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Prevalence of Chronic Kidney Disease in an Elderly Population: Impact of the Choice of the Equation Used for Estimating GFR

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Academic year: 2021

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Prevalence of chronic kidney disease in an elderly population: impact of the choice of the equation used for estimating GFR.

Christophe Mariat, Etienne Cavalier, Jean-Marie Krzesinski, Pierre Delanaye. Department of Nephrology, University of Liège, CHU Sart Tilman, Liège, Belgium

Department of Nephrology, University of Saint Etienne, Hopital Nord, Saint Etienne, France Department of clinical chemistry, University of Liège, CHU Sart Tilman, Liège, Belgium

Background: Early detection of CKD is the necessary step for an efficient politic of prevention. We have compared the prevalence of stage 3 CKD in an elderly population using either the creatinine- or the cystatine C based equations.

Methods: On a voluntary way, all the patients aged of forty five years or more and living in the Province of Liege (Belgium) were invited to be screened for CKD. This province has an area of 3862 km² and its population from 2005 data has been calculated to reach 1.037.161 inhabitants. Serum creatinine has been measured with an IDMS traceable method (compensated Jaffé from Roche Diagnostics). Cystatin C was measured with the nephelometric method from Siemens. The study period was between June 2008 and April 2009. GFR was estimated by creatinine-based equations (MDRD and new CKD-EPI equations) and by the three cystatin C-based equations published by the Levey’s group (Levey 1 equation is based only on cystatin C, Levey 2 is based on cystatin C, age, sex and ethnicity, Levey 3 combined age, sex, ethnicity, cystatin C and creatinine). Results: 1992 subjects were screened in this study: 47% were men and mean age was 62±8 years old. Mean serum creatinine and plasma cystatin C concentrations were 0.86±0.20 mg/dL and 0.76±0.16 mg/L. The prevalence of stage 3 CKD in this population using the MDRD or the CKD-EPI equations was 11.04 and 7.98%, respectively. If the three cystatin C equations are used for

estimating GFR, the prevalence would be 1.10, 2.11 and 3.82%.

Conclusion: In our population, we describe large discrepancies in the CKD prevalence according to the equations used for estimating GFR. The classical MDRD study equation gives the greater prevalence, notable comparing to the new CKD-EPI equation. This last equation is thought to be more accurate in normal creatinine ranges than the MDRD study one. Discrepancies are still more impressive when cystatin C and creatinine-based equations are compared. The choice of the equation used for estimating GFR has thus a true and great impact on the prevalence of CKD in epidemiological studies. Our work confirms the urgent need of studies with GFR measured by a reference method.

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