Assessment of Four Different eGFR Equations in Older Turkish Adults

Öz

Age-related physiologic changes and comorbidities make it difficult to estimate the glomerular filtration rate(GFR) in older adults. Although inulin clearance is accepted as the gold standard for measuring GFR, it is impractical in clinical practice. A total of 228 patients who underwent a 24-hour creatinine clearance test for the measured GFR (mGFR) were included in the study.The estimated GFR(eGFR) was calculated according to the Modification of Diet in Renal Disease(MDRD) and Chronic Kidney Disease Epidemiology Collaboration(CKD-epi), Berlin Initiative Study-1(BIS-1) and Full Age Spectrum(FAS) formula. The medians of the differences between mGFR and each eGFR equation were used for assessing the bias, and the interquartile range(IQR) of the differences was used for expressing the precision of each equation. The mean age was 76.98±7.83 years and the frequency of female patients was 58.20%. In all patients, FAS[bias=0.40(1.09%), IQR= 26.55 (%52.49)] and BIS-1[bias=1.36(4.27%), IQR=26.71 (%55.28)] were less biased.In the mGFR≥60 mL/min/1.73 m2 subgroup, MDRD was the most precise[bias= -1.73(-1.69%), IQR=25.14 (%49.75)]. in four equations.In patients younger than 75 years, MDRD and CKD-epi equations were less biased, and the CKD-epi equation had the smallest IQR[bias=2.80(4.52%),bias= -2.93(-4.29%), IQR=32.97(49.94%)], whereas, in those older than 75 years, BIS-1 and FAS equations were less biased. However, for the patients 30≤mGFR<60 and mGFR<30 mL/min/1.73 m2, BIS-1 had the lowest bias and smallest IQRs[bias=3.49(7.81%),IQR=14.28(33.20%) and bias=7.60(40.11%), IQR=13.81(39.59%)]. In conclusion, BIS-1 and FAS equations were less biased in older patients with mGFR<60 mL/min/1.73 m2, and MDRD and CKD-epi were less biased in patients with mGFR≥60 mL/min/1.73 m2.

Anahtar Kelimeler

• glomerular filtration rate
• older adults
• creatinine clearence
• glomerular filtration rate equation

Yaşlı Türk Bireylerde Dört Farklı eGFR Formülünün Değerlendirilmesi

Öz

Yaşla ilişkili fizyolojik değişiklikler ve eşlik eden hastalıklar, yaşlı bireylerde glomerüler filtrasyon hızının (GFH) tahmin edilmesini güçleştirmektedir. Klinik uygulamada altın standart olarak kabul edilen inülin klirensi, pratikte kullanımı zor olduğundan tercih edilmemektedir. Bu çalışmada, ölçülen GFH (mGFH) için 24 saatlik kreatinin klirens testi uygulanan toplam 228 hasta değerlendirilmiştir. Tahmini GFH (eGFH), Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI Berlin Initiative Study-1 (BIS-1) ve Full Age Spectrum (FAS) formüllerine göre hesaplanmıştır. MGFH ile her bir eGFH formülü arasındaki farkların medyanı yanlılığı, interkuartil aralığı (IQR) ise her formülün hassasiyetini göstermek amacıyla kullanılmıştır. Hastaların ortalama yaşı 76.98±7.83 yıl olup, kadın hasta sıklığı %58.20’dir. Tüm hastalarda FAS [yanlılık=0.40 (1.09%) IQR=26.55 (%52.49)] ve BIS-1 [yanlılık=1.36 (4.27%) IQR=26.71 (%55.28) ], formülleri daha az yanlılık göstermiştir. mGFH ≥60 mL/dk/1,73 m² alt grubunda, MDRD formülü dört formül arasında en hassas olanıdır [yanlılık= -1.73 (-1.69%), IQR=25.14 (%49.75)]. 75 yaş altı hastalarda MDRD ve CKD-EPI formülleri daha az yanlılık göstermiş, CKD-EPI formülü en dar IQR değerine sahip olmuştur [yanlılık=2.80 (4.52%), yanlılık= -2.93 (-4.29%), IQR=32.97 (49.94%)]. Ayrıca, 75 yaş üzerindeki bireylerde BIS-1 ve FAS formülleri daha az yanlılık göstermiştir. mGFH 30≤mGFH<60 ve mGFH<30 mL/dk/1.73 m² olan hastalarda ise, BIS-1 formülü en düşük yanlılık ve en dar IQR değerleriyle öne çıkmıştır [sırasıyla yanlılık=3.49 (7.81%), IQR=14.28 (33.20%) ve yanlılık=7.60 (40.11%), IQR=13.81 (39.59%)]. Sonuç olarak, mGFH <60 mL/dk/1.73 m² olan yaşlı hastalarda BIS-1 ve FAS formülleri daha az yanlılık gösterirken, mGFH ≥60 mL/dk/1.73 m² olan hastalarda MDRD ve CKD-EPI formülleri daha doğru sonuçlar vermektedir.

Anahtar Kelimeler

• Glomerüler filtrasyon hızı
• yaşlı bireyler
• kreatinin klirensi
• glomerüler filtrasyon hızı formülleri

Kaynakça

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