title: Comparison of Various Equations for Estimating GFR in Malawi: How to Determine Renal Function in Resource Limited Settings?
abstract: BACKGROUND
  Chronic kidney disease (CKD) is a probably underrated public health problem in Sub-Saharan-Africa, in particular in combination with HIV-infection. Knowledge about the CKD prevalence is scarce and in the available literature different methods to classify CKD are used impeding comparison and general prevalence estimates.
  
  
  METHODS
  This study assessed different serum-creatinine based equations for glomerular filtration rates (eGFR) and compared them to a cystatin C based equation. The study was conducted in Lilongwe, Malawi enrolling a population of 363 adults of which 32% were HIV-positive.
  
  
  RESULTS
  Comparison of formulae based on Bland-Altman-plots and accuracy revealed best performance for the CKD-EPI equation without the correction factor for black Americans. Analyzing the differences between HIV-positive and -negative individuals CKD-EPI systematically overestimated eGFR in comparison to cystatin C and therefore lead to underestimation of CKD in HIV-positives.
  
  
  CONCLUSIONS
  Our findings underline the importance for standardization of eGFR calculation in a Sub-Saharan African setting, to further investigate the differences with regard to HIV status and to develop potential correction factors as established for age and sex.
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Nicola
authors.initials: N
authors.lastname: Glaser
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Deckert
authors.affiliation: The Lighthouse Trust, Lilongwe, Malawi; Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America.
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Rothenbacher
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Neuhann
mesh_terms: D000328:Adult; D000465:Algorithms; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D005919:Glomerular Filtration Rate; D006297:Health Services Accessibility; D006801:Humans; D007677:Kidney Function Tests; D008295:Malawi / Q000453:epidemiology; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000503:physiopathology*
chemical_list: D003404:Creatinine