SWITCHING TO CKD-EPI LEADS TO UNDERDIAGNOSING CKD IN A COMMUNITY-BASED MEXICAN COHORT OF ADOLESCENTS AND YOUNG ADULTS - A CROSS-SECTIONAL STUDY

E-Poster

https://storage.unitedwebnetwork.com/files/1099/ca0ec449933eed0c2006289c031d9847.pdf

Abstract Title

First Name *

Alethia Paulina Monserrat

Last Name *

Guzmán Núñez

Co-author 1

Guido Filler guido-filler@lhsc.on.ca Western University Paediatrics London

Co-author 2

Ajay P. Sharma Ajay. Sharma@lhsc.on.ca Western university Paediatrics London

Co-author 3

Olivier C. Barbier obarbier@cinvestav.mx Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Toxicología CDMX

Co-author 4

Elodia Rojas Lima elodia.rojas@cinvestav.mx Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Toxicología CDMX

Co-author 5

Pablo Mendez-Hernández pmendezh@hotmail.com Universidad Autónoma de Tlaxcala Facultad de Ciencias de la Salud Talxcala

Co-author 6

Manolo Ortega-Romero rom_0@hotmail.com Hospital Infantil de México Federico Gómez Unidad de Investigación en Nefrología y Metabolismo Mineral Óseo CDMX

Co-author 7

Maria Esther Díaz González de Ferris mariaeferris@gmail.com The University of North Carolina at Chapel Hill Pediatrics North Carolina

Co-author 8

Mara Medeiros medeiro.mara@gmail.com Hospital Infantil de México Federico Gómez Unidad de Investigación en Nefrología y Metabolismo Mineral Óseo CDMX

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Introduction: Guidelines recommend switching estimation of glomerular filtration rate (eGFR) from the CKiD-U25 to the CKD-EPI formula at age 18. We investigated how this would affect chronic kidney disease (CKD) classification.

Methods

Methods: Serum creatinine was enzymatically measured in 1061 samples (one to two per patient) from 914 community-based 10-23 year--olds from Tlaxcala (located at the Meso-American region of México), who are at-risk of exposure to toxic trace elements, and possibly developing chronic kidney disease (CKD). We calculated their eGFR using CKiD-U25, modified Schwartz, Pottel full-age spectrum (FAS) and CKD-EPI formulae and performed correlation analysis, Bland & Altman analysis, characterizing CKD stage stratified by age and sex.

Results

Results: At baseline, the median age was 13 (IQR:12,15) years, and 55% were female. Median CKiD-U25 eGFR was 969 (IQR:833,1133) mL/min/173m2, significantly lower than the CKD-EPI eGFR which was 1408 (IQR:1299,1493) mL/min/173m2 (p<00001, Wilcoxon rank test). Mean bias was 3699±1289 mL/min/173m2. Pearson correlation was r=08296 (95% confidence interval 00898-08474). There was a better correlation between the modified Schwartz formula (r=09421(09349,09485)) and the Pottel FAS (r=09299(09212,09376)). Agreement was particularly low with eGFR >75mL/min/173 m2, in younger age and female sex. Modified Schwartz identified 281(264%) measurements as has having CKD 2 and 3 (2+), U25 identified 401 (37∙7%) measurements as has having CKD 2+, FAS identified 267 (25∙1%) measurements as has having CKD 2+, and CKD-EPI identified 51 (4∙8%) measurements as has having CKD 2+, respectively.

Conclusions

Conclusions: In this population, there was poor agreement between the various eGFR formulae. CKD-EPI identifies substantially fewer at-risk participants as having CKD. Based on our findings, switching from a paediatric approach to CKD-EPI at age 18 may not be accurate. However, since cystatin C is not available in many less-resourced countries, the data here favour the use of the modified Schwartz formula up to age 23.

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