Introduction: In 2021, CKD-EPI equation without the race coefficient (2021 CKD-EPI equation) was recommended for use in clinical practice by international guidelines. The performance of the 2021 equation in people with diabetes is unknown. This study aims to assess and compare the performance of the 2021 CKD-EPI equation to the 2009 CKD-EPI equation in individuals with type 1 and/or type 2 diabetes.

Methods: Datapoints (n=16,182) were collected from people with type 1 and type 2 diabetes from six international cohorts (Diabetes Control and Complication Trial [DCCT, USA], Colorado [USA], Germany, Korea, Spain, and Australia), with mGFR assessed using exogenous filtration markers. The intra-class correlation coefficient between mGFR and eGFR for 2009 CKD-EPI equation and 2021 CKD-EPI equation was estimated using (a) a one-step intra-individual participant data meta-analysis approach, and (b) a four-level mixed-effect linear model which included studies and individual participants as first and second level random effects, method of measurement as third level fixed effect and time as fourth level random effect.

Results: Overall performance of the 2009 CKD-EPI equation was excellent (ICC: 0.96, 95%CI: 0.88, 0.99) and 2021 CKD-EPI equations (ICC: 0.87, 95%CI: 0.77, 0.93) was good. However, subgroup analyses based on clinically relevant GFR ranges (<30, 30-59, 60-89 ml/min/1.73m2) revealed poor agreement between mGFR and eGFR measurements for the 2009 CKD-EPI equation (ICC: 0.41, 0.43, 0.40 respectively) and excellent agreement for GFR ≥90 ml/min/1.73m2 (ICC: 0.92). The 2021 CKD-EPI equation revealed poor agreement across GFR ranges <30, 30-59 and 60-89 (ICC: 0.38, 0.41, 0.39 respectively) and moderate agreement for GFR ≥90 ml/min/1.73m2 (ICC: 0.55).

Conclusion: These findings suggest that the 2009 CKD-EPI equation still performs better than the 2021 CKD-EPI equation without the race co-efficient, especially in higher GFR ranges for people with diabetes.

Disclosure

R. Kwok: None. R. MacIsaac: None. K. Kishore: None. T. Zafari: None. M. Hachem: None. D. Koye: None. E. Schaeffner: Consultant; AstraZeneca. Other Relationship; National Kidney Foundation. T. Jeong: None. W. Min: None. P. Bjornstad: Consultant; AstraZeneca, Boehringer-Ingelheim. Advisory Panel; Lilly Diabetes, Novo Nordisk, Bayer Inc., Horizon Therapeutics plc. L. Churilov: None. E.I. Ekinci: Advisory Panel; Lilly Diabetes. Research Support; Novo Nordisk, Boehringer-Ingelheim, Eli Lilly and Company. Board Member; Eli Lilly and Company. Advisory Panel; Abbott. Research Support; Endogenex, Versanis, AstraZeneca.

Funding

Australian Government Research Training Program (RTP) Scholarship

© 2024 by the American Diabetes Association
2024
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