Background: The directly measured glomerular filtrate rate (mGFR) is the gold standard for kidney function, but it is invasive and costly. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations have been widely used to estimate GFR, however, the comparative accuracy of estimated GFR (eGFR) using creatinine and cystatin C in CKD-EPI equations remains unclear. We performed this meta-analysis to assess the bias and accuracy of eGFR using equations of CKD-EPI, CKD-EPI, and CKD-EPI in adult populations relevant to primary health care.

Methods: Pubmed, Web of Science, EMBASE, and the Cochrane Library were searched from inception until December 2019 for related studies.

Results: A total of 35 studies with 23,667 participants, which reported the data on the bias, and/or P30, and/or R were included. The difference in the bias of eGFR using CKD-EPI was 4.84 mL/min/1.73 m (95% CI, 1.88~7.80) lower than using CKD-EPI, and 1.50 mL/min/1.73 m (95% CI, 0.05~2.95) lower than using CKD-EPI. These gaps increased in subgroups of low mGFR (<60 mL/min/1.73 m). CKD-EPI eGFR achieved the highest accuracy, 7.50% higher than CKD-EPI (95% CI, 4.81~10.18), and 3.21% higher than CKD-EPI (95% CI, -0.43~6.85); and the best correlation with mGFR, with Fisher's z transformed R of 1.20 (95% CI, 0.89-1.50).

Conclusions: CKD-EPI and CKD-EPI gave less bias and more accurate estimates of mGFR than CKD-EPI. More variables and coefficients could be added in CKD-EPI equations to achieve less bias and more accuracy in future research.

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Source
http://dx.doi.org/10.1016/j.ejim.2020.04.044DOI Listing

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