Journal
NATURE REVIEWS NEPHROLOGY
Volume 15, Issue 3, Pages 177-190Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/s41581-018-0080-9
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Funding
- DIABESITY working group of the ERA-EDTA
- IMBRAIN (CIBICAN) project [FP7-RE6-POT-2012-CT2012-31637-IMBRAIN]
- Instituto de Salud Carlos III (ISCIII) [PI13/00342, PI16/01814]
- REDINREN [RD16/0009, PI10/02428]
- IRSIN (Instituto Reina Sofia de Investigacion)
- FEDER
- ISCIII [CM15/00214]
- ISCIII Ramon y Cajal Programme
- Fundacion Caja Canarias [DIAB05]
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Since 1957, over 70 equations based on creatinine and/or cystatin C levels have been developed to estimate glomerular filtration rate (GFR). However, whether these equations accurately reflect renal function is debated. In this Perspectives article, we discuss >70 studies that compared estimated GFR (eGFR) with measured GFR (mGFR), involving similar to 40,000 renal transplant recipients and patients with chronic kidney disease (CKD), type 2 diabetes mellitus or polycystic kidney disease. Their results show that eGFR often differed from mGFR by +/- 30% or more, that eGFR values incorrectly staged CKD in 30-60% of patients, and that eGFR and mGFR gave different rates of GFR decline. Errors were unpredictable, and comparable for equations based on creatinine and/or cystatin C. We argue, therefore, that the persistence of these errors (despite intensive research) suggests that the problem lies with using creatinine and/or cystatin C as markers of renal function, rather than with the mathematical methods used for GFR estimation.
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