Estimating GFR by Serum Creatinine, Cystatin C, and β2-Microglobulin in Older Adults: Results From the Canadian Study of Longevity in Type 1 Diabetes
Introduction: Glomerular filtration rate (GFR) is routinely used for clinical assessment of kidney function. However, the accuracy of estimating equations in older adults is uncertain. Methods: In 66 adults with ≥50 years type 1 diabetes (T1D) duration and 73 nondiabetic controls from age/sex-matche...
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Elsevier
2019-06-01
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Series: | Kidney International Reports |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024919300713 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Daniel Scarr Petter Bjornstad Leif E. Lovblom Julie A. Lovshin Genevieve Boulet Yuliya Lytvyn Mohammed A. Farooqi Vesta Lai Andrej Orszag Alanna Weisman Hillary A. Keenan Michael H. Brent Narinder Paul Vera Bril David Z.I. Cherney Bruce A. Perkins |
spellingShingle |
Daniel Scarr Petter Bjornstad Leif E. Lovblom Julie A. Lovshin Genevieve Boulet Yuliya Lytvyn Mohammed A. Farooqi Vesta Lai Andrej Orszag Alanna Weisman Hillary A. Keenan Michael H. Brent Narinder Paul Vera Bril David Z.I. Cherney Bruce A. Perkins Estimating GFR by Serum Creatinine, Cystatin C, and β2-Microglobulin in Older Adults: Results From the Canadian Study of Longevity in Type 1 Diabetes Kidney International Reports |
author_facet |
Daniel Scarr Petter Bjornstad Leif E. Lovblom Julie A. Lovshin Genevieve Boulet Yuliya Lytvyn Mohammed A. Farooqi Vesta Lai Andrej Orszag Alanna Weisman Hillary A. Keenan Michael H. Brent Narinder Paul Vera Bril David Z.I. Cherney Bruce A. Perkins |
author_sort |
Daniel Scarr |
title |
Estimating GFR by Serum Creatinine, Cystatin C, and β2-Microglobulin in Older Adults: Results From the Canadian Study of Longevity in Type 1 Diabetes |
title_short |
Estimating GFR by Serum Creatinine, Cystatin C, and β2-Microglobulin in Older Adults: Results From the Canadian Study of Longevity in Type 1 Diabetes |
title_full |
Estimating GFR by Serum Creatinine, Cystatin C, and β2-Microglobulin in Older Adults: Results From the Canadian Study of Longevity in Type 1 Diabetes |
title_fullStr |
Estimating GFR by Serum Creatinine, Cystatin C, and β2-Microglobulin in Older Adults: Results From the Canadian Study of Longevity in Type 1 Diabetes |
title_full_unstemmed |
Estimating GFR by Serum Creatinine, Cystatin C, and β2-Microglobulin in Older Adults: Results From the Canadian Study of Longevity in Type 1 Diabetes |
title_sort |
estimating gfr by serum creatinine, cystatin c, and β2-microglobulin in older adults: results from the canadian study of longevity in type 1 diabetes |
publisher |
Elsevier |
series |
Kidney International Reports |
issn |
2468-0249 |
publishDate |
2019-06-01 |
description |
Introduction: Glomerular filtration rate (GFR) is routinely used for clinical assessment of kidney function. However, the accuracy of estimating equations in older adults is uncertain. Methods: In 66 adults with ≥50 years type 1 diabetes (T1D) duration and 73 nondiabetic controls from age/sex-matched subgroups (65 ± 8 years old and 77[55%] were women) we evaluated the performance of estimated GFR (eGFR) by creatinine (Modification of Diet and Renal Disease [MDRD], Chronic Kidney Disease–Epidemiology [CKD-EPI]cr), cystatin C (CKD-EPIcys, CKD-EPIcr-cys), and β2-microglobulin (β2M) compared with measured GFR by inulin clearance (mGFR). Performance was evaluated using metrics of bias (mean difference), precision (SD), and accuracy (proportion of eGFR that differed by >20% of mGFR). Results: Mean mGFR was 104 ± 18 ml/min per 1.73 m2 (range: 70–154 ml/min per 1.73 m2) and was not different between T1D and controls (103 ± 17 vs. 105 ± 19 ml/min per 1.73 m2, P = 0.39). All equations significantly underestimated mGFR (bias: −15 to −30 ml/min per 1.73 m2, P < 0.001 for all comparisons) except for β2M, which had bias of 1.9 ml/min per 1.73 m2 (P = 0.61). Bias was greatest in cystatin C–based equations. Precision was lowest for β2M (SD: 43.5 ml/min per 1.73 m2, P < 0.001 for each comparison). Accuracy was lowest for CKD-EPIcysC (69.1%, P < 0.001 for each comparison). Cystatin C–based equations demonstrated greater bias and lower accuracy in older age subgroups (<60, 60–69, ≥70 years). All equations demonstrated greater bias across higher ranges of mGFR (60–89, 90–119, ≥120 ml/min per 1.73 m2). Results were similar between T1D and controls except that β2M had lower performance in T1D. Conclusion: Better estimates of GFR in older adults are needed for research and clinical practice, as this subgroup of the population has an amplified risk for the development of chronic kidney disease (CKD) that requires accurate GFR estimation methods. Keywords: β2-microglobulin, creatinine, cystatin C, estimating equations, glomerular filtration rate, inulin clearance, older adults, type 1 diabetes |
url |
http://www.sciencedirect.com/science/article/pii/S2468024919300713 |
work_keys_str_mv |
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doaj-c292c75b1ebd4628986a5c56d7f5c87f2020-11-25T01:52:43ZengElsevierKidney International Reports2468-02492019-06-0146786796Estimating GFR by Serum Creatinine, Cystatin C, and β2-Microglobulin in Older Adults: Results From the Canadian Study of Longevity in Type 1 DiabetesDaniel Scarr0Petter Bjornstad1Leif E. Lovblom2Julie A. Lovshin3Genevieve Boulet4Yuliya Lytvyn5Mohammed A. Farooqi6Vesta Lai7Andrej Orszag8Alanna Weisman9Hillary A. Keenan10Michael H. Brent11Narinder Paul12Vera Bril13David Z.I. Cherney14Bruce A. Perkins15Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, CanadaDivision of Endocrinology, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA; Division of Nephrology, Department of Medicine, University of Colorado, Aurora, Colorado, USALunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, CanadaDivision of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, CanadaLunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, CanadaDivision of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, CanadaLunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, CanadaDivision of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, CanadaLunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, CanadaLunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, CanadaResearch Division, Joslin Diabetes Center, Boston, Massachusetts, USADepartment of Ophthalmology and Vision Sciences, Department of Medicine, University of Toronto, Toronto, Ontario, CanadaJoint Department of Medical Imaging, Division of Cardiothoracic Radiology, University Health Network, Toronto, Ontario, CanadaThe Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, CanadaDivision of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, CanadaLunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Correspondence: Bruce A. Perkins, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Sinai Health System, L5209–60 Murray Street Box 16, Toronto, Ontario, Canada M5T3L9.Introduction: Glomerular filtration rate (GFR) is routinely used for clinical assessment of kidney function. However, the accuracy of estimating equations in older adults is uncertain. Methods: In 66 adults with ≥50 years type 1 diabetes (T1D) duration and 73 nondiabetic controls from age/sex-matched subgroups (65 ± 8 years old and 77[55%] were women) we evaluated the performance of estimated GFR (eGFR) by creatinine (Modification of Diet and Renal Disease [MDRD], Chronic Kidney Disease–Epidemiology [CKD-EPI]cr), cystatin C (CKD-EPIcys, CKD-EPIcr-cys), and β2-microglobulin (β2M) compared with measured GFR by inulin clearance (mGFR). Performance was evaluated using metrics of bias (mean difference), precision (SD), and accuracy (proportion of eGFR that differed by >20% of mGFR). Results: Mean mGFR was 104 ± 18 ml/min per 1.73 m2 (range: 70–154 ml/min per 1.73 m2) and was not different between T1D and controls (103 ± 17 vs. 105 ± 19 ml/min per 1.73 m2, P = 0.39). All equations significantly underestimated mGFR (bias: −15 to −30 ml/min per 1.73 m2, P < 0.001 for all comparisons) except for β2M, which had bias of 1.9 ml/min per 1.73 m2 (P = 0.61). Bias was greatest in cystatin C–based equations. Precision was lowest for β2M (SD: 43.5 ml/min per 1.73 m2, P < 0.001 for each comparison). Accuracy was lowest for CKD-EPIcysC (69.1%, P < 0.001 for each comparison). Cystatin C–based equations demonstrated greater bias and lower accuracy in older age subgroups (<60, 60–69, ≥70 years). All equations demonstrated greater bias across higher ranges of mGFR (60–89, 90–119, ≥120 ml/min per 1.73 m2). Results were similar between T1D and controls except that β2M had lower performance in T1D. Conclusion: Better estimates of GFR in older adults are needed for research and clinical practice, as this subgroup of the population has an amplified risk for the development of chronic kidney disease (CKD) that requires accurate GFR estimation methods. Keywords: β2-microglobulin, creatinine, cystatin C, estimating equations, glomerular filtration rate, inulin clearance, older adults, type 1 diabeteshttp://www.sciencedirect.com/science/article/pii/S2468024919300713 |