Impact of Creatinine Calibration on Performance of GFR Estimating Equations in a Pooled Individual Patient Database

Lesley A. Stevens; Jane Manzi; Andrew S. Levey; Jing Chen; Amy E. Deysher; Tom Greene; Emilio D. Poggio; Christopher H. Schmid; Michael W. Steffes; Yaping (Lucy) Zhang; Frederick Van Lente; Josef Coresh

doi:10.1053/j.ajkd.2007.04.004

Impact of Creatinine Calibration on Performance of GFR Estimating Equations in a Pooled Individual Patient Database

Lesley A. Stevens, Jane Manzi, Andrew S. Levey, Jing Chen, Amy E. Deysher, Tom Greene, Emilio D. Poggio, Christopher H. Schmid, Michael W. Steffes, Yaping (Lucy) Zhang, Frederick Van Lente, Josef Coresh

Laboratory Medicine and Pathology

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

169 Scopus citations

Abstract

Background: Variation in performance of glomerular filtration rate (GFR) estimating equations is related to variation in calibration of the creatinine assay across clinical laboratories. Study Design: Cross-sectional analysis. Setting & Participants: 6 research studies and 4 clinical populations including 5,504 participants who had GFR measured using urinary clearance of iothalamate. Measurements: Standardized serum creatinine values obtained by means of calibration to the Cleveland Clinic Research Laboratory using frozen specimens, a calibration panel, and/or survey results from the College of American Pathologists. Predictor: Noncalibrated serum creatinine assayed in research and clinical laboratories compared with standardized serum creatinine. Outcome: Difference between measured GFR versus GFR estimated from the Modification of Diet in Renal Disease (MDRD) Study and Cockcroft-Gault equations. Results: For a noncalibrated serum creatinine value of 1 mg/dL (88.4 μmol/L), standardized serum creatinine value was 0.07 mg/dL (6.2 μmol/L) less than noncalibrated values. In the pooled data set, for the MDRD Study equation, calibration improved median percentage of difference between measured and estimated GFR from 9.0% (interquartile range [IQR], 28%) to 5.8% (IQR, 28%) and improved the percentage of estimates within 30% of measured GFR (P₃₀) from 80% to 83%. The effect of calibration was greater at higher levels of GFR and varied across studies. For the Cockcroft-Gault equation, calibration worsened the median percentage of difference from -2.0% (IQR, 38%) to -11.4% (IQR, 39%), and the P₃₀, from 74% to 69%. Limitations: College of American Pathologist samples were used for calibration of clinical populations; calibration factors do not account for drift over time in the serum creatinine assay; calibration cannot account for variation in assay performance among individuals. Conclusion: Calibration improves the performance of the MDRD Study equation. After calibration, larger errors remain for GFR estimates greater than 60 mL/min/1.73 m² (>1 mL/s/1.73 m²).

Original language	English (US)
Pages (from-to)	21-35
Number of pages	15
Journal	American Journal of Kidney Diseases
Volume	50
Issue number	1
DOIs	https://doi.org/10.1053/j.ajkd.2007.04.004
State	Published - Jul 2007

Bibliographical note

Funding Information:
CKD-EPI is funded by grants from the National Institute of Diabetes, Digestive, and Kidney Disease (NIDDK) as part of a cooperative agreement in which the NIDDK has substantial involvement in the design of the study and collection, analysis, and interpretation of the data. The NIDDK was not required to approve publication of the finished manuscript. The institutional review boards of all participating institutions approved the study.

Keywords

Chronic kidney disease
Cockcroft-Gault equation
Modification of Diet in Renal Disease Study equation
calibration
creatinine
estimated glomerular filtration rate
glomerular filtration rate
individual patient meta-analysis

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Stevens, L. A., Manzi, J., Levey, A. S., Chen, J., Deysher, A. E., Greene, T., Poggio, E. D., Schmid, C. H., Steffes, M. W., Zhang, Y. L., Van Lente, F., & Coresh, J. (2007). Impact of Creatinine Calibration on Performance of GFR Estimating Equations in a Pooled Individual Patient Database. American Journal of Kidney Diseases, 50(1), 21-35. https://doi.org/10.1053/j.ajkd.2007.04.004

Impact of Creatinine Calibration on Performance of GFR Estimating Equations in a Pooled Individual Patient Database. / Stevens, Lesley A.; Manzi, Jane; Levey, Andrew S.; Chen, Jing; Deysher, Amy E.; Greene, Tom; Poggio, Emilio D.; Schmid, Christopher H.; Steffes, Michael W.; Zhang, Yaping (Lucy); Van Lente, Frederick; Coresh, Josef.

In: American Journal of Kidney Diseases, Vol. 50, No. 1, 07.2007, p. 21-35.

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

Stevens, LA, Manzi, J, Levey, AS, Chen, J, Deysher, AE, Greene, T, Poggio, ED, Schmid, CH, Steffes, MW, Zhang, YL, Van Lente, F & Coresh, J 2007, 'Impact of Creatinine Calibration on Performance of GFR Estimating Equations in a Pooled Individual Patient Database', American Journal of Kidney Diseases, vol. 50, no. 1, pp. 21-35. https://doi.org/10.1053/j.ajkd.2007.04.004

Stevens, Lesley A. ; Manzi, Jane ; Levey, Andrew S. ; Chen, Jing ; Deysher, Amy E. ; Greene, Tom ; Poggio, Emilio D. ; Schmid, Christopher H. ; Steffes, Michael W. ; Zhang, Yaping (Lucy) ; Van Lente, Frederick ; Coresh, Josef. / Impact of Creatinine Calibration on Performance of GFR Estimating Equations in a Pooled Individual Patient Database. In: American Journal of Kidney Diseases. 2007 ; Vol. 50, No. 1. pp. 21-35.

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title = "Impact of Creatinine Calibration on Performance of GFR Estimating Equations in a Pooled Individual Patient Database",

abstract = "Background: Variation in performance of glomerular filtration rate (GFR) estimating equations is related to variation in calibration of the creatinine assay across clinical laboratories. Study Design: Cross-sectional analysis. Setting & Participants: 6 research studies and 4 clinical populations including 5,504 participants who had GFR measured using urinary clearance of iothalamate. Measurements: Standardized serum creatinine values obtained by means of calibration to the Cleveland Clinic Research Laboratory using frozen specimens, a calibration panel, and/or survey results from the College of American Pathologists. Predictor: Noncalibrated serum creatinine assayed in research and clinical laboratories compared with standardized serum creatinine. Outcome: Difference between measured GFR versus GFR estimated from the Modification of Diet in Renal Disease (MDRD) Study and Cockcroft-Gault equations. Results: For a noncalibrated serum creatinine value of 1 mg/dL (88.4 μmol/L), standardized serum creatinine value was 0.07 mg/dL (6.2 μmol/L) less than noncalibrated values. In the pooled data set, for the MDRD Study equation, calibration improved median percentage of difference between measured and estimated GFR from 9.0% (interquartile range [IQR], 28%) to 5.8% (IQR, 28%) and improved the percentage of estimates within 30% of measured GFR (P30) from 80% to 83%. The effect of calibration was greater at higher levels of GFR and varied across studies. For the Cockcroft-Gault equation, calibration worsened the median percentage of difference from -2.0% (IQR, 38%) to -11.4% (IQR, 39%), and the P30, from 74% to 69%. Limitations: College of American Pathologist samples were used for calibration of clinical populations; calibration factors do not account for drift over time in the serum creatinine assay; calibration cannot account for variation in assay performance among individuals. Conclusion: Calibration improves the performance of the MDRD Study equation. After calibration, larger errors remain for GFR estimates greater than 60 mL/min/1.73 m2 (>1 mL/s/1.73 m2).",

keywords = "Chronic kidney disease, Cockcroft-Gault equation, Modification of Diet in Renal Disease Study equation, calibration, creatinine, estimated glomerular filtration rate, glomerular filtration rate, individual patient meta-analysis",

author = "Stevens, {Lesley A.} and Jane Manzi and Levey, {Andrew S.} and Jing Chen and Deysher, {Amy E.} and Tom Greene and Poggio, {Emilio D.} and Schmid, {Christopher H.} and Steffes, {Michael W.} and Zhang, {Yaping (Lucy)} and {Van Lente}, Frederick and Josef Coresh",

note = "Funding Information: CKD-EPI is funded by grants from the National Institute of Diabetes, Digestive, and Kidney Disease (NIDDK) as part of a cooperative agreement in which the NIDDK has substantial involvement in the design of the study and collection, analysis, and interpretation of the data. The NIDDK was not required to approve publication of the finished manuscript. The institutional review boards of all participating institutions approved the study. ",

year = "2007",

month = jul,

doi = "10.1053/j.ajkd.2007.04.004",

language = "English (US)",

volume = "50",

pages = "21--35",

journal = "American Journal of Kidney Diseases",

issn = "0272-6386",

publisher = "W.B. Saunders Ltd",

number = "1",

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TY - JOUR

T1 - Impact of Creatinine Calibration on Performance of GFR Estimating Equations in a Pooled Individual Patient Database

AU - Stevens, Lesley A.

AU - Manzi, Jane

AU - Levey, Andrew S.

AU - Chen, Jing

AU - Deysher, Amy E.

AU - Greene, Tom

AU - Poggio, Emilio D.

AU - Schmid, Christopher H.

AU - Steffes, Michael W.

AU - Zhang, Yaping (Lucy)

AU - Van Lente, Frederick

AU - Coresh, Josef

N1 - Funding Information: CKD-EPI is funded by grants from the National Institute of Diabetes, Digestive, and Kidney Disease (NIDDK) as part of a cooperative agreement in which the NIDDK has substantial involvement in the design of the study and collection, analysis, and interpretation of the data. The NIDDK was not required to approve publication of the finished manuscript. The institutional review boards of all participating institutions approved the study.

PY - 2007/7

Y1 - 2007/7

N2 - Background: Variation in performance of glomerular filtration rate (GFR) estimating equations is related to variation in calibration of the creatinine assay across clinical laboratories. Study Design: Cross-sectional analysis. Setting & Participants: 6 research studies and 4 clinical populations including 5,504 participants who had GFR measured using urinary clearance of iothalamate. Measurements: Standardized serum creatinine values obtained by means of calibration to the Cleveland Clinic Research Laboratory using frozen specimens, a calibration panel, and/or survey results from the College of American Pathologists. Predictor: Noncalibrated serum creatinine assayed in research and clinical laboratories compared with standardized serum creatinine. Outcome: Difference between measured GFR versus GFR estimated from the Modification of Diet in Renal Disease (MDRD) Study and Cockcroft-Gault equations. Results: For a noncalibrated serum creatinine value of 1 mg/dL (88.4 μmol/L), standardized serum creatinine value was 0.07 mg/dL (6.2 μmol/L) less than noncalibrated values. In the pooled data set, for the MDRD Study equation, calibration improved median percentage of difference between measured and estimated GFR from 9.0% (interquartile range [IQR], 28%) to 5.8% (IQR, 28%) and improved the percentage of estimates within 30% of measured GFR (P30) from 80% to 83%. The effect of calibration was greater at higher levels of GFR and varied across studies. For the Cockcroft-Gault equation, calibration worsened the median percentage of difference from -2.0% (IQR, 38%) to -11.4% (IQR, 39%), and the P30, from 74% to 69%. Limitations: College of American Pathologist samples were used for calibration of clinical populations; calibration factors do not account for drift over time in the serum creatinine assay; calibration cannot account for variation in assay performance among individuals. Conclusion: Calibration improves the performance of the MDRD Study equation. After calibration, larger errors remain for GFR estimates greater than 60 mL/min/1.73 m2 (>1 mL/s/1.73 m2).

AB - Background: Variation in performance of glomerular filtration rate (GFR) estimating equations is related to variation in calibration of the creatinine assay across clinical laboratories. Study Design: Cross-sectional analysis. Setting & Participants: 6 research studies and 4 clinical populations including 5,504 participants who had GFR measured using urinary clearance of iothalamate. Measurements: Standardized serum creatinine values obtained by means of calibration to the Cleveland Clinic Research Laboratory using frozen specimens, a calibration panel, and/or survey results from the College of American Pathologists. Predictor: Noncalibrated serum creatinine assayed in research and clinical laboratories compared with standardized serum creatinine. Outcome: Difference between measured GFR versus GFR estimated from the Modification of Diet in Renal Disease (MDRD) Study and Cockcroft-Gault equations. Results: For a noncalibrated serum creatinine value of 1 mg/dL (88.4 μmol/L), standardized serum creatinine value was 0.07 mg/dL (6.2 μmol/L) less than noncalibrated values. In the pooled data set, for the MDRD Study equation, calibration improved median percentage of difference between measured and estimated GFR from 9.0% (interquartile range [IQR], 28%) to 5.8% (IQR, 28%) and improved the percentage of estimates within 30% of measured GFR (P30) from 80% to 83%. The effect of calibration was greater at higher levels of GFR and varied across studies. For the Cockcroft-Gault equation, calibration worsened the median percentage of difference from -2.0% (IQR, 38%) to -11.4% (IQR, 39%), and the P30, from 74% to 69%. Limitations: College of American Pathologist samples were used for calibration of clinical populations; calibration factors do not account for drift over time in the serum creatinine assay; calibration cannot account for variation in assay performance among individuals. Conclusion: Calibration improves the performance of the MDRD Study equation. After calibration, larger errors remain for GFR estimates greater than 60 mL/min/1.73 m2 (>1 mL/s/1.73 m2).

KW - Chronic kidney disease

KW - Cockcroft-Gault equation

KW - Modification of Diet in Renal Disease Study equation

KW - calibration

KW - creatinine

KW - estimated glomerular filtration rate

KW - glomerular filtration rate

KW - individual patient meta-analysis

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Impact of Creatinine Calibration on Performance of GFR Estimating Equations in a Pooled Individual Patient Database

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