Ann Lab Med.  2023 May;43(3):244-252. 10.3343/alm.2023.43.3.244.

Accuracy of the New Creatinine-based Equations for Estimating Glomerular Filtration Rate in Koreans

• Jeong TD
• Hong J
• Lee W
• Chun S
• Min WK

• KMID: 2551708
• DOI: http://doi.org/10.3343/alm.2023.43.3.244

Abstract

Background
New creatinine-based estimated glomerular filtration rate (eGFR) equations, including the 2021 Chronic Kidney Disease Epidemiology Collaboration (2021 CKD-EPI) and European Kidney Function Consortium (EKFC) equations, have been introduced recently. We assessed the performance of the 2021 CKD-EPI and EKFC equations in the Korean population.
Methods
We analyzed 1,654 Korean patients aged ≥18 years who underwent chromium-51-ethylenediamine tetraacetic acid GFR measurements (mGFR). Bias (eGFR–mGFR), root mean square error (RMSE), and proportion of eGFR within 30% of mGFR (P30) of the 2009 CKD-EPI, 2021 CKD-EPI, and EFKC equations were compared. The concordance rate between eGFR and mGFR categories was evaluated. Both eGFR and mGFR categories were classified into six groups: ≥90, 89–60, 59–45, 44–30, 29–15, and <15 mL/min/1.73 m².
Results
The median bias (mL/min/1.73 m2) was 1.8 for the 2009 CKD-EPI equation, 4.8 for the 2021 CKD-EPI equation, and –0.3 for the EKFC equation. The P30 and RMSE were 78.2% and 17.0 for the 2009 CKD-EPI equation, 75.6% and 17.4 for the 2021 CKD-EPI equation, and 80.0% and 16.7 for the EKFC equation, respectively. The overall GFR category concordance rate between eGFR and mGFR was 63.4% for the 2009 CKD-EPI equation, 60.5% for the 2021 CKD-EPI equation, and 61.0% for the EKFC equation.
Conclusions
Among the three eGFR equations, the EKFC equation had the smallest bias and highest P30 in Koreans. The 2009 CKD-EPI equation had a lower bias than the 2021 CKD-EPI equation.

Keyword

Accuracy; Estimated glomerular filtration rate; Creatinine

Figure

• 

  Fig. 1 Scatter and Bland–Altman plots of the concordance rate between mGFR and eGFR. (A, B) for 2009 CKD-EPI, (C, D) for 2021 CKD-EPI, and (E, F) for EKFC. Abbreviations: CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; eGFR, estimated glomerular filtration rate; EKFC, European Kidney Function Consortium; mGFR, measured glomerular filtration rate; IQR, interquartile range.

• 

  Fig. 2 Distribution of eGFR categories and CKD stages according to eGFR equation in the Korean general population. Data from the KNHANES 2019–2020. eGFR (mL/min/1.73 m2) categories: G3a, 59–45; G3b, 44–30; G4, 29–15; G5, <15. CKD was defined as an eGFR <60 mL/min/1.73 m2 or urinary albumin-to-creatinine ratio >30 mg/g. For details, see Supplemental Data Fig. S1 and Supplemental Table S2. *P<0.05, †P<0.001, ‡not significant. Abbreviations: eGFR, estimated glomerular filtration rate; CDK, chronic kidney disease; KNHANES, Korea National Health and Nutrition Examination Survey

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