Key result
EKFC outperforms CKD-EPI for eGFR estimation across the lifespan, avoiding ~20 ml/min bias in young adults.
Why the study?
The 2024 KDIGO guidelines recommend age-adapted equations, but the widely used 2009 CKD-EPI equation cannot be used in children and has uncertain performance in young adults and the elderly.
Does the EKFC equation improve the accuracy of eGFR estimation and CKD staging compared to the CKD-EPI equation across the lifespan?
Observational (n=30,104)
Does the EKFC equation improve the accuracy of eGFR estimation and CKD staging compared to the CKD-EPI equation across the lifespan?
The EKFC equation provides a more robust and continuous estimation of GFR across the lifespan compared to the CKD-EPI equation, particularly improving accuracy in young adults.
EKFC may improve eGFR accuracy in young adults; leaves open whether it should replace CKD-EPI pending outcome validation.
Introduction Chronic kidney disease (CKD) represents a major public health issue, with early detection depending on accurate estimation of glomerular filtration rate (GFR). The 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend age-adapted equations, whereas the 2009 CKD Epidemiology Collaboration (CKD-EPI) equation remains widely used in Europe despite its inapplicability in children and uncertain performance in young adults and the elderly. The objectives of this study were to compare the European Kidney Function Consortium (EKFC) and 2009 CKD-EPI equations for estimated GFR (eGFR)-based CKD staging in a general population (PCrAGE substudy), and to evaluate their performance against measured GFR (mGFR) in a reference cohort (mGFR substudy). Methods We analyzed data from 30,104 individuals aged 2 to 99 years with plasma creatinine (PCr) available (PCrAGE). eGFR was calculated using EKFC (all ages), CKD-EPI (adults), and Berlin Initiative Study 1 (BIS1, aged > 70 years). Performance was tested in 4144 mGFR measurements using bias and P30 across age groups and CKD stages. Results In PCrAGE, switching from CKD-EPI to EKFC impacted CKD staging (3.2% from stage II to III; 0.4% from stage III tp IV). In the mGFR cohort, all equations showed declining accuracy with advancing CKD stage. EKFC consistently had the lowest bias and highest P30 in adults. CKD-EPI performed poorly in young adults (aged 18–25 years), showing substantial positive bias (∼20 ml/min per 1.73 m 2 ) and reduced accuracy. In older adults (aged > 70 years), performance was similar across equations. Conclusion EKFC provides a continuous and robust equation for eGFR estimation across the lifespan, offering an advantage over CKD-EPI.
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Mul et al. (2026) conducted an observational in Chronic kidney disease (n=30,104). European Kidney Function Consortium (EKFC) equation vs. 2009 CKD-EPI equation was evaluated on Bias and P30 across age groups and CKD stages. The EKFC equation provided more accurate eGFR estimation across the lifespan than the CKD-EPI equation, which showed substantial positive bias (~20 ml/min per 1.73 m2) in young adults.
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