GFRs in Chinese CKD: A systematic review

Purpose: This was an evidence-based study to assess which creatinine-based equation was most useful for estimated glomerular filtration rate (eGFR) in Chinese adults with chronic kidney disease (CKD).

Methods: Multiple databases were searched to collect relevant studies on creatinine-based eGFR equations for Chinese adults with CKD in Chinese and English from January 2009 to January 2023, using "glomerular filtration rate", "GFR equations", "Chinese CKD", "chronic kidney disease", "equation development" and "equation validation". The quality of each study was assessed using the diagnostic test accuracy review by RevMan 5.4 software. The equation name, study publication year, first author, reference method for eGFR, CKD numbers, age (age ranges) of individuals, mGFR value, bias, precision, and 30% accuracy (P₃₀) of each included equation were recorded accordingly by 2 independent investigators.

Results: Of the 838 studies identified, 23 studies based on 6 creatinine-based GFR equations were included in the present review, ie, the CKD-EPI, Asian modified CKD-EPI, FAS, EKFC, Xiangya, and BSI1 equations. A total of 2979 CKD patients were included for FAS equation external assessment, and the total P₃₀ was 72.6 %; 970 CKD patients for the EKFC equation, and the total P₃₀ was 73.1 %. 1778 CKD patients (≥60 years of age) with a mean eGFR from 39.7 to 47.6 mL/min/1.73 m² were pooled to assess the prediction accuracy of the BSI1 equation and demonstrated that the bias was small (-3.8-3.5 mL/min/1.73 m²), the precision was excellent (10.2-16.8 mL/min/1.73 m²), and the total P₃₀ was 69.6 %.

Conclusions: Currently, the FAS and EKFC equations have higher P₃₀ for eGFR among Chinese adult CKD patients. The bias and precision of BSI1 formulas was acceptable for eGFR in elderly ≥ 60 years of age, while the P₃₀ was relatively low. Therefore, there is a clinical need to develop more accurate equations for eGFR in older CKD adults. While promising, these findings require further validation in large well controlled clinical studies.