Performance of Panel-Estimated GFR Among Hospitalized Older Adults
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Dokumenter
- Fulltext
Forlagets udgivne version, 957 KB, PDF-dokument
Rationale & Objective: Older adults represent nearly half of all hospitalized patients and are vulnerable to inappropriate dosing of medications eliminated through the kidneys. However, few studies in this population have evaluated the performance of equations for estimating the glomerular filtration rate (GFR)—particularly those that incorporate multiple filtration markers. Study Design: Cross-sectional diagnostic test substudy of a randomized clinical trial. Setting & Participants: Adults ≥ 65 years of age presenting to the emergency department of Copenhagen University Hospital Amager and Hvidovre in Hvidovre, Denmark, between October 2018 and April 2021. Tests Compared: Measured GFR (mGFR) determined using 99mTc-DTPA plasma clearance compared with estimated GFR (eGFR) calculated using 6 different equations based on creatinine; 3 based on creatinine and cystatin C combined; and 2 based on panels of markers including creatinine, cystatin C, β-trace protein (BTP) and/or β2-microglobulin (B2M). Outcome: The performance of each eGFR equation compared with mGFR with respect to bias, relative bias, inaccuracy (1-P30), and root mean squared error (RMSE). Results: We assessed eGFR performance for 106 patients (58% female, median age 78.3 years, median mGFR 62.9 mL/min/1.73 m2). Among the creatinine-based equations, the 2009 CKD-EPIcr equation yielded the smallest relative bias (+4.2%). Among the creatinine-cystatin C combination equations, the 2021 CKD-EPIcomb equation yielded the smallest relative bias (−3.4%), inaccuracy (3.8%), and RMSE (0.139). Compared with the 2021 CKD-EPIcomb, the CKD-EPIpanel equation yielded a smaller RMSE (0.136) but larger relative bias (−4.0%) and inaccuracy (5.7%). Limitations: Only White patients were included; only a subset of patients from the original clinical trial underwent GFR measurement; and filtration marker concentration can be affected by subclinical changes in volume status. Conclusions: The 2009 CKD-EPIcr, 2021 CKD-EPIcomb, and CKD-EPIpanel equations performed best and notably outperformed their respective full-age spectrum equations. The addition of cystatin C to creatinine-based equations improved performance, while the addition of BTP and/or B2M yielded minimal improvement. Funding: Grants from public sector industry (Amgros I/S) and government (Capital Region of Denmark). Trial Registration: Registered at ClinicalTrials.gov with registration number NCT03741283. Plain-Language Summary: Inaccurate kidney function assessment can lead to medication errors, a common cause of hospitalization and early readmission among older adults. Several novel methods have been developed to estimate kidney function based on a panel of kidney function markers that can be measured from a single blood sample. We evaluated the accuracy of these new methods (relative to a gold standard method) among 106 hospitalized older adults. We found that kidney function estimates combining 2 markers (creatinine and cystatin C) were highly accurate and noticeably more accurate than estimates based on creatinine alone. Estimates incorporating additional markers such as β-trace protein and β2-microglobulin did not further improve accuracy.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | American Journal of Kidney Diseases |
| Vol/bind | 82 |
| Udgave nummer | 6 |
| Sider (fra-til) | 715-724 |
| Antal sider | 10 |
| ISSN | 0272-6386 |
| DOI | |
| Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:
Esben Iversen, MD, PhD, Anne Kathrine Bengaard, MSc, Aino Leegaard Andersen, PhD, Juliette Tavenier, PhD, Rikke Lundsgaard Nielsen, MSc, Helle Gybel Juul-Larsen, PhD, Lillian Mørch Jørgensen, MD, Olivia Bornæs, MSc, Baker Nawfal Jawad, MSc, Anissa Aharaz, MSc, Anne Byriel Walls, PhD, Thomas Kallemose, MSc, Kim Dalhoff, MD, DMSc, Jan Olof Nehlin, DMSc, MSc, Mads Hornum, MD, PhD, Bo Feldt-Rasmussen, MD, DMSc, Morten Damgaard, MD, PhD, Ove Andersen, MD, DMSc, and Morten Baltzer Houlind, PhD. Research idea and study design: EI, AKB, ALA, ABW, KD, JON, MH, BF-R, MD, OA, MBH; data collection: AKB, ALA, JT, RLN, HGJ-L, LMJ, OB, BNJ, AA, MD, MBH; data management: EI, AKB, ALA, JT, TK, MBH; statistical analysis: EI, AKB, TK, MBH. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. This study was supported by the Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; the Capital Region Pharmacy, Herlev, Denmark; and the Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark. In addition, the study received financial support from the Capital Region's strategic funds; the Capital Region's fund for transitional research; and the Danish Research Unit for Hospital Pharmacy, Amgros I/S, Copenhagen, Denmark. Dr Houlind was supported personally by postdoctoral fellowships from the Capital Region's Research Foundation for Health Research (grant A6882 and A7140) and the BRIDGE Translational Excellence Program at the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (grant NNF20SA0064340). The funders had no role in study design, data collection, analysis, reporting, or the decision to submit for publication. Dr Ove Andersen is a named inventor on patents covering suPAR owned by Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark and licensed to ViroGates A/S. The remaining authors declare that they have no relevant financial interests. The authors would like to thank all patients and staff involved in the OptiNAM trial. Additionally, we thank Pernille Lemvig and all staff at the Department of Clinical Physiology and Nuclear Medicine for their instrumental work in coordinating and collecting GFR measurements. Finally, we thank our laboratory technicians at the Department of Clinical Research for their assistance with biomarker measurements, and Louise Christensen for her assistance with medication data collection. The data underlying this study are not publicly available due to privacy and/or ethical restrictions. The data can be shared upon reasonable request to the corresponding author. Received November 29, 2022. Evaluated by 2 external peer reviewers, with direct editorial input from a Statistics/Methods Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form May 10, 2023.
Funding Information:
This study was supported by the Department of Clinical Research , Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; the Capital Region Pharmacy, Herlev, Denmark; and the Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark. In addition, the study received financial support from the Capital Region’s strategic funds ; the Capital Region’s fund for transitional research; and the Danish Research Unit for Hospital Pharmacy, Amgros I/S, Copenhagen, Denmark. Dr Houlind was supported personally by postdoctoral fellowships from the Capital Region’s Research Foundation for Health Research (grant A6882 and A7140) and the BRIDGE Translational Excellence Program at the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (grant NNF20SA0064340). The funders had no role in study design, data collection, analysis, reporting, or the decision to submit for publication.
Publisher Copyright:
© 2023 The Authors
ID: 375208597