Improving Glomerular Filtration Rate Estimation—Across the Age and Diversity Spectrum
Authors: Andrew S. Levey, Hocine Tighiouart, Lesley A. Inker
Journal: Annals of Internal Medicine (2020)

EditorialsFebruary 2021Improving Glomerular Filtration Rate Estimation—Across the Age and Diversity SpectrumCorrection(s) for this article:CorrectionsJun 2022Correction: Improving Glomerular Filtration Rate Estimation—Across the Age and Diversity SpectrumFREEAndrew S. Levey, MD, Hocine Tighiouart, MS, and Lesley A. Inker, MD, MSAndrew S. Levey, MDTufts Medical Center, Boston, Massachusetts (A.S.L., L.A.I.), Hocine Tighiouart, MSTufts Medical Center and Tufts University, Boston, Massachusetts (H.T.), and Lesley A. Inker, MD, MSTufts Medical Center, Boston, Massachusetts (A.S.L., L.A.I.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-6983 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Assessment of glomerular filtration rate (GFR) is central to medical practice, research, and public health. In an update to its chronic kidney disease guideline, KDIGO (Kidney Disease: Improving Global Outcomes) recommends estimating GFR by measuring serum creatinine (SCr) levels as an initial test but acknowledges that estimated GFR (eGFR) is less accurate than measured GFR (mGFR); therefore, KDIGO recommends subsequent confirmatory testing (estimating GFR by using serum cystatin C, measured creatinine clearance, or mGFR) if greater accuracy is needed for clinical decision making. The guideline recommends using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for adults (with variables including ...References1. Levey AS, Tighiouart H, Simon AL, et al. Comparing newer GFR estimating equations using creatinine and cystatin C to the CKD-EPI equations in adults [Letter]. Am J Kidney Dis. 2017;70:587-9. [PMID: 28552371] doi:10.1053/j.ajkd.2017.04.012 CrossrefMedlineGoogle Scholar2. Levey AS, Coresh J, Tighiouart H, et al. Measured and estimated glomerular filtration rate: current status and future directions. Nat Rev Nephrol. 2020;16:51-64. [PMID: 31527790] doi:10.1038/s41581-019-0191-y CrossrefMedlineGoogle Scholar3. Ng DK, Schwartz GJ, Schneider MF, et al. Combination of pediatric and adult formulas yield valid glomerular filtration rate estimates in young adults with a history of pediatric chronic kidney disease. Kidney Int. 2018;94:170-7. [PMID: 29735307] doi:10.1016/j.kint.2018.01.034 CrossrefMedlineGoogle Scholar4. Pottel H, Björk J, Courbebaisse M, et al. Development and validation of a modified full age spectrum creatinine-based equation to estimate glomerular filtration rate. A cross-sectional analysis of pooled data. Ann Intern Med. 2021;174:183-91. doi:10.7326/M20-4366 LinkGoogle Scholar5. Pottel H, Hoste L, Dubourg L, et al. An estimated glomerular filtration rate equation for the full age spectrum. Nephrol Dial Transplant. 2016;31:798-806. [PMID: 26932693] doi:10.1093/ndt/gfv454 CrossrefMedlineGoogle Scholar6. Björk J, Nyman U, Delanaye P, et al. A novel method for creatinine adjustment makes the revised Lund-Malmö GFR estimating equation applicable in children. Scand J Clin Lab Invest. 2020;80:456-63. [PMID: 32628043] doi:10.1080/00365513.2020.1774641 CrossrefMedlineGoogle Scholar7. Eneanya ND, Yang W, Reese PP. Reconsidering the consequences of using race to estimate kidney function. JAMA. 2019;322:113-4. [PMID: 31169890] doi:10.1001/jama.2019.5774 CrossrefMedlineGoogle Scholar8. Powe NR. Black kidney function matters: use or misuse of race? JAMA. 2020;324:737-8. [PMID: 32761164] doi:10.1001/jama.2020.13378 CrossrefMedlineGoogle Scholar9. Levey AS, Titan SM, Powe NR, et al. Kidney disease, race, and GFR estimation. Clin J Am Soc Nephrol. 2020;15:1203-12. [PMID: 32393465] doi:10.2215/CJN.12791019 CrossrefMedlineGoogle Scholar10. Sehgal AR. Race and the false precision of glomerular filtration rate estimates [Editorial]. Ann Intern Med. 2020. doi:10.7326/M20-4951 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Tufts Medical Center, Boston, Massachusetts (A.S.L., L.A.I.)Tufts Medical Center and Tufts University, Boston, Massachusetts (H.T.)Acknowledgment: The authors thank Juhi Chaudhari, MPH (Division of Nephrology, Tufts Medical Center), for manuscript assistance.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-6983.Corresponding Author: Andrew S. Levey, MD, Tufts Medical Center, Box 391, 800 Washington Street, Boston, MA 02111; e-mail, [email protected]org.Correction: This article was updated on 2 May 2022 to account for correction of an error in calculation of eGFR. Interpretation of results in the third paragraph of the editorial have been changed to match the corrected results. The corrections in the results do not alter the conclusions of the editorial. A correction has been published (doi:10.7326/L22-0175).Current Author Addresses: Drs. Levey, Inker, and Tighiouart: Tufts Medical Center, Box 391, 800 Washington Street, Boston, MA 02111.This article was published at Annals.org on 10 November 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDevelopment and Validation of a Modified Full Age Spectrum Creatinine-Based Equation to Estimate Glomerular Filtration Rate Hans Pottel , Jonas Björk , Marie Courbebaisse , Lionel Couzi , Natalie Ebert , Björn O. Eriksen , R. Neil Dalton , Laurence Dubourg , François Gaillard , Cyril Garrouste , Anders Grubb , Lola Jacquemont , Magnus Hansson , Nassim Kamar , Edmund J. Lamb , Christophe Legendre , Karin Littmann , Christophe Mariat , Toralf Melsom , Lionel Rostaing , Andrew D. Rule , Elke Schaeffner , Per-Ola Sundin , Stephen Turner , Arend Bökenkamp , Ulla Berg , Kajsa Åsling-Monemi , Luciano Selistre , Anna Åkesson , Anders Larsson , Ulf Nyman , and Pierre Delanaye Correction: Improving Glomerular Filtration Rate Estimation—Across the Age and Diversity Spectrum Metrics Cited byAccuracy of the New Creatinine-based Equations for Estimating Glomerular Filtration Rate in KoreansCorrection: Improving Glomerular Filtration Rate Estimation—Across the Age and Diversity SpectrumAnalytical Validation of GFRNMR: A Blood-Based Multiple Biomarker Assay for Accurate Estimation of Glomerular Filtration RateApplicability of Creatinine-based equations for estimating glomerular filtration rate in elderly Chinese patientsEstimating Glomerular Filtration Rate from Serum Myo-Inositol, Valine, Creatinine and Cystatin CNew Creatinine- and Cystatin C–Based Equations to Estimate GFR without RaceNew GFR-estimating equations for children and young adults in North America and Europe February 2021Volume 174, Issue 2Page: 265-267KeywordsAdolescentsAdultsChildrenChronic kidney diseaseCreatinineEpidemiologyEstimated glomerular filtration rateGlomerular filtration rateRacial and ethnic issuesYoung adults ePublished: 10 November 2020 Issue Published: February 2021 Copyright & PermissionsCopyright © 2020 by American College of Physicians. 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