Paper
The Impact of the New CKD-EPI Equation on GFR Estimation in the Elderly.
Published Oct 14, 2022 · Natalie Ebert, H. Pottel, M. Giet
Deutsches Arzteblatt international
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Abstract
The Impact of the New CKD-EPI Equation on GFR Estimation in the ElderlyIn clinical routine, GFR is most commonly calculated using serum creatinine and GFR estimating equations.This indirect method, which includes patient's age and sex, provides a simple and rapid estimate of kidney function.The GFR result is a criterion for diagnosing chronic kidney disease (CKD) and its staging using the KDIGO definition (KDIGO, Kidney Disease: Improving Global Outcomes).A patient's CKD stage is important for assessing disease progression, selecting and dosing medication, before administering iodine-containing contrast medium, for deciding whether to commence renal replacement therapy, and before planned living kidney donation.Old age is regularly associated with multiple chronic diseases, often accompanied by the use of multiple medications (an important risk factor for nephrotoxicity), which is why proper renal function assessment is particularly important.The commonly used creatinine-based CKD-EPI (ASR) equation (1, 2) has recently been revised (CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; ASR, age, sex, and race) because the included variable for race has been criticized for resulting in unequal treatment of black patients.Critics argued that race is not a biological but a social construct and is therefore obsolete for calculating GFR.As a result, in November 2021, the CKD-EPI equation was redeveloped using a broad database, was validated, and published as a "race free" CKD-EPI (AS) equation (3) based solely on age and sex.The new CKD-EPI (AS) equation is currently recommended for every patient in the United States, and it may be assumed that it will also be adopted in German speaking countries.But at the moment it is uncertain whether this is of any use when applied to elderly patients.The current study compares the estimate accuracy of the new CKD-EPI (AS) equation with the CKD-EPI (ASR) equation and the European Kidney Function Consortium (EKFC) equation recently developed in Europe (4).
The new CKD-EPI (AS) equation, based solely on age and sex, may not accurately estimate GFR in elderly patients due to its reliance on race variables.
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