Comparison of Various Equations for Estimating GFR in Malawi: How to Determine Renal Function in Resource Limited Settings?
Identifieur interne : 000E45 ( Pmc/Checkpoint ); précédent : 000E44; suivant : 000E46Comparison of Various Equations for Estimating GFR in Malawi: How to Determine Renal Function in Resource Limited Settings?
Auteurs : Nicola Glaser [Allemagne] ; Andreas Deckert [Allemagne] ; Sam Phiri [Malawi, États-Unis] ; Dietrich Rothenbacher [Allemagne] ; Florian Neuhann [Allemagne]Source :
- PLoS ONE [ 1932-6203 ] ; 2015.
Abstract
Chronic kidney disease (CKD) is a probably underrated public health problem in Sub-Saharan-Africa, in particular in combination with HIV-infection. Knowledge about the CKD prevalence is scarce and in the available literature different methods to classify CKD are used impeding comparison and general prevalence estimates.
This study assessed different serum-creatinine based equations for glomerular filtration rates (eGFR) and compared them to a cystatin C based equation. The study was conducted in Lilongwe, Malawi enrolling a population of 363 adults of which 32% were HIV-positive.
Comparison of formulae based on Bland-Altman-plots and accuracy revealed best performance for the CKD-EPI equation without the correction factor for black Americans. Analyzing the differences between HIV-positive and –negative individuals CKD-EPI systematically overestimated eGFR in comparison to cystatin C and therefore lead to underestimation of CKD in HIV-positives.
Our findings underline the importance for standardization of eGFR calculation in a Sub-Saharan African setting, to further investigate the differences with regard to HIV status and to develop potential correction factors as established for age and sex.
Url:
DOI: 10.1371/journal.pone.0130453
PubMed: 26083345
PubMed Central: 4470826
Affiliations:
- Allemagne, Malawi, États-Unis
- Bade-Wurtemberg, Caroline du Nord, District de Karlsruhe, District de Tübingen
- Heidelberg, Ulm
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<front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title>
<p>Chronic kidney disease (CKD) is a probably underrated public health problem in Sub-Saharan-Africa, in particular in combination with HIV-infection. Knowledge about the CKD prevalence is scarce and in the available literature different methods to classify CKD are used impeding comparison and general prevalence estimates.</p>
</sec>
<sec id="sec002"><title>Methods</title>
<p>This study assessed different serum-creatinine based equations for glomerular filtration rates (eGFR) and compared them to a cystatin C based equation. The study was conducted in Lilongwe, Malawi enrolling a population of 363 adults of which 32% were HIV-positive.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>Comparison of formulae based on Bland-Altman-plots and accuracy revealed best performance for the CKD-EPI equation without the correction factor for black Americans. Analyzing the differences between HIV-positive and –negative individuals CKD-EPI systematically overestimated eGFR in comparison to cystatin C and therefore lead to underestimation of CKD in HIV-positives.</p>
</sec>
<sec id="sec004"><title>Conclusions</title>
<p>Our findings underline the importance for standardization of eGFR calculation in a Sub-Saharan African setting, to further investigate the differences with regard to HIV status and to develop potential correction factors as established for age and sex.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosone</journal-id>
<journal-title-group><journal-title>PLoS ONE</journal-title>
</journal-title-group>
<issn pub-type="epub">1932-6203</issn>
<publisher><publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, CA USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26083345</article-id>
<article-id pub-id-type="pmc">4470826</article-id>
<article-id pub-id-type="doi">10.1371/journal.pone.0130453</article-id>
<article-id pub-id-type="publisher-id">PONE-D-14-55125</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Comparison of Various Equations for Estimating GFR in Malawi: How to Determine Renal Function in Resource Limited Settings?</article-title>
<alt-title alt-title-type="running-head">Evaluation of Different eGFR Formulae in a Malawian Cohort</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author" equal-contrib="yes"><name><surname>Glaser</surname>
<given-names>Nicola</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref rid="cor001" ref-type="corresp">*</xref>
</contrib>
<contrib contrib-type="author" equal-contrib="yes"><name><surname>Deckert</surname>
<given-names>Andreas</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref rid="cor001" ref-type="corresp">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Phiri</surname>
<given-names>Sam</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rothenbacher</surname>
<given-names>Dietrich</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Neuhann</surname>
<given-names>Florian</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff001"><label>1</label>
<addr-line>Institute of Public Health, University of Heidelberg, Heidelberg, Germany</addr-line>
</aff>
<aff id="aff002"><label>2</label>
<addr-line>The Lighthouse Trust, Lilongwe, Malawi</addr-line>
</aff>
<aff id="aff003"><label>3</label>
<addr-line>Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America</addr-line>
</aff>
<aff id="aff004"><label>4</label>
<addr-line>Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Guerrot</surname>
<given-names>Dominique</given-names>
</name>
<role>Academic Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>Rouen University Hospital, FRANCE</addr-line>
</aff>
<author-notes><fn fn-type="conflict" id="coi001"><p><bold>Competing Interests: </bold>
With regards to the honorarium Florian Neuhann receives from Gilead Sciences, the authors state that this does not alter their adherence to PLOS ONE policies on sharing data and materials.</p>
</fn>
<fn fn-type="con" id="contrib001"><p>Conceived and designed the experiments: FN NG SP. Performed the experiments: NG. Analyzed the data: NG AD DR FN. Contributed reagents/materials/analysis tools: SP AD DR. Wrote the paper: NG AD FN SP DR.</p>
</fn>
<corresp id="cor001">* E-mail: <email>nicola.glaser@posteo.de</email>
(NG); <email>a.deckert@uni-heidelberg.de</email>
(AD)</corresp>
</author-notes>
<pub-date pub-type="epub"><day>17</day>
<month>6</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="collection"><year>2015</year>
</pub-date>
<volume>10</volume>
<issue>6</issue>
<elocation-id>e0130453</elocation-id>
<history><date date-type="received"><day>13</day>
<month>12</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>20</day>
<month>5</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-year>2015</copyright-year>
<copyright-holder>Glaser et al</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>
, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited</license-p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:type="simple" xlink:href="pone.0130453.pdf"></self-uri>
<abstract><sec id="sec001"><title>Background</title>
<p>Chronic kidney disease (CKD) is a probably underrated public health problem in Sub-Saharan-Africa, in particular in combination with HIV-infection. Knowledge about the CKD prevalence is scarce and in the available literature different methods to classify CKD are used impeding comparison and general prevalence estimates.</p>
</sec>
<sec id="sec002"><title>Methods</title>
<p>This study assessed different serum-creatinine based equations for glomerular filtration rates (eGFR) and compared them to a cystatin C based equation. The study was conducted in Lilongwe, Malawi enrolling a population of 363 adults of which 32% were HIV-positive.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>Comparison of formulae based on Bland-Altman-plots and accuracy revealed best performance for the CKD-EPI equation without the correction factor for black Americans. Analyzing the differences between HIV-positive and –negative individuals CKD-EPI systematically overestimated eGFR in comparison to cystatin C and therefore lead to underestimation of CKD in HIV-positives.</p>
</sec>
<sec id="sec004"><title>Conclusions</title>
<p>Our findings underline the importance for standardization of eGFR calculation in a Sub-Saharan African setting, to further investigate the differences with regard to HIV status and to develop potential correction factors as established for age and sex.</p>
</sec>
</abstract>
<funding-group><funding-statement>The study was funded through a grant by the HECTOR Stiftung, Mannheim Germany (<ext-link ext-link-type="uri" xlink:href="http://www.hector-stiftung.de/">http://www.hector-stiftung.de/</ext-link>
). FN received the funding. Grant number M55. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement>
</funding-group>
<counts><fig-count count="8"></fig-count>
<table-count count="5"></table-count>
<page-count count="17"></page-count>
</counts>
<custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name>
<meta-value>All relevant data are within the paper and its Supporting Information files.</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
<notes><title>Data Availability</title>
<p>All relevant data are within the paper and its Supporting Information files.</p>
</notes>
</front>
</pmc>
<affiliations><list><country><li>Allemagne</li>
<li>Malawi</li>
<li>États-Unis</li>
</country>
<region><li>Bade-Wurtemberg</li>
<li>Caroline du Nord</li>
<li>District de Karlsruhe</li>
<li>District de Tübingen</li>
</region>
<settlement><li>Heidelberg</li>
<li>Ulm</li>
</settlement>
</list>
<tree><country name="Allemagne"><region name="Bade-Wurtemberg"><name sortKey="Glaser, Nicola" sort="Glaser, Nicola" uniqKey="Glaser N" first="Nicola" last="Glaser">Nicola Glaser</name>
</region>
<name sortKey="Deckert, Andreas" sort="Deckert, Andreas" uniqKey="Deckert A" first="Andreas" last="Deckert">Andreas Deckert</name>
<name sortKey="Neuhann, Florian" sort="Neuhann, Florian" uniqKey="Neuhann F" first="Florian" last="Neuhann">Florian Neuhann</name>
<name sortKey="Rothenbacher, Dietrich" sort="Rothenbacher, Dietrich" uniqKey="Rothenbacher D" first="Dietrich" last="Rothenbacher">Dietrich Rothenbacher</name>
</country>
<country name="Malawi"><noRegion><name sortKey="Phiri, Sam" sort="Phiri, Sam" uniqKey="Phiri S" first="Sam" last="Phiri">Sam Phiri</name>
</noRegion>
</country>
<country name="États-Unis"><region name="Caroline du Nord"><name sortKey="Phiri, Sam" sort="Phiri, Sam" uniqKey="Phiri S" first="Sam" last="Phiri">Sam Phiri</name>
</region>
</country>
</tree>
</affiliations>
</record>
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