Analytical Validation of GFRNMR: A Blood-Based Multiple Biomarker Assay for Accurate Estimation of Glomerular Filtration Rate

Accurate and precise monitoring of kidney function is critical for a timely and reliable diagnosis of chronic kidney disease (CKD). The determination of kidney function usually involves the estimation of the glomerular filtration rate (eGFR). We recently reported the clinical performance of a new eGFR equation (GFR(NMR)) based on the nuclear magnetic resonance (NMR) measurement of serum myo-inositol, valine, and creatinine, in addition to the immunoturbidometric quantification of serum cystatin C, age and sex. We now describe the analytical performance evaluation of GFR(NMR) according to the Clinical and Laboratory Standards Institute guidelines. Within-laboratory coefficients of variation (CV%) of the GFR(NMR) equation did not exceed 4.3%, with a maximum CV% for repeatability of 3.7%. Between-site reproducibility (three sites) demonstrated a maximum CV% of 5.9%. GFR(NMR) stability was demonstrated for sera stored for up to 8 days at 2-10 degrees C and for NMR samples stored for up to 10 days in the NMR device at 6 +/- 2 degrees C. Substance interference was limited to 4/40 (10.0%) of the investigated substances, resulting in an underestimated GFR(NMR) (for glucose and metformin) or a loss of results (for naproxen and ribavirin) for concentrations twice as high as usual clinical doses. The analytical performances of GFR(NMR), combined with its previously reported clinical performance, support the potential integration of this NMR method into clinical practice.

Automated summary

Accurate and precise monitoring of kidney function is crucial for diagnosing chronic kidney disease promptly and reliably. A new eGFR equation called GFR(NMR) has been developed based on nuclear magnetic resonance measurement of serum myo-inositol, valine, and creatinine, along with the immunoturbidometric quantification of serum cystatin C, age, and sex. The analytical performance evaluation of GFR(NMR) according to established guidelines shows good within-laboratory and between-site reproducibility, as well as stability in sample storage. However, there is limited substance interference, which could affect the accuracy of GFR(NMR) results for certain substances.