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Abstract
Background: the most commonly used equations to estimate glomerular filtration rate (GFR) are the CKD-EPIdemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD). There are differences in the performance of these equations across certain ethnic groups and it is possible that the results from regions with different ethnic composition cannot be extrapolated to Latin-American populations.
Objectives: to assess the performance of the CKD-EPI and MDRD equations to estimate the GFR in Latin-American countries.
Methods: the study protocol has been registered in PROSPERO (CRD42019123434). During January 2019, we performed a systematic search in PubMed, Scopus, and 'Biblioteca Regional de Medicina' (BIREME) to identify studies that reported estimated GFR using the CKD-EPI and MDRD equations and compared them with a measured GFR using exogenous filtration markers, in adults of Latin-American countries. Two review authors performed study selection, data extraction, and risk of bias evaluation in parallel. We performed meta-analyses for the following outcomes: P30, bias (using mean difference (MD) and its 95% confidence intervals (95% CI)), sensitivity, and specificity; and evaluated certainty of evidence using the GRADE methodology.
Results: we included 12 papers in this review, of which we meta-analyzed six (five from Brazil and one from Mexico). Meta-analyses that compared CKD-EPI using creatinine measured with calibration traceable to isotope dilution mass spectrometry (CKD-EPI-Cr IDMS) and MDRD-4 IDMS did not show statistically significant differences in bias (MD 0.55 mL/min/1.73m2, 95% CI −3.34 to 4.44; 5 studies, in favour of CKD-EPI-Cr IDMS), P30 (MD 4%, 95% CI −4% to 13%; 2 studies; Figure 1), sensitivity (76% and 75%, respectively; 2 studies), and specificity (91% and 89%, respectively; 2 studies). With very low-certainty evidence for bias and P30, and low-certainty evidence for sensitivity and specificity.
Conclusions: we found that the performance of CKD-EPI-Cr IDMS and MDRD-4 IDMS do not differ significantly, although CKD-EPI-Cr IDMS tends to have a non-significantly better performance in terms of P30. However, since most of the meta-analyzed studies were from Brazil, results may not be extrapolated to other Latin-American countries.
Patient or healthcare consumer involvement: this study has a direct implication for patients, since it was commissioned by the Peruvian Social Security (which provides care to 35% of the Peruvian population) as part of the elaboration of the clinical practice guideline for diagnosis and management of chronic kidney disease. The information we would like to present in this Colloquium will be discussed with the Guideline Elaboration Group, a recommendation will be reached, and it will be implemented by the Peruvian Social Security.
Objectives: to assess the performance of the CKD-EPI and MDRD equations to estimate the GFR in Latin-American countries.
Methods: the study protocol has been registered in PROSPERO (CRD42019123434). During January 2019, we performed a systematic search in PubMed, Scopus, and 'Biblioteca Regional de Medicina' (BIREME) to identify studies that reported estimated GFR using the CKD-EPI and MDRD equations and compared them with a measured GFR using exogenous filtration markers, in adults of Latin-American countries. Two review authors performed study selection, data extraction, and risk of bias evaluation in parallel. We performed meta-analyses for the following outcomes: P30, bias (using mean difference (MD) and its 95% confidence intervals (95% CI)), sensitivity, and specificity; and evaluated certainty of evidence using the GRADE methodology.
Results: we included 12 papers in this review, of which we meta-analyzed six (five from Brazil and one from Mexico). Meta-analyses that compared CKD-EPI using creatinine measured with calibration traceable to isotope dilution mass spectrometry (CKD-EPI-Cr IDMS) and MDRD-4 IDMS did not show statistically significant differences in bias (MD 0.55 mL/min/1.73m2, 95% CI −3.34 to 4.44; 5 studies, in favour of CKD-EPI-Cr IDMS), P30 (MD 4%, 95% CI −4% to 13%; 2 studies; Figure 1), sensitivity (76% and 75%, respectively; 2 studies), and specificity (91% and 89%, respectively; 2 studies). With very low-certainty evidence for bias and P30, and low-certainty evidence for sensitivity and specificity.
Conclusions: we found that the performance of CKD-EPI-Cr IDMS and MDRD-4 IDMS do not differ significantly, although CKD-EPI-Cr IDMS tends to have a non-significantly better performance in terms of P30. However, since most of the meta-analyzed studies were from Brazil, results may not be extrapolated to other Latin-American countries.
Patient or healthcare consumer involvement: this study has a direct implication for patients, since it was commissioned by the Peruvian Social Security (which provides care to 35% of the Peruvian population) as part of the elaboration of the clinical practice guideline for diagnosis and management of chronic kidney disease. The information we would like to present in this Colloquium will be discussed with the Guideline Elaboration Group, a recommendation will be reached, and it will be implemented by the Peruvian Social Security.
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