A comparison between 2017 FAS and 2012 CKD-EPI equations: a multi-center validation study in Chinese adult population
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The recent guidelines recommend using the estimated glomerular filtration rate (eGFR) to evaluate renal function. There are two reported full-age-spectrum (FAS) equations in 2017, which are based on serum cystatin C concentrations with or without accompanying serum creatinine level (FASCr–Cys or FASCys). We compared the performance and assessed the applicability of the new FAS equation with the 2012 CKD-EPI (CKD-EPICys and CKD-EPICr–Cys) equation in Chinese subjects.
A total of 1184 patients, mean aged 55.06 year who underwent 99mTc-DTPA GFR measurements (rGFR) from four hospitals were enrolled. The bias (eGFR-rGFR), precision (interquartile range of difference [IQR]), and accuracy (the proportion of eGFR within 30% of rGFR [P30]) of eGFR and rGFR calculated by four equations were compared.
Generally, the equation based on the combination of Cys and Scr performed superior to that on the basis of Cys alone, either the CKD-EPICr–Cys or the FASCr–Cys. Detailedly, referred to rGFR (67.33 ml/min/1.73 m2), the CKD-EPICys, CKD-EPICr–Cys, FASCys, and the FASCr–Cys estimated GFR 56.46 ml/min/1.73 m2, 62.79 ml/min/1.73 m2, 56.45 ml/min/1.73 m2, and 61.04 ml/min/1.73 m2, gave ROCAUC0.944, 0.954, 0.943, and 0.953, respectively. Another comparison as to bias, precision, P30, and RMSE with FASCr–Cys were − 2.87 ml/min/1.73 m2, 19.01 ml/min/1.73 m2, 74.16%, and 17.84 ml/min/1.73 m2 showed that FASCr–Cys performed approximately more accurate than other equations, as well as the diagnostic consistency of GFR staging. In the rGFR < 60 ml/min/1.73 m2 subgroup, the FASCr–Cys equation showed the best performance. In older subjects, compared with FASCys, CKD-EPICr–Cys, and CKD-EPICys, the FASCr–Cys equation had relatively less bias (− 8.09 vs. − 9.63, − 7.52, − 11.04, P < 0.05), most precise (15.18 vs. 16.32, 15.22, 16.63), and most accuracy, P30 was statistically different from the other equations, and achieved a ideal value > 70%.
The performance of the FASCr–Cys equation is better than that of the CKD-EPICr–Cys equation in the Chinese population, particularly in the elderly. Yet, further modification of FAS equations from a large-scale study could be more suitable for the Chinese population, particularly in older people.
KeywordsGlomerular filtration rate (GFR) Creatinine Cystatin C Estimating equation Full-age-spectrum
This work was supported by the grants from the National Natural Science Foundation of China H0511-81670677, Clinical Medicine Research Special Funds of Chinese Medical Association 15020020590, Jiangsu Provincial Key Discipline of Medicine ZDXKA2016003, Jiangsu Provincial Key Laboratory of Geriatrics, Jiangsu Province’s Key Medical Talents Program ZDRCA2016021, Jiangsu Province 333 Project BRA2017409, Jiangsu Province’s Key Medical Young Talents Program QNRC2016592, and Jiangsu cadres health care research BJ16016, BJ17018.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by the ethics committee of the First Affiliated Hospital of Nanjing Medical University and conducted in accordance with the Declaration of Helsinki.
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