ArticleNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2025
Comparison of estimated glomerular filtration rate equations on prediction of mortality, kidney failure and acute kidney injury.
Article in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Cardiometabolic risk burden and kidney function in middle-aged and older adults: evidence from two national, cross-sectional studies in China and the United States.Renal failure · 2026Article
- Evaluating Long-Term Outcomes Across eGFR Equations in Older Adults.Kidney international reports · 2026Article
- Changing from the CKD-EPI to the EKFC creatinine equation to estimate glomerular filtration rate in adults in a Northern European health system.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2026Article
- Impact of switching from the CKD-EPIClinical kidney journal · 2025Article
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Abstract
backgroundThe Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)ASR-NB2009 estimated glomerular filtration rate (eGFR) equation has shown substantial overestimation of GFR in Europeans, hence new equations have been developed. We examined the effect of introducing the European Kidney Function Consortium (EKFC) or Lund-Malmö revised (LMR) eGFR equations on KDIGO eGFR category classification in a large cohort. We compared the EKFC and LMR equations with the CKD-EPIASR-NB2009 formula in view of discriminative ability of all-cause mortality, kidney failure with replacement therapy (KFRT) and acute kidney injury (AKI) risks across eGFR categories.
methodsIndividuals aged ≥18 years with a serum creatinine measurement (December 2006-July 2024) at University Medical Center Utrecht, were included. Hazard ratios (HRs) were analysed for all outcomes per eGFR category, per equation. Harrell's Concordance index (C-index) was used to assess the ability of risk discrimination across eGFR categories. Whether reclassification between eGFR categories was justified by the occurrence of events, was assessed with net reclassification improvement analysis.
resultsIn total, 285 686 individuals were included. Compared with the CKD-EPIASR-NB2009 equation, the EKFC and LMR estimated GFR lower [mean -6.3 (standard deviation, SD 5.3) and -10.7 (SD 6.5) mL/min/1.732, respectively]. The number of individuals with eGFR <60 mL/min/1.73 m2 increased 29.0% (EKFC) and 36.4% (LMR). The EKFC predominantly reclassified older individuals, and the LMR older men, to worse eGFR categories. HRs of reclassified individuals to worse eGFR categories were mainly higher compared with the non-reclassified. The EKFC and LMR equations showed equal/improved C-index for mortality (EKFC 0.584/LMR 0.588/CKD-EPIASR-NB2009 0.570), KFRT (0.895/0.900/0.897) and AKI (0.606/0.609/0.599). The LMR equation reclassified more individuals without an event to worse eGFR categories.
conclusioneGFR category classification was substantially different when using the EKFC or LMR equation compared with the CKD-EPIASR-NB2009 formula. Both equations showed equal to improved ability of risk stratification across eGFR categories. Shifts in eGFR category classification might significantly impact clinical decisions. Given that we have identified variation between equations, a careful consideration of the advantages and disadvantages of different eGFR equations is essential.
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