Enzymatic creatinine assays allow estimation of glomerular filtration rate in stages 1 and 2 chronic kidney disease using CKD-EPI equation.
The National Kidney Disease Education Program group demonstrated that MDRD equation is sensitive to creatinine measurement error, particularly at higher glomerular filtration rates. Thus, MDRD-based eGFR above 60 mL/min/1.73 m² should not be reported numerically. However, little is known about the impact of analytical error on CKD-EPI-based estimates. This study aimed at assessing the impact of analytical characteristics (bias and imprecision) of 12 enzymatic and 4 compensated Jaffe previously characterized creatinine assays on MDRD and CKD-EPI eGFR. In a simulation study, the impact of analytical error was assessed on a hospital population of 24084 patients. Ability using each assay to correctly classify patients according to chronic kidney disease (CKD) stages was evaluated. For eGFR between 60 and 90 mL/min/1.73 m², both equations were sensitive to analytical error. Compensated Jaffe assays displayed high bias in this range and led to poorer sensitivity/specificity for classification according to CKD stages than enzymatic assays. As compared to MDRD equation, CKD-EPI equation decreases impact of analytical error in creatinine measurement above 90 mL/min/1.73 m². Compensated Jaffe creatinine assays lead to important errors in eGFR and should be avoided. Accurate enzymatic assays allow estimation of eGFR until 90 mL/min/1.73 m² with MDRD and 120 mL/min/1.73 m² with CKD-EPI equation.
Department of Biochemistry, CHU Lapeyronie, Montpellier, France.
Nils
N
Kuster
Department of Biochemistry, CHU Lapeyronie, Montpellier, France. Electronic address: jp-cristol@chu-montpellier.fr.
Jean-Paul
JP
Cristol
Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium; Department of Clinical Chemistry, University of Liège, CHU Sart Tilman, Liège, Belgium.
Etienne
E
Cavalier
Department of Biochemistry, CHU Lapeyronie, Montpellier, France.
Anne-Sophie
AS
Bargnoux
Service de néphrologie, CHU Bretonneau, Tours, France.
Jean-Michel
JM
Halimi
Physiologie Rénale, Hôpital Européen Georges Pompidou, APHP, Paris, France.
Marc
M
Froissart
Biochimie métabolique, Groupe hospitalier Pitié Salpêtrière, APHP, Paris, France.
Laurence
L
Piéroni
Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium.
Pierre
P
Delanaye
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000032:analysis* / Q000378:metabolism; D057075:Enzyme Assays; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology*; D055815:Young Adult
D003404:Creatinine
CKD; CKD-EPI; Chronic Kidney Disease Epidemiology Collaboration; Creatinine; Enzymatic assays; Estimated glomerular filtration rate; GFR; IDMS; Isotope Dilution Mass Spectrometry; KDIGO; Kidney Disease Improving Global Outcomes; MDRD; Modification of Diet in Renal Disease; NKDEP; National Kidney Disease Education Program; SFBC; Scr; Société Française de Biologie Clinique; TE; Total error; chronic kidney disease; eGFR; estimated glomerular filtration rate; glomerular filtration rate; serum creatinine