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Comparison of the Schwartz and CKD-EPI Equations for Estimating Glomerular
Filtration Rate in Children, Adolescents, and Adults: A Retrospective
Cross-Sectional Study
#MMPMID27023756
Selistre L
; Rabilloud M
; Cochat P
; de Souza V
; Iwaz J
; Lemoine S
; Beyerle F
; Poli-de-Figueiredo CE
; Dubourg L
PLoS Med
2016[Mar]; 13
(3
): e1001979
PMID27023756
show ga
BACKGROUND: Estimating kidney glomerular filtration rate (GFR) is of utmost
importance in many clinical conditions. However, very few studies have evaluated
the performance of GFR estimating equations over all ages and degrees of kidney
impairment. We evaluated the reliability of two major equations for GFR
estimation, the CKD-EPI and Schwartz equations, with urinary clearance of inulin
as gold standard. METHODS AND FINDINGS: The study included 10,610 participants
referred to the Renal and Metabolic Function Exploration Unit of Edouard Herriot
Hospital (Lyon, France). GFR was measured by urinary inulin clearance (only first
measurement kept for analysis) then estimated with isotope dilution mass
spectrometry (IDMS)-traceable CKD-EPI and Schwartz equations. The participants'
ages ranged from 3 to 90 y, and the measured GFRs from 3 to 160 ml/min/1.73 m2. A
linear mixed-effects model was used to model the bias (mean ratio of estimated
GFR to measured GFR). Equation reliability was also assessed using precision
(interquartile range [IQR] of the ratio) and accuracy (percentage of estimated
GFRs within the 10% [P10] and 30% [P30] limits above and below the measured GFR).
In the whole sample, the mean ratio with the CKD-EPI equation was significantly
higher than that with the Schwartz equation (1.17 [95% CI 1.16; 1.18] versus 1.08
[95% CI 1.07; 1.09], p < 0.001, t-test). At GFR values of 60-89 ml/min/1.73 m2,
the mean ratios with the Schwartz equation were closer to 1 than the mean ratios
with the CKD-EPI equation whatever the age class (1.02 [95% CI 1.01; 1.03] versus
1.15 [95% CI 1.13; 1.16], p < 0.001, t-test). In young adults (18-40 y), the
Schwartz equation had a better precision and was also more accurate than the
CKD-EPI equation at GFR values under 60 ml/min/1.73 m2 (IQR: 0.32 [95% CI 0.28;
0.33] versus 0.40 [95% CI 0.36; 0.44]; P30: 81.4 [95% CI 78.1; 84.7] versus 63.8
[95% CI 59.7; 68.0]) and also at GFR values of 60-89 ml/min/1.73 m2. In all
patients aged ?65 y, the CKD-EPI equation performed better than the Schwartz
equation (IQR: 0.33 [95% CI 0.31; 0.34] versus 0.40 [95% CI 0.38; 0.41]; P30:
77.6 [95% CI 75.7; 79.5] versus 67.5 [95% CI 65.4; 69.7], respectively). In
children and adolescents (2-17 y), the Schwartz equation was superior to the
CKD-EPI equation (IQR: 0.23 [95% CI 0.21; 0.24] versus 0.33 [95% CI 0.31; 0.34];
P30: 88.6 [95% CI 86.7; 90.4] versus 29.4 [95% CI 26.8; 32.0]). This study is
limited by its retrospective design, single-center setting with few non-white
patients, and small number of patients with severe chronic kidney disease.
CONCLUSIONS: The results from this study suggest that the Schwartz equation may
be more reliable than the CKD-EPI equation for estimating GFR in children and
adolescents and in adults with mild to moderate kidney impairment up to age 40 y.
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