Estimating Glomerular Filtration Rate Using Full Age Spectrum Equation to Assess Kidney Function in Hypertensive Patients: A Cross-sectional Study

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Balkar Chand
Lovleen Bhatia
Kanchan Vohra


Background: Estimated glomerular filtration rate (eGFR) is accepted as the best indicator of kidney function and commonly assessed from serum creatinine (Cr) and cystatin C (Cys-C) based equations. The present cross-sectional, observational study aimed to assess eGFR using a new and validated Full Age Spectrum (FAS) equation and compared with eGFR assessed using old and established equations in hypertensive patients.

Materials and Methods: Overall, 60 subjects were recruited for the study, including 30 hypertensive patients and 30 age and sex matched healthy subjects. Serum creatinine and cystatin C were measured using commercial biochemical kits. These levels were used to derive and compare eGFR using our different equations, namely, Cockcroft and Gault (CG), Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease-epidemiology collaboration (CKD-EPI), and FAS equation. Student t-test was used for comparison between two groups and One-way ANOVA test was used to find multiple comparison with-in the hypertensive and control group. Pearson’s Univariate correlation followed by multiple linear regression analysis was applied to find independent predictors of eGFR. All data were analyzed using Sigma-Stat.

Results: There was significant difference found in the eGFR levels using different equations in hypertensive subjects as compared to healthy subjects (P<0.01). With–in hypertensive subjects and with-in heathy subjects, a significant difference was also reported (both P<0.01). For FAS-based GFR, age was found as independent predictor of eGFR by all FAS equations. eGFR estimated using Cr based equations resulted in significant difference in categorizing number of subjects into CKD v/s non-CKD depending on their eGFR levels. But there was no difference found for the above in serum cystatin C based equations (P=0.26).

Conclusion: Present data showed that eGFR derived using all set of equations resulted in variable eGFR levels. But, use of Cr based equations instead of Cys-C or combine Cr-Cys based equations resulted in wide variation i.e. change in GFR due to change in marker.

Full age spectrum, glomerular filtration rate, hypertensive patients, equations, creatinine, cystatin C.

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How to Cite
Chand, B., Bhatia, L., & Vohra, K. (2020). Estimating Glomerular Filtration Rate Using Full Age Spectrum Equation to Assess Kidney Function in Hypertensive Patients: A Cross-sectional Study. Journal of Advances in Medical and Pharmaceutical Sciences, 22(7), 1-9.
Original Research Article


Wang HJ, Si QJ, Shi Y, Guo Y, Li Y, Wang YT. The prognostic values of beta-2 microglobulin for risks of cardiovascular events and mortality in the elderly patients with isolated systolic hypertension. J Res Med Sci. 2018; 23:82.

Avinash S, Singh VP, Agarwal AK, Chatterjee S, Arya V. Identification and stratification of diabetic kidney disease using serum cystatin C and serum creatinine based estimating equations in type-2 diabetes: A comparative analysis. J Assoc Physicians India. 2015; 63(11):28-35.

Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kid Dis. 2002;40(2): 221-6.

Garg P, Hidalgo G. Glomerular Filtration Rate Estimation by Serum Creatinine or Serum Cystatin C in Preterm (< 31 Weeks) Neonates. Indian Pediatr. 2017;54(6):508-9.

Cockcroft-Gault and Modification of Diet in Renal Disease equation: an observational, cross-sectional study. BMC Nephrol. 2009;10(1):4.

Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med. 1999; 130(6): 461-70

Hoek FJ, Kemperman FA, Krediet RT. A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrol Dial Transplant. 2003;18(10):2024-31.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J. A new equation to estimate Glomerular filtration rate. Ann Int Med. 2009; 150(9): 604-12.

Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, Kusek JW, Manzi J, Van Lente F, Zhang YL, Coresh J. Estimating glomerular filtration rate from serum creatinine and cystatin C. NEJM. 2012;367(1):20-9.

Pottel H, Delanaye P, Schaeffner E, Dubourg L, Eriksen BO, Melsom T, Lamb EJ, Rule AD, Turner ST, Glassock RJ, De Souza V. Estimating glomerular filtration rate for the full age spectrum from serum creatinine and cystatin C. Nephrol Dial Transplant. 2017; 32:497-507.

Yong Z, Li F, Pei X, Liu X, Song D, Zhang X, Zhao W. A comparison between 2017 FAS and 2012 CKD-EPI equations: a multi-center validation study in Chinese adult population. Int Urol Nephrol. 2019.3;51(1): 139-46.

Jeong TD, Cho EJ, Lee W, Chun S, Hong KS, Min WK. Accuracy assessment of five equations used for estimating the glomerular filtration rate in Korean adults. Ann Lab Med. 2017;37(5):371-80.

Omuse G, Maina D, Mwangi J, Wambua C, Kanyua A, Kagotho E, Amayo A, Ojwang P, Erasmus R. Comparison of equations for estimating glomerular filtration rate in screening for chronic kidney disease in asymptomatic black Africans: a cross sectional study. BMC Nephrol. 2017; 18(1): 369.

Björk J, Bäck SE, Ebert N, Evans M, Grubb A, Hansson M, Jones I, Lamb EJ, Martus P, Schaeffner E, Sjöström P. GFR estimation based on standardized creatinine and cystatin C: a European multicenter analysis in older adults. Clin Chem Lab Med. 2018;56(3):422-35.

Huang S, Wu X. Clinical application of full age spectrum formula based on serum creatinine in patients with chronic kidney disease. Zhonghua wei zhong bing ji jiu yi xue. 2018;30(9):877-81.

Chen A, Sun Y, Li W, Yang J, Yao Z, Shi L, Jia J. Application of GFR estimation equations in elderly patients with measured GFR below 60 mL/min/1.73 m2. Aging Clin Exp Res. 2019; 21:1-8.

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311:507-520.

Wei L, Ye X, Pei X, Wu J, Zhao W. Reference intervals for serum cystatin C and factors influencing cystatin C levels other than renal function in the elderly. PLOS one. 2014;9(1): e86066:1-6.

Stevens LA, Levey AS. Measured GFR as a confirmatory test for estimated GFR. J Am Soc Nephrol. 2009;20(11):2305-2313.

Iliadis F, Didangelos T, Ntemka A, Makedou A, Moralidis E, Gotzamani-Psarakou et al. Glomerular filtration rate estimation in patients with type 2 diabetes: creatinine-or cystatin C-based equations. Diabetologia. 2011;54(12):2987-2994.

Ozer BA, Baykal A, Dursun B, Gultekin M, Suleymanlar G. Can cystatin C be a better marker for the early detection of renal damage in primary hypertensive patients? Renal Failure. 2005;27(3):247-253.

Cerasola G, Mulè G, Cottone S, Nardi E, Cusimano P. Hypertension, microalbumin-uria and renal dysfunction: the Renal Dysfunction in Hypertension (REDHY) study. Nephrol. 2008;12: 368-373.

Malyszko J, Bachorzewska-Gajewska H, Malyszko J, Iaina-Levin N, Kobus G, Dobrzycki S. Markers of kidney function in the elderly in relation to the new CKD-EPI formula for estimation of glomerular filtration rate. AMS. 2011;7(4):658-664.

Obiols J, Bargnoux AS, Kuster N, Fesler P, Pieroni L, Badiou S, Dupuy AM, Ribstein J, Cristol JP. Validation of a new standardized cystatin C turbidimetric assay: evaluation of the three novel CKD-EPI equations in hypertensive patients. Clin Biochem. 2013;46(15):1542-1547.

Salgado JV, França AK, Cabral NA, Lages J, Ribeiro VS, Santos AM, Salgado BJ. Cystatin C, kidney function, and cardiovascular risk factors in primary hypertension. Revista da Associação Médica Brasileira. 2013;59(1):21-27.

Monteiro Junior FD, Ferreira PA, Nunes JA, Júnior C, Brito RL, Costa JH, Lima JR, Lages JS, Salgado Filho N, Lima VC. Correlation between serum cystatin C and markers of subclinical atherosclerosis in hypertensive patients. Arquivos Brasileiros de Cardiologia. 2012;99(4):899-906.

Kaze FF, Halle MP, Mopa HT, Ashuntantang G, Fouda H, Ngogang J, Kengne AP. Prevalence and risk factors of chronic kidney disease in urban adult Cameroonians according to three common estimators of the glomerular filtration rate: a cross-sectional study. BMC Nephrol. 2015;16(1):96-104.

Flamant M, Haymann JP, Vidal-Petiot E, Letavernier E, Clerici C, Boffa JJ, Vrtovsnik F. GFR estimation using the Cockcroft-Gault, MDRD study, and CKD-EPI equations in the elderly. Am J Kidney Dis. 2012;60(5):847-849.

Delanaye P, Cavalier E, Mariat C, Maillard N, Krzesinski JM. MDRD or CKD-EPI study equations for estimating prevalence of stage 3 CKD in epidemiological studies: which difference? Is this difference relevant? BMC nephrol. 2010;11(1):8-15.

Duan Y, Wang X, Zhang J, Ye P, Cao R, Yang X, Bai Y, Wu H. Body mass index is an independent predictive factor for kidney function evaluated by glomerular filtration rate in a community-dwelling population. Eat Weight Disord. 2019;24(4):731- 738.