Validation of equations to estimate kidney function with and without adjustment by race/color in Brazilian adults (ELSA-Brazil)

Almeida, Wagner Luis da Cruz; Barreto, Sandhi Maria; Vidigal, Pedro Guatimosim; Mill, José Geraldo

doi:10.1590/1980-549720230057

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Revista Brasileira de Epidemiologia

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Original Article • Rev. bras. Epidemiol. 26 • 2023 • https://doi.org/10.1590/1980-549720230057 copy

Validation of equations to estimate kidney function with and without adjustment by race/color in Brazilian adults (ELSA-Brazil)

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate accuracy and agreement between creatinine clearance (CrCl) measured in 12-h urine and glomerular filtration rate (GFR) calculated by the Modification of Diet in Renal Disease (MDRD-4) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas, with and without adjustment for race/color.

Methods:

Baseline data from the Longitudinal Study of Adult Health (ELSA-Brazil) in adults (35-74 years of age) of both genders were used. Serum creatinine was measured in fasting blood and urinary creatinine was measured in an overnight 12-h urine collect. The agreement between CrCl and the calculated GFR was analyzed by the Bland-Altman method. One-way analysis of variance (ANOVA) with race/color factor was used to verify differences between means of CrCl and GFR with and without correction for race/color. Statistical significance was accepted for p<0.05.

Results:

From 15,105 participants in the ELSA-Brazil, 12,813 had a validated urine collect. The Bland-Altman diagrams showed that formulas and CrCl agree with each other with a better accuracy for GFR <90 mL/.min x 1.73m². The adjustment by race/color increased data dispersion. In this range, one-way ANOVA of CrCl with race/color factor showed similarity between groups (p=0.27).

Conclusion:

MDRD-4 and CKD-EPI are useful formulas for screening cases of chronic kidney disease, and correction by race/color, only in blacks or in black and brown subjects, proved to be unnecessary and reduced the reliability of the equations.

Keywords:
Glomerular filtration rate; Chronic kidney diseases; Kidney function tests; Creatinine

	Measured and estimated GFR – mean ± standard deviation
	Men	Women	All
CrCl	103.0±21.9	98.4±22.0	100.5±22.1
GFR_CKD-EPI^* * no adjustment;	82.0±14.5	82.3±16.1	82.1±15.4
GFR_CKD-EPI^† † with adjustment for blacks only;	84.3±17.3	87.7±17.3	86.1±16.9
GFR_CKD-EPI^‡ ‡ with adjustment only for black and brown subjects.	90.5±18.0	90.8±20.1	90.6±19.1
GFR_MDRD-4^* * no adjustment;	80.3±14.3	78.7±16.4	79.5±15.5
GFR_MDRD-4^† † with adjustment for blacks only;	82.0±16.0	83.3±17.6	82.8±16.9
GFR_MDRD-4^‡ ‡ with adjustment only for black and brown subjects.	86.8±17.5	85.3±20.2	86.0±19.0

	Complete sample	n=12,813	GFR <90 mL/min/1.73m²	n=3,896
Method	Welch F	p-value	Welch F	p-value
CrCl	43.74	<0.01	1.98	0.27
GFR_MDRD-4^* * no adjustment;	13.02	<0.01	13.17	<0.01
GFR_MDRD-4^† † with adjustment for blacks only;	355.86	<0.01	71.38	<0.01
GFR_MDRD-4^‡ ‡ with adjustment only for black and brown subjects;	950.30	<0.01	267.38	<0.01
GFR_CKD-EPI^* * no adjustment;	11.74	<0.01	10.63	<0.01
GFR_CKD-EPI^† † with adjustment for blacks only;	954.19	<0.01	253.24	<0.01
GFR_CKD-EPI^‡ ‡ with adjustment only for black and brown subjects;	2,188.29	<0.01	701.94	<0.01

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[1] CORRESPONDING AUTHOR: Wagner Luis da Cruz Almeida. Travessa Chácara Mirineu, 200, casa 5, Condomínio Villa Paradiso, CEP 47071-776, Feira de Santana (BA), Brasil. E-mail: wlcalmeidapai@gmail.com