; John H. Eckfeldt; Lesley A. Inker; Andrew S. Levey

doi:10.1016/j.xkme.2019.11.004

GFR Estimation Using a Panel of Filtration Markers in Shanghai and Beijing

Nan Chen, Hao Shi, Luxia Zhang, Li Zuo, Jingyuan Xie, Danshu Xie, Amy B. Karger, Shiyuan Miao, Hong Ren, Wen Zhang, Weiming Wang, Yujing Pan, Wei Minji, Zhun Sui, Aghogho Okparavero, Andrew Simon, Juhi Chaudhari, John H. Eckfeldt, Lesley A. Inker, Andrew S. Levey

Laboratory Medicine and Pathology

Research output: Contribution to journal › Article › peer-review

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Abstract

Rationale & Objectives: Estimated glomerular filtration rate (eGFR) using creatinine and cystatin C (eGFR_cr-cys) may be less accurate compared to measured GFR (mGFR) in China than in North America, Europe, and Australia due to variation across regions in their non-GFR determinants. The non-GFR determinants of β₂-microglobulin (B2M) and β-trace protein (BTP) differ from those of creatinine and cystatin C. Thus, the average eGFR using all 4 markers (eGFR_avg) could be more accurate than eGFR_cr-cys in China. Study Design: Diagnostic test study. Setting & Participants: 1,066 participants in Shanghai and Beijing with creatinine and cystatin C and 666 participants with all 4 filtration markers. Tests Compared: Index tests were previously developed equations for eGFR using creatinine, cystatin C, B2M, and BTP and combinations. The reference test was mGFR using plasma clearance of iohexol. We compared the performance of eGFR_avg to eGFR_cr-cys using the proportion of participants with errors in eGFR >30% of mGFR (1 − P₃₀) and root mean square error (RMSE) of the regression of eGFR on mGFR on the logarithmic scale. We also compared classification and reclassification of mGFR categories using eGFR_avg compared to eGFR_cr-cys. Outcomes: Accuracy was significantly better for eGFR_avg (1 − P₃₀ of 10.4% and RMSE of 0.214) compared to eGFR_cr-cys (1 − P₃₀ of 13.8% and RMSE of 0.232; P = 0.004 and P = 0.006, respectively). However, improvements in accuracy did not generally translate into significant improvement in classification or reclassification of mGFR categories. Limitations: Study population may not be generalizable to clinical settings other than large urban medical centers in China. Conclusions: A panel of endogenous filtration markers including B2M and BTP in addition to creatinine and cystatin C may improve GFR estimation in China. Further study is necessary to determine whether GFR estimation using B2M and BTP can be improved and whether these improvements lead to useful clinical applications.

Original language	English (US)
Pages (from-to)	172-180
Number of pages	9
Journal	Kidney Medicine
Volume	2
Issue number	2
DOIs	https://doi.org/10.1016/j.xkme.2019.11.004
State	Published - Mar 1 2020

Bibliographical note

Publisher Copyright:
© 2020 The Authors

Keywords

China
Estimated GFR
beta-2 microglobulin
beta-trace protein
creatinine
cystatin C

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Chen, N., Shi, H., Zhang, L., Zuo, L., Xie, J., Xie, D., Karger, A. B., Miao, S., Ren, H., Zhang, W., Wang, W., Pan, Y., Minji, W., Sui, Z., Okparavero, A., Simon, A., Chaudhari, J., Eckfeldt, J. H., Inker, L. A., & Levey, A. S. (2020). GFR Estimation Using a Panel of Filtration Markers in Shanghai and Beijing. Kidney Medicine, 2(2), 172-180. https://doi.org/10.1016/j.xkme.2019.11.004

Chen, N, Shi, H, Zhang, L, Zuo, L, Xie, J, Xie, D, Karger, AB, Miao, S, Ren, H, Zhang, W, Wang, W, Pan, Y, Minji, W, Sui, Z, Okparavero, A, Simon, A, Chaudhari, J, Eckfeldt, JH, Inker, LA & Levey, AS 2020, 'GFR Estimation Using a Panel of Filtration Markers in Shanghai and Beijing', Kidney Medicine, vol. 2, no. 2, pp. 172-180. https://doi.org/10.1016/j.xkme.2019.11.004

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title = "GFR Estimation Using a Panel of Filtration Markers in Shanghai and Beijing",

abstract = "Rationale & Objectives: Estimated glomerular filtration rate (eGFR) using creatinine and cystatin C (eGFRcr-cys) may be less accurate compared to measured GFR (mGFR) in China than in North America, Europe, and Australia due to variation across regions in their non-GFR determinants. The non-GFR determinants of β2-microglobulin (B2M) and β-trace protein (BTP) differ from those of creatinine and cystatin C. Thus, the average eGFR using all 4 markers (eGFRavg) could be more accurate than eGFRcr-cys in China. Study Design: Diagnostic test study. Setting & Participants: 1,066 participants in Shanghai and Beijing with creatinine and cystatin C and 666 participants with all 4 filtration markers. Tests Compared: Index tests were previously developed equations for eGFR using creatinine, cystatin C, B2M, and BTP and combinations. The reference test was mGFR using plasma clearance of iohexol. We compared the performance of eGFRavg to eGFRcr-cys using the proportion of participants with errors in eGFR >30% of mGFR (1 − P30) and root mean square error (RMSE) of the regression of eGFR on mGFR on the logarithmic scale. We also compared classification and reclassification of mGFR categories using eGFRavg compared to eGFRcr-cys. Outcomes: Accuracy was significantly better for eGFRavg (1 − P30 of 10.4% and RMSE of 0.214) compared to eGFRcr-cys (1 − P30 of 13.8% and RMSE of 0.232; P = 0.004 and P = 0.006, respectively). However, improvements in accuracy did not generally translate into significant improvement in classification or reclassification of mGFR categories. Limitations: Study population may not be generalizable to clinical settings other than large urban medical centers in China. Conclusions: A panel of endogenous filtration markers including B2M and BTP in addition to creatinine and cystatin C may improve GFR estimation in China. Further study is necessary to determine whether GFR estimation using B2M and BTP can be improved and whether these improvements lead to useful clinical applications.",

keywords = "China, Estimated GFR, beta-2 microglobulin, beta-trace protein, creatinine, cystatin C",

author = "Nan Chen and Hao Shi and Luxia Zhang and Li Zuo and Jingyuan Xie and Danshu Xie and Karger, {Amy B.} and Shiyuan Miao and Hong Ren and Wen Zhang and Weiming Wang and Yujing Pan and Wei Minji and Zhun Sui and Aghogho Okparavero and Andrew Simon and Juhi Chaudhari and Eckfeldt, {John H.} and Inker, {Lesley A.} and Levey, {Andrew S.}",

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doi = "10.1016/j.xkme.2019.11.004",

language = "English (US)",

volume = "2",

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T1 - GFR Estimation Using a Panel of Filtration Markers in Shanghai and Beijing

AU - Chen, Nan

AU - Shi, Hao

AU - Zhang, Luxia

AU - Zuo, Li

AU - Xie, Jingyuan

AU - Xie, Danshu

AU - Karger, Amy B.

AU - Miao, Shiyuan

AU - Ren, Hong

AU - Zhang, Wen

AU - Wang, Weiming

AU - Pan, Yujing

AU - Minji, Wei

AU - Sui, Zhun

AU - Okparavero, Aghogho

AU - Simon, Andrew

AU - Chaudhari, Juhi

AU - Eckfeldt, John H.

AU - Inker, Lesley A.

AU - Levey, Andrew S.

PY - 2020/3/1

Y1 - 2020/3/1

N2 - Rationale & Objectives: Estimated glomerular filtration rate (eGFR) using creatinine and cystatin C (eGFRcr-cys) may be less accurate compared to measured GFR (mGFR) in China than in North America, Europe, and Australia due to variation across regions in their non-GFR determinants. The non-GFR determinants of β2-microglobulin (B2M) and β-trace protein (BTP) differ from those of creatinine and cystatin C. Thus, the average eGFR using all 4 markers (eGFRavg) could be more accurate than eGFRcr-cys in China. Study Design: Diagnostic test study. Setting & Participants: 1,066 participants in Shanghai and Beijing with creatinine and cystatin C and 666 participants with all 4 filtration markers. Tests Compared: Index tests were previously developed equations for eGFR using creatinine, cystatin C, B2M, and BTP and combinations. The reference test was mGFR using plasma clearance of iohexol. We compared the performance of eGFRavg to eGFRcr-cys using the proportion of participants with errors in eGFR >30% of mGFR (1 − P30) and root mean square error (RMSE) of the regression of eGFR on mGFR on the logarithmic scale. We also compared classification and reclassification of mGFR categories using eGFRavg compared to eGFRcr-cys. Outcomes: Accuracy was significantly better for eGFRavg (1 − P30 of 10.4% and RMSE of 0.214) compared to eGFRcr-cys (1 − P30 of 13.8% and RMSE of 0.232; P = 0.004 and P = 0.006, respectively). However, improvements in accuracy did not generally translate into significant improvement in classification or reclassification of mGFR categories. Limitations: Study population may not be generalizable to clinical settings other than large urban medical centers in China. Conclusions: A panel of endogenous filtration markers including B2M and BTP in addition to creatinine and cystatin C may improve GFR estimation in China. Further study is necessary to determine whether GFR estimation using B2M and BTP can be improved and whether these improvements lead to useful clinical applications.

AB - Rationale & Objectives: Estimated glomerular filtration rate (eGFR) using creatinine and cystatin C (eGFRcr-cys) may be less accurate compared to measured GFR (mGFR) in China than in North America, Europe, and Australia due to variation across regions in their non-GFR determinants. The non-GFR determinants of β2-microglobulin (B2M) and β-trace protein (BTP) differ from those of creatinine and cystatin C. Thus, the average eGFR using all 4 markers (eGFRavg) could be more accurate than eGFRcr-cys in China. Study Design: Diagnostic test study. Setting & Participants: 1,066 participants in Shanghai and Beijing with creatinine and cystatin C and 666 participants with all 4 filtration markers. Tests Compared: Index tests were previously developed equations for eGFR using creatinine, cystatin C, B2M, and BTP and combinations. The reference test was mGFR using plasma clearance of iohexol. We compared the performance of eGFRavg to eGFRcr-cys using the proportion of participants with errors in eGFR >30% of mGFR (1 − P30) and root mean square error (RMSE) of the regression of eGFR on mGFR on the logarithmic scale. We also compared classification and reclassification of mGFR categories using eGFRavg compared to eGFRcr-cys. Outcomes: Accuracy was significantly better for eGFRavg (1 − P30 of 10.4% and RMSE of 0.214) compared to eGFRcr-cys (1 − P30 of 13.8% and RMSE of 0.232; P = 0.004 and P = 0.006, respectively). However, improvements in accuracy did not generally translate into significant improvement in classification or reclassification of mGFR categories. Limitations: Study population may not be generalizable to clinical settings other than large urban medical centers in China. Conclusions: A panel of endogenous filtration markers including B2M and BTP in addition to creatinine and cystatin C may improve GFR estimation in China. Further study is necessary to determine whether GFR estimation using B2M and BTP can be improved and whether these improvements lead to useful clinical applications.

KW - China

KW - Estimated GFR

KW - beta-2 microglobulin

KW - beta-trace protein

KW - creatinine

KW - cystatin C

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ER -

GFR Estimation Using a Panel of Filtration Markers in Shanghai and Beijing

Abstract

Bibliographical note

Keywords

UN SDGs

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