Original InvestigationPathogenesis and Treatment of Kidney DiseaseEstimating GFR Using Serum Cystatin C Alone and in Combination With Serum Creatinine: A Pooled Analysis of 3,418 Individuals With CKD
Section snippets
Sources of Data
CKD Epidemiology Collaboration (CKD-EPI) is a research group formed to develop and validate improved estimating equations for GFR by pooling data from research studies and clinical populations (hereafter referred to as “studies”). (See Appendix text and Appendix Fig 1 for description of data sets included in CKD-EPI.) The present analysis is based on pooled individual-level patient data from the MDRD Study, African American Study of Kidney Disease (AASK), Collaborative Study Group (CSG), and a
Clinical Characteristics
Table 1 lists clinical characteristics by study for the development and internal and external validation data sets, as well as for the overall population. All patients were considered to have CKD. Mean GFR was 48 mL/min/1.73 m2 (5th to 95th percentile, 15 to 95; [0.8 mL/s/1.73 m2; 5th to 95th percentile, 0.3 to 1.6]). Mean ± SD serum concentrations of creatinine and cystatin C were 2.1 ± 1.1 mg/dL (186 ± 97 μmol/L) and 1.8 ± 0.8 mg/L (135 ± 60 nmol/L), respectively. Correlation between them was
Discussion
In this study, we pooled data from 3,418 patients with CKD in 3 research studies and 1 clinical population to develop and compare GFR-estimating equations using serum creatinine, cystatin C, or both levels. Strengths of the study include the large study population, calibration of creatinine assays in each study to standardized values, measurement of cystatin C in a single laboratory, multiple-period urinary clearances of validated filtration markers for measurement of GFR, and use of a separate
Acknowledgements
Author affiliations are as follows. Division of Nephrology, Tufts-New England Medical Center, Boston, MA: Lesley A. Stevens, MD, MS, Christopher H. Schmid, PhD, Robert D. Bruce III, BA, Yaping (Lucy) Zhang, MD, and Andrew S. Levey, MD; Johns Hopkins Medical Institutions, Baltimore, MD: Josef Coresh, MD, PhD, MPH; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA: Harold I. Feldman, MD, MSCE; Georges Pompidou European Hospital, Paris Descartes
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Originally published online as doi:10.1053/j.ajkd.2007.11.018 on January 31, 2008.
Because an author of this manuscript is an editor for AJKD, the peer-review and decision-making processes were handled entirely by an Associate Editor (Marcello Tonelli, MD, University of Alberta) who served as Acting Editor-in-Chief. Details of the journal’s procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.