Néphrologie & Thérapeutique


New developments and future prospects in the field of glomerular filtration rate estimation Volume 19, issue 1, February 2023

1 Université Paris Est Créteil, Inserm U955, Institut Mondor de recherche biomédicale (IMRB), 8, rue du Général Sarrail, 94010 Créteil cedex, France
2 Hôpitaux universitaires Henri Mondor, AP-HP, Service de néphrologie et transplantation, Fédération hospitalo-universitaire « Innovative therapy for immune disorders », 1, rue Gustave Eiffel, 94010 Créteil, France
3 Hôpital Bichat, AP-HP, Département de physiologie-explorations fonctionnelles, 46, rue Henri Huchard, 75018 Paris et Université Paris Cité, Paris, France
4 Université de Liège, CHU de Liège, Département de néphrologie, dialyse, transplantation, Avenue de l’hôpital, 14000 Liège, Belgique
5 Hôpital universitaire Carémeau, Département de néphrologie, dialyse, aphérèse, 4, rue du Professeur Robert Debré, 30900 Nîmes, France
Correspondance : T. Stehlé

Glomerular filtration rate (GFR) is estimated from equations based on serum or plasma concentrations of endogenous markers (creatinine and/or cystatin C), and demographic data (age, sex, ± ethnicity). These equations are accurate at the population level, but often inaccurate at the individual level. The creatinine-based Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation published in 2009 (CKD-EPIcr-2009), and the CKD-EPI equation published in 2012 based on creatinine and cystatin C, were recalibrated in 2021 to remove their dedicated race correction factors for black American subjects. All creatinine-based CKD-EPI equations overestimate true GFR in subjects younger than 30 years. The Full Age Spectrum (FAS) equation, applicable across the entire age spectrum (pediatrics to old age), solved this problem, but remained suboptimal at low GFR values. The European Kidney Function Consortium (EKFC) equation published in 2021 was an improvement of the FAS equation, which also includes the Q factor (median creatinine in the general population). EKFC is applicable across the age spectrum and is efficient at low and normal GFR values. The new creatinine-based CKD-EPI equation (CKD-EPIcr-2021) underestimates GFR in Black Americans and overestimates it in non-Black Americans. In European and African subjects, CKD-EPIcr-2021 overestimates true GFR and should not be adopted. The EKFC equation, which performs well in this population, also performs well in European Black subjects and in African subjects, provided dedicated Q factors are used.