Key result
Indian-specific recalibration of the EKFC eGFR equation improves accuracy to 69% vs original equations.
Why the study?
The performance of the EKFC crea eGFR equation recalibrated using Indian-specific median serum creatinine and normal GFR, as well as its ability to correctly classify CKD in an Indian cohort, had not been evaluated.
Does recalibrating the EKFC eGFR equation with Indian-specific parameters improve accuracy and reduce bias in estimating GFR in Indian adults?
Cross-Sectional (n=1,174)
Yes
Does recalibrating the EKFC eGFR equation with Indian-specific parameters improve accuracy and reduce bias in estimating GFR in Indian adults?
Mean Difference: -1.2 (95% CI -2.2–0.1)
Absolute Event Rate: -1.2% vs 9.9%
p-value: p=<0.001
Recalibrating the EKFC eGFR equation with Indian-specific parameters significantly reduces bias and improves accuracy for estimating GFR in the Indian population.
May support ethnicity-specific eGFR recalibration in Indian adults; leaves open prospective validation before clinical adoption.
Background The new European Kidney Function Consortium (EKFC) eGFR equation utilizes rescaled serum creatinine to an age- and sex-specific normal median value, making it applicable across the entire age spectrum. We evaluated the performance of the recalibrated EKFC crea equation using Indian-specific Q (median serum creatinine) and K (normal GFR) in a large Indian cohort and the ability to correctly classify CKD. Methods Indian adults (healthy and patients with CKD) were recruited. Plasma iohexol clearance was used to measure glomerular filtration rate (mGFR). Indian-specific Q values were derived from healthy individuals, and K from those under the age of 40 years. We evaluated EKFC crea , CKD-EPI 2021 , and recalibrated the EKFC crea equations, incorporating the Indian Q (ISQ), Indian constant (ISK), and both (ISQ + ISK). We evaluated bias and accuracy (P 30 ) for all equations. Results A total of 1,174 participants (615 healthy, 559 CKD), mean age 48 years, with equal gender distribution, were recruited. The EKFC crea equation showed a mean bias of 9.9 (95% CI: 8.7, 11.1) mL/min/1.73 m 2 with P 30 ; 58.1%. EKFC ISQ reduced bias to 4.9 (95% CI: 3.7, 6.0) mL/min/1.73 m 2 and improved P 30 to 64%. EKFC ISK achieved a bias of -1.2 (95% CI: -0.1, -2.2) mL/min/1.73 m 2 and P 30 of 69%. 30%, 48%, and 67% of CKD patients were categorized into lower categories using the EKFC ISQ , EKFC ISK , and EKFC ISQ+ISK equations, respectively, against the CKD-EPI 2021 . Conclusion Recalibrating EKFC crea with Indian-specific Q and K reduced bias and improved accuracy, with EKFC ISK emerging as the best model. Adopting this recalibrated equation in clinical practice and public health initiatives after validation in diverse cohorts could lead to more accurate CKD diagnosis and staging in India.
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Yadav et al. (2026) conducted a cross-sectional in Chronic Kidney Disease (n=1,174). Recalibrated EKFC equation (EKFC ISK) vs. Original EKFC crea and CKD-EPI 2021 equations was evaluated on Mean bias (difference between eGFR and measured GFR) (MD -1.2, 95% CI -2.2 to 0.1, p=<0.001). Recalibrating the EKFC eGFR equation with an Indian-specific normal GFR constant (EKFC ISK) reduced mean bias to -1.2 ml/min per 1.73 m2 and improved P30 accuracy to 69%.
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