TY - JOUR
T1 - Comparative performance of CKD-EPI equations in people with diabetes
T2 - An international pooled analysis of individual participant data
AU - Kwok, Rodney
AU - Kishore, Kartik
AU - Zafari, Tina
AU - Koye, Digsu N.
AU - Hachem, Mariam
AU - de Boer, Ian H.
AU - Jeong, Tae Dong
AU - Min, Won Ki
AU - Porrini, Esteban
AU - Bjornstad, Petter
AU - MacIsaac, Richard J.
AU - Churilov, Leonid
AU - Ekinci, Elif I.
N1 - Publisher Copyright:
© 2025 The Authors
PY - 2025/5
Y1 - 2025/5
N2 - Aim: This study assessed the concordance and misclassification of chronic kidney disease (CKD) stages between directly measured glomerular filtration rate (mGFR) and estimates of GFR (eGFR) using the creatinine-based CKD-EPI-2009 and the CKD-EPI-2021 equations in individuals with diabetes. Methods: Data from 5,177 individuals across six international diabetes cohorts included mGFR measurements using exogenous filtration markers. We calculated an intra-class correlation coefficient (ICC), bias, precision and accuracy between mGFR and CKD-EPI estimates using a four-level mixed-effect linear variance component model. Results: The pooled cohort included people with type 1 (n = 1,748, median age: 33 years [IQR: 27, 40], mGFR = 104.2 ml/min per 1.73 m2) and type 2 diabetes (n = 3,429, median age: 66 years [IQR: 58, 73], mGFR = 58.4 ml/min per 1.73 m2). Both CKD-EPI equations showed good agreement (2009 ICC: 0.90; 2021 ICC: 0.87) but substantial bias (2009: 3.7 ml/min/1.73 m2; 2021: 8.6 ml/min/1.73 m2), low precision (2009: 12.4 ml/min/1.73 m2; 2021: 13.91 ml/min/1.73 m2), and limited accuracy (2009 p30: 77 %; 2021 p30: 70 %) compared to mGFR. Conclusion: The use of CKD-EPI equations has the potential for misdiagnosis and suboptimal CKD management in people with diabetes. Alternative methods of estimating kidney function for people with diabetes are needed to optimally manage diabetes-related kidney disease.
AB - Aim: This study assessed the concordance and misclassification of chronic kidney disease (CKD) stages between directly measured glomerular filtration rate (mGFR) and estimates of GFR (eGFR) using the creatinine-based CKD-EPI-2009 and the CKD-EPI-2021 equations in individuals with diabetes. Methods: Data from 5,177 individuals across six international diabetes cohorts included mGFR measurements using exogenous filtration markers. We calculated an intra-class correlation coefficient (ICC), bias, precision and accuracy between mGFR and CKD-EPI estimates using a four-level mixed-effect linear variance component model. Results: The pooled cohort included people with type 1 (n = 1,748, median age: 33 years [IQR: 27, 40], mGFR = 104.2 ml/min per 1.73 m2) and type 2 diabetes (n = 3,429, median age: 66 years [IQR: 58, 73], mGFR = 58.4 ml/min per 1.73 m2). Both CKD-EPI equations showed good agreement (2009 ICC: 0.90; 2021 ICC: 0.87) but substantial bias (2009: 3.7 ml/min/1.73 m2; 2021: 8.6 ml/min/1.73 m2), low precision (2009: 12.4 ml/min/1.73 m2; 2021: 13.91 ml/min/1.73 m2), and limited accuracy (2009 p30: 77 %; 2021 p30: 70 %) compared to mGFR. Conclusion: The use of CKD-EPI equations has the potential for misdiagnosis and suboptimal CKD management in people with diabetes. Alternative methods of estimating kidney function for people with diabetes are needed to optimally manage diabetes-related kidney disease.
KW - Creatinine
KW - Diabetes Mellitus, Type 1
KW - Diabetes Mellitus, Type 2
KW - Diabetic Nephropathies
KW - Glomerular Filtration Rate
KW - Renal Insufficiency, Chronic
UR - http://www.scopus.com/inward/record.url?scp=105000528445&partnerID=8YFLogxK
U2 - 10.1016/j.diabres.2025.112104
DO - 10.1016/j.diabres.2025.112104
M3 - Article
C2 - 40096945
AN - SCOPUS:105000528445
SN - 0168-8227
VL - 223
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
M1 - 112104
ER -
