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. 2021 Jun;40(2):220-230.
doi: 10.23876/j.krcp.20.210. Epub 2021 Jun 9.

Effect of estimating equations for glomerular filtration rate on novel surrogate markers for renal outcome

Kipyo Kim  1 , Eunji Baek  2 , Suryeong Go  2 , Hyung-Eun Son  2 , Ji-Young Ryu  2 , Yongjin Yi  3 , Jong Cheol Jeong  2 , Sejoong Kim  2   4 , Ho Jun Chin  2   4
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Effect of estimating equations for glomerular filtration rate on novel surrogate markers for renal outcome

Kipyo Kim et al. Kidney Res Clin Pract. 2021 Jun.

Abstract

Backgrounds: Recently, alternative surrogate endpoints such as a 30% or 40% decline in estimated glomerular filtration rate (eGFR) or eGFR slope over 2 to 3 years have been proposed for predicting renal outcomes. However, the impact of GFR estimation methods on the accuracy and effectiveness of surrogate markers is unknown.

Methods: We retrospectively enrolled participants in health screening programs at three hospitals from 1995 to 2009. We defined two different participant groups as YR1 and YR3, which had available 1-year or 3-year eGFR values along with their baseline eGFR levels. We compared the effectiveness of eGFR percentage change or slope to estimate end-stage renal disease (ESRD) risk according to two estimating equations (modified Modification of Diet in Renal Disease equation [eGFRm] and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation [eGFRc]) for GFR.

Results: In the YR1 and YR3 groups, 9,971 and 10,171 candidates were enrolled and ESRD incidence during follow-up was 0.26% and 0.19%, respectively. The eGFR percentage change was more effective than eGFR slope in estimating ESRD risk, regardless of the method of estimation. A 40% of decline in eGFR was better than 30%, and a 3-year baseline period was better than a 1-year period for prediction accuracy. Although some diagnostic indices from the CKD-EPI equation were better, we found no significant differences in the discriminative ability and hazard ratios for incident ESRD between eGFRc and eGFRm in either eGFR percentage change or eGFR slope.

Conclusion: There were no significant differences in the prediction accuracy of GFR percentage change or eGFR slope between eGFRc and eGFRm in the general population.

Keywords: Chronic kidney disease; End-stage renal disease; Glomerular filtration rate; Renal endpoint; Surrogate endpoint.

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Conflict of interest statement

Conflict of interest

All authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.. Selection of study participants.
1-year period, 6–18 months after the first examination; 3-year period, 30–42 months after the first examination. eGFR, estimated glomerular filtration rate; eGFRc, eGFR by the 2009 Chronic Kidney Disease-Epidemiology Collaboration creatinine equation; eGFRm, eGFR by the modified Modification of Diet in Renal Disease equation.
Figure 2.
Figure 2.. Receiver operating characteristic curves for changes in eGFR.
During 1-year (A) and 3-year (B) periods for ESRD estimation. The eGFR was estimated based on isotope dilution mass spectrometry-traceable creatinine. eGFR, estimated glomerular filtration rate; eGFRc, eGFR by the 2009 Chronic Kidney Disease-Epidemiology Collaboration creatinine equation; eGFRm, eGFR by the modified Modification of Diet in Renal Disease equation; ESRD, end-stage renal disease.
Figure 3.
Figure 3.. Adjusted hazard ratio for end-stage renal disease associated with percent change in eGFR.
eGFRc (A) and eGFRm (B) over 1 year; eGFRc (C) and eGFRm (D) over 3 years. eGFR, estimated glomerular filtration rate; eGFRc, eGFR by the 2009 Chronic Kidney Disease-Epidemiology Collaboration creatinine equation; eGFRm, eGFR by the modified Modification of Diet in Renal Disease equation.
Figure 4.
Figure 4.. Adjusted hazard ratio for end-stage renal disease associated with eGFR slope.
eGFRc slope (A) and eGFRm slope (B) over 1 year; the eGFRc slope (C) and eGFRm slope (D) over 3 years. eGFR, estimated glomerular filtration rate; eGFRc, eGFR by the 2009 Chronic Kidney Disease-Epidemiology Collaboration creatinine equation; eGFRm, eGFR by the modified Modification of Diet in Renal Disease equation.
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