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Exploration of chronic kidney disease prevalence estimates using new measures of kidney function in the health survey for England

Exploration of chronic kidney disease prevalence estimates using new measures of kidney function in the health survey for England
Exploration of chronic kidney disease prevalence estimates using new measures of kidney function in the health survey for England
Background: chronic kidney disease (CKD) diagnosis relies on glomerular filtration rate (eGFR) estimation, traditionally using the creatinine-based Modification of Diet in Renal Disease (MDRD) equation. The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation performs better in estimating eGFR and predicting mortality and CKD progression risk. Cystatin C is an alternative glomerular filtration marker less influenced by muscle mass. CKD risk stratification is improved by combining creatinine eGFR with cystatin C and urinary albumin to creatinine ratio (uACR). We aimed to identify the impact of introducing CKDEPI and cystatin C on the estimated prevalence and risk stratification of CKD in England and to describe prevalence and associations of cystatin C.

Methods and findings: cross sectional study of 5799 people in the nationally representative 2009 and 2010 Health Surveys for England. Primary outcome measures: prevalence of MDRD, CKDEPI and cystatin C-defined eGFR<60ml/min/1.73m2; prevalence of CKD biomarker combinations (creatinine, cystatin C, uACR). Using CKDEPI instead of MDRD reduced the prevalence of eGFR<60ml/min/1.73m2 from 6.0% (95% CI 5.4–6.6%) to 5.2% (4.7–5.8%) equivalent to around 340,000 fewer individuals in England. Those reclassified as not having CKD evidenced a lower risk profile. Prevalence of cystatin C eGFR<60ml/min/1.73m2 was 7.7% and independently associated with age, lack of qualifications, being an ex-smoker, BMI, hypertension, and albuminuria. Measuring cystatin C in the 3.9% people with CKDEPI-defined eGFR<60ml/min/1.73m2 without albuminuria (CKD Category G3a A1) reclassified about a third into a lower risk group with one of three biomarkers and two thirds into a group with two of three. Measuring cystatin C in the 6.7% people with CKDEPI eGFR >60ml/min/1.73m2 with albuminuria (CKD Category G1-2) reclassified almost a tenth into a higher risk group.

Limitations: cross sectional study, single eGFR measure, no measured (‘true’) GFR.

Conclusions: introducing the CKDEPI equation and targeted cystatin C measurement reduces estimated CKD prevalence and improves risk stratification
1932-6203
Fraser, Simon D.S.
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Aitken, Grant
aeaa0f62-76c2-4adc-97ba-8533cdb9d11c
Taal, Maarten W.
10eeea62-a2fc-43b6-b5af-359e75c501ea
Mindell, Jennifer S.
e3983969-4181-4699-9bf5-ee876f7c54c2
Moon, Graham
68cffc4d-72c1-41e9-b1fa-1570c5f3a0b4
Day, Julie
4fc7e066-aed2-444e-905c-ba309b3bc347
O’Donoghue, Donal
fb6d8702-0dad-492b-b5d7-a51771a42940
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Fraser, Simon D.S.
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Aitken, Grant
aeaa0f62-76c2-4adc-97ba-8533cdb9d11c
Taal, Maarten W.
10eeea62-a2fc-43b6-b5af-359e75c501ea
Mindell, Jennifer S.
e3983969-4181-4699-9bf5-ee876f7c54c2
Moon, Graham
68cffc4d-72c1-41e9-b1fa-1570c5f3a0b4
Day, Julie
4fc7e066-aed2-444e-905c-ba309b3bc347
O’Donoghue, Donal
fb6d8702-0dad-492b-b5d7-a51771a42940
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a

Fraser, Simon D.S., Aitken, Grant, Taal, Maarten W., Mindell, Jennifer S., Moon, Graham, Day, Julie, O’Donoghue, Donal and Roderick, Paul J. (2015) Exploration of chronic kidney disease prevalence estimates using new measures of kidney function in the health survey for England. PLoS ONE, 10 (2), [e0118676]. (doi:10.1371/journal.pone.0118676).

Record type: Article

Abstract

Background: chronic kidney disease (CKD) diagnosis relies on glomerular filtration rate (eGFR) estimation, traditionally using the creatinine-based Modification of Diet in Renal Disease (MDRD) equation. The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation performs better in estimating eGFR and predicting mortality and CKD progression risk. Cystatin C is an alternative glomerular filtration marker less influenced by muscle mass. CKD risk stratification is improved by combining creatinine eGFR with cystatin C and urinary albumin to creatinine ratio (uACR). We aimed to identify the impact of introducing CKDEPI and cystatin C on the estimated prevalence and risk stratification of CKD in England and to describe prevalence and associations of cystatin C.

Methods and findings: cross sectional study of 5799 people in the nationally representative 2009 and 2010 Health Surveys for England. Primary outcome measures: prevalence of MDRD, CKDEPI and cystatin C-defined eGFR<60ml/min/1.73m2; prevalence of CKD biomarker combinations (creatinine, cystatin C, uACR). Using CKDEPI instead of MDRD reduced the prevalence of eGFR<60ml/min/1.73m2 from 6.0% (95% CI 5.4–6.6%) to 5.2% (4.7–5.8%) equivalent to around 340,000 fewer individuals in England. Those reclassified as not having CKD evidenced a lower risk profile. Prevalence of cystatin C eGFR<60ml/min/1.73m2 was 7.7% and independently associated with age, lack of qualifications, being an ex-smoker, BMI, hypertension, and albuminuria. Measuring cystatin C in the 3.9% people with CKDEPI-defined eGFR<60ml/min/1.73m2 without albuminuria (CKD Category G3a A1) reclassified about a third into a lower risk group with one of three biomarkers and two thirds into a group with two of three. Measuring cystatin C in the 6.7% people with CKDEPI eGFR >60ml/min/1.73m2 with albuminuria (CKD Category G1-2) reclassified almost a tenth into a higher risk group.

Limitations: cross sectional study, single eGFR measure, no measured (‘true’) GFR.

Conclusions: introducing the CKDEPI equation and targeted cystatin C measurement reduces estimated CKD prevalence and improves risk stratification

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journal pone 0118676 - Version of Record
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More information

Accepted/In Press date: 2 October 2014
Published date: 20 February 2015
Organisations: Population, Health & Wellbeing (PHeW)

Identifiers

Local EPrints ID: 374576
URI: http://eprints.soton.ac.uk/id/eprint/374576
ISSN: 1932-6203
PURE UUID: 53a782b4-f801-4c73-b733-89c06b4d44c8
ORCID for Simon D.S. Fraser: ORCID iD orcid.org/0000-0002-4172-4406
ORCID for Graham Moon: ORCID iD orcid.org/0000-0002-7256-8397
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 23 Feb 2015 09:24
Last modified: 09 Jan 2022 03:29

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Contributors

Author: Grant Aitken
Author: Maarten W. Taal
Author: Jennifer S. Mindell
Author: Graham Moon ORCID iD
Author: Julie Day
Author: Donal O’Donoghue

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