Impact of a single eGFR and eGFR-estimating equation on chronic kidney disease reclassification: A cohort study in primary care

Jennifer A. Hirst; Maria D.L.A. Vazquez Montes; Clare J. Taylor; José M. Ordóñez-Mena; Emma Ogburn; Vanshika Sharma; Brian Shine; Tim James; F. D.Richard Hobbs

doi:10.3399/bjgp18X697937

Impact of a single eGFR and eGFR-estimating equation on chronic kidney disease reclassification: A cohort study in primary care

Jennifer A. Hirst^*, Maria D.L.A. Vazquez Montes, Clare J. Taylor, José M. Ordóñez-Mena, Emma Ogburn, Vanshika Sharma, Brian Shine, Tim James, F. D.Richard Hobbs

^*Corresponding author for this work

Applied Health Research

Research output: Contribution to journal › Article › peer-review

Abstract

Background Chronic kidney disease (CKD) is diagnosed using the estimated glomerular filtration rate (eGFR) and the urinary albumin:creatinine ratio (ACR). The eGFR is calculated from serum creatinine levels using the Modification of Diet in Renal Disease (MDRD) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Aim To compare the performance of one versus two eGFR/ACR measurements, and the impact of equation choice, on CKD diagnosis and classification. Design and setting Cohort study in primary care in the Thames Valley region of the UK. Method Data were from 485 participants aged >60 years in the Oxford Renal Cohort Study with at least two eGFR tests. The proportion of study participants diagnosed and classified into different CKD stages using one and two positive tests were compared. Prevalence of CKD diagnosis and classification by CKD stage were compared when eGFR was calculated using MDRD and CKD-EPI equations. Results Participants included in the analysis had a mean age of 72.1 (±6.8) years and 57.0% were female. Use of a single screening test overestimated the proportion of people with CKD by around 25% no matter which equation was used, compared with the use of two tests. The mean eGFR was 1.4 ml/min/1.73 m² (95% CI = 1.1 to 1.6) higher using the CKD-EPI equation compared with the MDRD equation. More patients were diagnosed with CKD when using the MDRD equation, compared with the CKD-EPI equation, once (64% versus 63%, respectively) and twice (39% versus 38%, respectively), and 16 individuals, all of who had CKD stages 2 or 3A with MDRD, were reclassified as having a normal urinary ACR when using the CKD-EPI equation. Conclusion Current guidance to use two eGFR measures to diagnose CKD remains appropriate in an older primary care population to avoid overdiagnosis. A change from MDRD to CKD-EPI equation could result in one in 12 patients with a CKD diagnosis with MDRD no longer having a diagnosis of CKD.

Original language	English
Pages (from-to)	e524-e530
Journal	British Journal of General Practice
Volume	68
Issue number	673
DOIs	https://doi.org/10.3399/bjgp18X697937
Publication status	Published - Aug 2018

Bibliographical note

Funding Information:
Jennifer Hirst is funded by the National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford; Clare Taylor is funded by an NIHR Academic Clinical Lectureship; FD Richard Hobbs acknowledges part-support from the NIHR School for Primary Care Research, the NIHR Collaboration for Leadership in Applied Research in Health and Care, Oxford, and the NIHR Oxford Biomedical Research Centre.

Publisher Copyright:
© British Journal of General Practice.

Keywords

Chronic kidney diseases
CKD-EPI
eGFR
Glomerular filtration rate
Kidney failure, chronic
MDRD
Overdiagnosis
Renal insufficiency, chronic

ASJC Scopus subject areas

Family Practice

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10.3399/bjgp18X697937

Cite this

Hirst, J. A., Vazquez Montes, M. D. L. A., Taylor, C. J., Ordóñez-Mena, J. M., Ogburn, E., Sharma, V., Shine, B., James, T., & Hobbs, F. D. R. (2018). Impact of a single eGFR and eGFR-estimating equation on chronic kidney disease reclassification: A cohort study in primary care. British Journal of General Practice, 68(673), e524-e530. https://doi.org/10.3399/bjgp18X697937

@article{60f597f1d6694cb3966b95cf1503bc70,

title = "Impact of a single eGFR and eGFR-estimating equation on chronic kidney disease reclassification: A cohort study in primary care",

abstract = "Background Chronic kidney disease (CKD) is diagnosed using the estimated glomerular filtration rate (eGFR) and the urinary albumin:creatinine ratio (ACR). The eGFR is calculated from serum creatinine levels using the Modification of Diet in Renal Disease (MDRD) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Aim To compare the performance of one versus two eGFR/ACR measurements, and the impact of equation choice, on CKD diagnosis and classification. Design and setting Cohort study in primary care in the Thames Valley region of the UK. Method Data were from 485 participants aged >60 years in the Oxford Renal Cohort Study with at least two eGFR tests. The proportion of study participants diagnosed and classified into different CKD stages using one and two positive tests were compared. Prevalence of CKD diagnosis and classification by CKD stage were compared when eGFR was calculated using MDRD and CKD-EPI equations. Results Participants included in the analysis had a mean age of 72.1 (±6.8) years and 57.0% were female. Use of a single screening test overestimated the proportion of people with CKD by around 25% no matter which equation was used, compared with the use of two tests. The mean eGFR was 1.4 ml/min/1.73 m2 (95% CI = 1.1 to 1.6) higher using the CKD-EPI equation compared with the MDRD equation. More patients were diagnosed with CKD when using the MDRD equation, compared with the CKD-EPI equation, once (64% versus 63%, respectively) and twice (39% versus 38%, respectively), and 16 individuals, all of who had CKD stages 2 or 3A with MDRD, were reclassified as having a normal urinary ACR when using the CKD-EPI equation. Conclusion Current guidance to use two eGFR measures to diagnose CKD remains appropriate in an older primary care population to avoid overdiagnosis. A change from MDRD to CKD-EPI equation could result in one in 12 patients with a CKD diagnosis with MDRD no longer having a diagnosis of CKD.",

keywords = "Chronic kidney diseases, CKD-EPI, eGFR, Glomerular filtration rate, Kidney failure, chronic, MDRD, Overdiagnosis, Renal insufficiency, chronic",

author = "Hirst, {Jennifer A.} and {Vazquez Montes}, {Maria D.L.A.} and Taylor, {Clare J.} and Ord{\'o}{\~n}ez-Mena, {Jos{\'e} M.} and Emma Ogburn and Vanshika Sharma and Brian Shine and Tim James and Hobbs, {F. D.Richard}",

note = "Funding Information: Jennifer Hirst is funded by the National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford; Clare Taylor is funded by an NIHR Academic Clinical Lectureship; FD Richard Hobbs acknowledges part-support from the NIHR School for Primary Care Research, the NIHR Collaboration for Leadership in Applied Research in Health and Care, Oxford, and the NIHR Oxford Biomedical Research Centre. Publisher Copyright: {\textcopyright} British Journal of General Practice.",

year = "2018",

month = aug,

doi = "10.3399/bjgp18X697937",

language = "English",

volume = "68",

pages = "e524--e530",

journal = "British Journal of General Practice",

issn = "0960-1643",

publisher = "Royal College of General Practitioners",

number = "673",

}

TY - JOUR

T1 - Impact of a single eGFR and eGFR-estimating equation on chronic kidney disease reclassification

T2 - A cohort study in primary care

AU - Hirst, Jennifer A.

AU - Vazquez Montes, Maria D.L.A.

AU - Taylor, Clare J.

AU - Ordóñez-Mena, José M.

AU - Ogburn, Emma

AU - Sharma, Vanshika

AU - Shine, Brian

AU - James, Tim

AU - Hobbs, F. D.Richard

N1 - Funding Information: Jennifer Hirst is funded by the National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford; Clare Taylor is funded by an NIHR Academic Clinical Lectureship; FD Richard Hobbs acknowledges part-support from the NIHR School for Primary Care Research, the NIHR Collaboration for Leadership in Applied Research in Health and Care, Oxford, and the NIHR Oxford Biomedical Research Centre. Publisher Copyright: © British Journal of General Practice.

PY - 2018/8

Y1 - 2018/8

N2 - Background Chronic kidney disease (CKD) is diagnosed using the estimated glomerular filtration rate (eGFR) and the urinary albumin:creatinine ratio (ACR). The eGFR is calculated from serum creatinine levels using the Modification of Diet in Renal Disease (MDRD) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Aim To compare the performance of one versus two eGFR/ACR measurements, and the impact of equation choice, on CKD diagnosis and classification. Design and setting Cohort study in primary care in the Thames Valley region of the UK. Method Data were from 485 participants aged >60 years in the Oxford Renal Cohort Study with at least two eGFR tests. The proportion of study participants diagnosed and classified into different CKD stages using one and two positive tests were compared. Prevalence of CKD diagnosis and classification by CKD stage were compared when eGFR was calculated using MDRD and CKD-EPI equations. Results Participants included in the analysis had a mean age of 72.1 (±6.8) years and 57.0% were female. Use of a single screening test overestimated the proportion of people with CKD by around 25% no matter which equation was used, compared with the use of two tests. The mean eGFR was 1.4 ml/min/1.73 m2 (95% CI = 1.1 to 1.6) higher using the CKD-EPI equation compared with the MDRD equation. More patients were diagnosed with CKD when using the MDRD equation, compared with the CKD-EPI equation, once (64% versus 63%, respectively) and twice (39% versus 38%, respectively), and 16 individuals, all of who had CKD stages 2 or 3A with MDRD, were reclassified as having a normal urinary ACR when using the CKD-EPI equation. Conclusion Current guidance to use two eGFR measures to diagnose CKD remains appropriate in an older primary care population to avoid overdiagnosis. A change from MDRD to CKD-EPI equation could result in one in 12 patients with a CKD diagnosis with MDRD no longer having a diagnosis of CKD.

AB - Background Chronic kidney disease (CKD) is diagnosed using the estimated glomerular filtration rate (eGFR) and the urinary albumin:creatinine ratio (ACR). The eGFR is calculated from serum creatinine levels using the Modification of Diet in Renal Disease (MDRD) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Aim To compare the performance of one versus two eGFR/ACR measurements, and the impact of equation choice, on CKD diagnosis and classification. Design and setting Cohort study in primary care in the Thames Valley region of the UK. Method Data were from 485 participants aged >60 years in the Oxford Renal Cohort Study with at least two eGFR tests. The proportion of study participants diagnosed and classified into different CKD stages using one and two positive tests were compared. Prevalence of CKD diagnosis and classification by CKD stage were compared when eGFR was calculated using MDRD and CKD-EPI equations. Results Participants included in the analysis had a mean age of 72.1 (±6.8) years and 57.0% were female. Use of a single screening test overestimated the proportion of people with CKD by around 25% no matter which equation was used, compared with the use of two tests. The mean eGFR was 1.4 ml/min/1.73 m2 (95% CI = 1.1 to 1.6) higher using the CKD-EPI equation compared with the MDRD equation. More patients were diagnosed with CKD when using the MDRD equation, compared with the CKD-EPI equation, once (64% versus 63%, respectively) and twice (39% versus 38%, respectively), and 16 individuals, all of who had CKD stages 2 or 3A with MDRD, were reclassified as having a normal urinary ACR when using the CKD-EPI equation. Conclusion Current guidance to use two eGFR measures to diagnose CKD remains appropriate in an older primary care population to avoid overdiagnosis. A change from MDRD to CKD-EPI equation could result in one in 12 patients with a CKD diagnosis with MDRD no longer having a diagnosis of CKD.

KW - Chronic kidney diseases

KW - CKD-EPI

KW - eGFR

KW - Glomerular filtration rate

KW - Kidney failure, chronic

KW - MDRD

KW - Overdiagnosis

KW - Renal insufficiency, chronic

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SN - 0960-1643

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JO - British Journal of General Practice

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ER -

Impact of a single eGFR and eGFR-estimating equation on chronic kidney disease reclassification: A cohort study in primary care

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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