Key result
The Pottel height-independent equation outperformed other eGFR equations in African children, demonstrating the lowest mean bias (-3.41) and highest concordance with the Schwartz CKiD reference standard.
Why the study?
Which eGFR equation utilizing Cystatin C and creatinine performs best compared to the Schwartz CKiD reference standard in Sub-Saharan African children and adolescents?
Cohort (n=688)
No
Which eGFR equation utilizing Cystatin C and creatinine performs best compared to the Schwartz CKiD reference standard in Sub-Saharan African children and adolescents?
Mean Difference: -3.41 (95% CI -4.25–-2.57)
The Pottel height-independent equation is the most accurate and concordant method for estimating GFR in Sub-Saharan African children compared to the Schwartz CKiD reference standard.
Supports Pottel equation preference in Sub-Saharan African children; leaves open prospective validation before practice change.
Backgrounds Accurate eGFR assessment is crucial for early CKD detection, management and optimal medication dosing, but its validation, especially for Cystatin C-based equations, are limited in African children and adolescents with CKD. This study evaluates eGFR equations utilising Cystatin C and creatinine in this population. Methods: This prospective community-based cohort study assessed CKD in children aged 1 to 18 using Cystatin C and serum creatinine. We evaluated eGFR performance with the Bland-Altman plot and ROC curve. Lin's concordance assessed agreement between various equations and the reference standard (Schwartz CKiD equations). Pairwise ROC curve comparisons determined statistical differences in estimation equation performance. Results: The mean age of 688 children and adolescents evaluated for CKD was 7.8 (± 3.9) years, with 341 (49.6%) being male. The Pottel equation had the lowest mean bias (-3.41, 95% CI: -2.57 to -4.25), highest discriminatory power (0.989), highest accuracy across all age groups, and highest CKD detection. Bouvet's formula had the highest mean bias [-48.66 (95% CI: -50.75 to -46.57)] across all age groups, but an average ROC discriminatory power of 0.889. Zappitelli had a lower ROC discriminatory value (0.547) but a modest bias (-20.22; 95% CI -22.21 to -18.23). Lin's concordance with Schwartz CKiD was highest with Pottel (0.99) and lowest with Bouvet (0.08). Zappetti and Chehade disagreed most, but Pottel and Chehade agreed closely on equation pairwise comparisons. Conclusion: In African children with CKD, Pottel's height-independent equation outperformed Chehade, Zappitelli, and Bouvet in terms of ROC discriminatory value, accuracy, and Schwartz CKiD concordance.
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Alao et al. (2023) conducted a cohort in Chronic kidney disease (n=688). Pottel eGFR equation vs. Schwartz CKiD equation was evaluated on Mean bias compared to revised Schwartz CKiD formula (Mean bias -3.41, 95% CI -2.57 to -4.25). The Pottel height-independent equation outperformed other eGFR equations in African children, demonstrating the lowest mean bias (-3.41) and highest concordance with the Schwartz CKiD reference standard.
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