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Systematic review and metaanalysis comparing the bias and accuracy of the modification of diet in renal disease and chronic kidney disease epidemiology collaboration equations in community-based populations
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Lasserson, Daniel, O'Callaghan, Chris A., Stevens, Richard J., Hobbs, F. D. Richard, McLellan, Julie H., Verbakel, Jan Y., Hirst, Jennifer A. and McFadden, Emily C. (2018) Systematic review and metaanalysis comparing the bias and accuracy of the modification of diet in renal disease and chronic kidney disease epidemiology collaboration equations in community-based populations. Clinical Chemistry and Laboratory Medicine, 64 (3). pp. 475-485. doi:10.1373/clinchem.2017.276683 ISSN 1434-6621.
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Official URL: http://dx.doi.org/10.1373/clinchem.2017.276683
Abstract
BACKGROUND
The majority of patients with chronic kidney disease are diagnosed and monitored in primary care. Glomerular filtration rate (GFR) is a key marker of renal function, but direct measurement is invasive; in routine practice, equations are used for estimated GFR (eGFR) from serum creatinine. We systematically assessed bias and accuracy of commonly used eGFR equations in populations relevant to primary care.
CONTENT
MEDLINE, EMBASE, and the Cochrane Library were searched for studies comparing measured GFR (mGFR) with eGFR in adult populations comparable to primary care and reporting both the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations based on standardized creatinine measurements. We pooled data on mean bias (difference between eGFR and mGFR) and on mean accuracy (proportion of eGFR within 30% of mGFR) using a random-effects inverse-variance weighted metaanalysis. We included 48 studies of 26875 patients that reported data on bias and/or accuracy. Metaanalysis of within-study comparisons in which both formulae were tested on the same patient cohorts using isotope dilution-mass spectrometry-traceable creatinine showed a lower mean bias in eGFR using CKD-EPI of 2.2 mL/min/1.73 m2 (95% CI, 1.1–3.2; 30 studies; I2 = 74.4%) and a higher mean accuracy of CKD-EPI of 2.7% (1.6–3.8; 47 studies; I2 = 55.5%). Metaregression showed that in both equations bias and accuracy favored the CKD-EPI equation at higher mGFR values.
SUMMARY
Both equations underestimated mGFR, but CKD-EPI gave more accurate estimates of GFR.
Item Type: | Journal Article | ||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
Journal or Publication Title: | Clinical Chemistry and Laboratory Medicine | ||||||
Publisher: | Walter de Gruyter GmbH & Co. KG | ||||||
ISSN: | 1434-6621 | ||||||
Official Date: | 1 March 2018 | ||||||
Dates: |
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Volume: | 64 | ||||||
Number: | 3 | ||||||
Page Range: | pp. 475-485 | ||||||
DOI: | 10.1373/clinchem.2017.276683 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Description: | Free access |
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