Evaluation of risk stratification for acute kidney injury: a comparative analysis of EKFC, 2009 and 2021 CKD-EPI glomerular filtration estimating equations
Background The adoption of the 2021 CKD-EPIcr equation for glomerular filtration rate (GFR) estimation provided a race-free eGFR calculation. However, the discriminative performance for AKI risk has been rarely validated. We aimed to evaluate the differences in acute kidney injury (AKI) prediction o...
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| Veröffentlicht in: | Journal of nephrology 2024-04, Vol.37 (3), p.681-693 |
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| creator | Cho, Jeong Min Koh, Jung Hun Kim, Minsang Jung, Sehyun Cho, Semin Lee, Soojin Kim, Yaerim Kim, Yong Chul Lee, Hajeong Han, Seung Seok Oh, Kook-Hwan Joo, Kwon Wook Kim, Yon Su Kim, Dong Ki Park, Sehoon |
| description | Background
The adoption of the 2021 CKD-EPIcr equation for glomerular filtration rate (GFR) estimation provided a race-free eGFR calculation. However, the discriminative performance for AKI risk has been rarely validated. We aimed to evaluate the differences in acute kidney injury (AKI) prediction or reclassification power according to the three eGFR equations.
Methods
We performed a retrospective observational study within a tertiary hospital from 2011 to 2021. Acute kidney injury was defined according to KDIGO serum creatinine criteria. Glomerular filtration rate estimates were calculated by three GFR estimating equations: 2009 and 2021 CKD-EPIcr, and EKFC. In three equations, AKI prediction performance was evaluated with area under receiver operator curves (AUROC) and reclassification power was evaluated with net reclassification improvement analysis.
Results
A total of 187,139 individuals, including 27,447 (14.7%) AKI and 159,692 (85.3%) controls, were enrolled. In the multivariable regression prediction model, the 2009 CKD-EPIcr model (continuous eGFR model 2, 0.7583 [0.755–0.7617]) showed superior performance in AKI prediction to the 2021 CKD-EPIcr (0.7564 [0.7531–0.7597], |
| doi_str_mv | 10.1007/s40620-023-01883-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11150313</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2926076855</sourcerecordid><originalsourceid>FETCH-LOGICAL-c447t-f3d0b7ecbcc779b4d8b222fbe83f4e23570977ffea167b6431a215afbed55fe93</originalsourceid><addsrcrecordid>eNp9UU1v1DAUtBCIlsIf4IB85EDAn3HCBVXLFqpWggOcLcd5Xrx14q2drLS_hT-LtylVuXDy6L15M2MNQq8peU8JUR-yIDUjFWG8IrRpeKWeoFOqmKhqItunj_AJepHzlhAmJRPP0QlvuJB1U5-i3-u9CbOZfBxxdDj5fIPzlMrAebuMXUzY2HkCfOP7EQ7Yj9s5HT5ig20cduZI3gM2owmH7PNRZn11sXqHGSFtGfcFMIpXV5-r9fdLvAlxgDQHk7Dz4c6qmECe_FDguMFwu-TJL9EzZ0KGV_fvGfp5sf6x-lpdf_tyuTq_rqwQaqoc70mnwHbWKtV2om86xpjroOFOAONSkVYp58DQWnW14NQwKk0h9FI6aPkZ-rTo7uZugN7CWFIFvUslUTroaLz-dzP6X3oT95pSKgmnvCi8vVdI8XYuf9GDzxZCMCPEOWvWspqoupGyUNlCtSnmnMA9-FCij7XqpVZdatV3tWpVjt48Tvhw8rfHQuALIZfVuIGkt3FOpZH8P9k_jICwsg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2926076855</pqid></control><display><type>article</type><title>Evaluation of risk stratification for acute kidney injury: a comparative analysis of EKFC, 2009 and 2021 CKD-EPI glomerular filtration estimating equations</title><source>MEDLINE</source><source>Springer Online Journals Complete</source><creator>Cho, Jeong Min ; Koh, Jung Hun ; Kim, Minsang ; Jung, Sehyun ; Cho, Semin ; Lee, Soojin ; Kim, Yaerim ; Kim, Yong Chul ; Lee, Hajeong ; Han, Seung Seok ; Oh, Kook-Hwan ; Joo, Kwon Wook ; Kim, Yon Su ; Kim, Dong Ki ; Park, Sehoon</creator><creatorcontrib>Cho, Jeong Min ; Koh, Jung Hun ; Kim, Minsang ; Jung, Sehyun ; Cho, Semin ; Lee, Soojin ; Kim, Yaerim ; Kim, Yong Chul ; Lee, Hajeong ; Han, Seung Seok ; Oh, Kook-Hwan ; Joo, Kwon Wook ; Kim, Yon Su ; Kim, Dong Ki ; Park, Sehoon</creatorcontrib><description>Background
The adoption of the 2021 CKD-EPIcr equation for glomerular filtration rate (GFR) estimation provided a race-free eGFR calculation. However, the discriminative performance for AKI risk has been rarely validated. We aimed to evaluate the differences in acute kidney injury (AKI) prediction or reclassification power according to the three eGFR equations.
Methods
We performed a retrospective observational study within a tertiary hospital from 2011 to 2021. Acute kidney injury was defined according to KDIGO serum creatinine criteria. Glomerular filtration rate estimates were calculated by three GFR estimating equations: 2009 and 2021 CKD-EPIcr, and EKFC. In three equations, AKI prediction performance was evaluated with area under receiver operator curves (AUROC) and reclassification power was evaluated with net reclassification improvement analysis.
Results
A total of 187,139 individuals, including 27,447 (14.7%) AKI and 159,692 (85.3%) controls, were enrolled. In the multivariable regression prediction model, the 2009 CKD-EPIcr model (continuous eGFR model 2, 0.7583 [0.755–0.7617]) showed superior performance in AKI prediction to the 2021 CKD-EPIcr (0.7564 [0.7531–0.7597], < 0.001) or EKFC model in AUROC (0.7577 [0.7543–0.761], < 0.001). Moreover, in reclassification of AKI, the 2021 CKD-EPIcr and EKFC models showed a worse classification performance than the 2009 CKD-EPIcr model. (− 7.24 [− 8.21–− 6.21], − 2.38 [− 2.72–− 1.97]).
Conclusion
Regarding AKI risk stratification, the 2009 CKD-EPIcr equation showed better discriminative performance compared to the 2021 CKD-EPIcr equation in the study population.
Graphical abstract</description><identifier>ISSN: 1724-6059</identifier><identifier>ISSN: 1121-8428</identifier><identifier>EISSN: 1724-6059</identifier><identifier>DOI: 10.1007/s40620-023-01883-7</identifier><identifier>PMID: 38345686</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Acute Kidney Injury - diagnosis ; Acute Kidney Injury - physiopathology ; Adult ; Aged ; Creatinine - blood ; Female ; Glomerular Filtration Rate ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Nephrology ; Original ; Original Article ; Predictive Value of Tests ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - physiopathology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; ROC Curve ; Urology</subject><ispartof>Journal of nephrology, 2024-04, Vol.37 (3), p.681-693</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-f3d0b7ecbcc779b4d8b222fbe83f4e23570977ffea167b6431a215afbed55fe93</citedby><cites>FETCH-LOGICAL-c447t-f3d0b7ecbcc779b4d8b222fbe83f4e23570977ffea167b6431a215afbed55fe93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40620-023-01883-7$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40620-023-01883-7$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,315,781,785,886,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38345686$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cho, Jeong Min</creatorcontrib><creatorcontrib>Koh, Jung Hun</creatorcontrib><creatorcontrib>Kim, Minsang</creatorcontrib><creatorcontrib>Jung, Sehyun</creatorcontrib><creatorcontrib>Cho, Semin</creatorcontrib><creatorcontrib>Lee, Soojin</creatorcontrib><creatorcontrib>Kim, Yaerim</creatorcontrib><creatorcontrib>Kim, Yong Chul</creatorcontrib><creatorcontrib>Lee, Hajeong</creatorcontrib><creatorcontrib>Han, Seung Seok</creatorcontrib><creatorcontrib>Oh, Kook-Hwan</creatorcontrib><creatorcontrib>Joo, Kwon Wook</creatorcontrib><creatorcontrib>Kim, Yon Su</creatorcontrib><creatorcontrib>Kim, Dong Ki</creatorcontrib><creatorcontrib>Park, Sehoon</creatorcontrib><title>Evaluation of risk stratification for acute kidney injury: a comparative analysis of EKFC, 2009 and 2021 CKD-EPI glomerular filtration estimating equations</title><title>Journal of nephrology</title><addtitle>J Nephrol</addtitle><addtitle>J Nephrol</addtitle><description>Background
The adoption of the 2021 CKD-EPIcr equation for glomerular filtration rate (GFR) estimation provided a race-free eGFR calculation. However, the discriminative performance for AKI risk has been rarely validated. We aimed to evaluate the differences in acute kidney injury (AKI) prediction or reclassification power according to the three eGFR equations.
Methods
We performed a retrospective observational study within a tertiary hospital from 2011 to 2021. Acute kidney injury was defined according to KDIGO serum creatinine criteria. Glomerular filtration rate estimates were calculated by three GFR estimating equations: 2009 and 2021 CKD-EPIcr, and EKFC. In three equations, AKI prediction performance was evaluated with area under receiver operator curves (AUROC) and reclassification power was evaluated with net reclassification improvement analysis.
Results
A total of 187,139 individuals, including 27,447 (14.7%) AKI and 159,692 (85.3%) controls, were enrolled. In the multivariable regression prediction model, the 2009 CKD-EPIcr model (continuous eGFR model 2, 0.7583 [0.755–0.7617]) showed superior performance in AKI prediction to the 2021 CKD-EPIcr (0.7564 [0.7531–0.7597], < 0.001) or EKFC model in AUROC (0.7577 [0.7543–0.761], < 0.001). Moreover, in reclassification of AKI, the 2021 CKD-EPIcr and EKFC models showed a worse classification performance than the 2009 CKD-EPIcr model. (− 7.24 [− 8.21–− 6.21], − 2.38 [− 2.72–− 1.97]).
Conclusion
Regarding AKI risk stratification, the 2009 CKD-EPIcr equation showed better discriminative performance compared to the 2021 CKD-EPIcr equation in the study population.
Graphical abstract</description><subject>Acute Kidney Injury - diagnosis</subject><subject>Acute Kidney Injury - physiopathology</subject><subject>Adult</subject><subject>Aged</subject><subject>Creatinine - blood</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Nephrology</subject><subject>Original</subject><subject>Original Article</subject><subject>Predictive Value of Tests</subject><subject>Renal Insufficiency, Chronic - diagnosis</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>ROC Curve</subject><subject>Urology</subject><issn>1724-6059</issn><issn>1121-8428</issn><issn>1724-6059</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9UU1v1DAUtBCIlsIf4IB85EDAn3HCBVXLFqpWggOcLcd5Xrx14q2drLS_hT-LtylVuXDy6L15M2MNQq8peU8JUR-yIDUjFWG8IrRpeKWeoFOqmKhqItunj_AJepHzlhAmJRPP0QlvuJB1U5-i3-u9CbOZfBxxdDj5fIPzlMrAebuMXUzY2HkCfOP7EQ7Yj9s5HT5ig20cduZI3gM2owmH7PNRZn11sXqHGSFtGfcFMIpXV5-r9fdLvAlxgDQHk7Dz4c6qmECe_FDguMFwu-TJL9EzZ0KGV_fvGfp5sf6x-lpdf_tyuTq_rqwQaqoc70mnwHbWKtV2om86xpjroOFOAONSkVYp58DQWnW14NQwKk0h9FI6aPkZ-rTo7uZugN7CWFIFvUslUTroaLz-dzP6X3oT95pSKgmnvCi8vVdI8XYuf9GDzxZCMCPEOWvWspqoupGyUNlCtSnmnMA9-FCij7XqpVZdatV3tWpVjt48Tvhw8rfHQuALIZfVuIGkt3FOpZH8P9k_jICwsg</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Cho, Jeong Min</creator><creator>Koh, Jung Hun</creator><creator>Kim, Minsang</creator><creator>Jung, Sehyun</creator><creator>Cho, Semin</creator><creator>Lee, Soojin</creator><creator>Kim, Yaerim</creator><creator>Kim, Yong Chul</creator><creator>Lee, Hajeong</creator><creator>Han, Seung Seok</creator><creator>Oh, Kook-Hwan</creator><creator>Joo, Kwon Wook</creator><creator>Kim, Yon Su</creator><creator>Kim, Dong Ki</creator><creator>Park, Sehoon</creator><general>Springer International Publishing</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240401</creationdate><title>Evaluation of risk stratification for acute kidney injury: a comparative analysis of EKFC, 2009 and 2021 CKD-EPI glomerular filtration estimating equations</title><author>Cho, Jeong Min ; Koh, Jung Hun ; Kim, Minsang ; Jung, Sehyun ; Cho, Semin ; Lee, Soojin ; Kim, Yaerim ; Kim, Yong Chul ; Lee, Hajeong ; Han, Seung Seok ; Oh, Kook-Hwan ; Joo, Kwon Wook ; Kim, Yon Su ; Kim, Dong Ki ; Park, Sehoon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c447t-f3d0b7ecbcc779b4d8b222fbe83f4e23570977ffea167b6431a215afbed55fe93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Acute Kidney Injury - diagnosis</topic><topic>Acute Kidney Injury - physiopathology</topic><topic>Adult</topic><topic>Aged</topic><topic>Creatinine - blood</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Nephrology</topic><topic>Original</topic><topic>Original Article</topic><topic>Predictive Value of Tests</topic><topic>Renal Insufficiency, Chronic - diagnosis</topic><topic>Renal Insufficiency, Chronic - physiopathology</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>ROC Curve</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cho, Jeong Min</creatorcontrib><creatorcontrib>Koh, Jung Hun</creatorcontrib><creatorcontrib>Kim, Minsang</creatorcontrib><creatorcontrib>Jung, Sehyun</creatorcontrib><creatorcontrib>Cho, Semin</creatorcontrib><creatorcontrib>Lee, Soojin</creatorcontrib><creatorcontrib>Kim, Yaerim</creatorcontrib><creatorcontrib>Kim, Yong Chul</creatorcontrib><creatorcontrib>Lee, Hajeong</creatorcontrib><creatorcontrib>Han, Seung Seok</creatorcontrib><creatorcontrib>Oh, Kook-Hwan</creatorcontrib><creatorcontrib>Joo, Kwon Wook</creatorcontrib><creatorcontrib>Kim, Yon Su</creatorcontrib><creatorcontrib>Kim, Dong Ki</creatorcontrib><creatorcontrib>Park, Sehoon</creatorcontrib><collection>Springer Nature OA/Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cho, Jeong Min</au><au>Koh, Jung Hun</au><au>Kim, Minsang</au><au>Jung, Sehyun</au><au>Cho, Semin</au><au>Lee, Soojin</au><au>Kim, Yaerim</au><au>Kim, Yong Chul</au><au>Lee, Hajeong</au><au>Han, Seung Seok</au><au>Oh, Kook-Hwan</au><au>Joo, Kwon Wook</au><au>Kim, Yon Su</au><au>Kim, Dong Ki</au><au>Park, Sehoon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of risk stratification for acute kidney injury: a comparative analysis of EKFC, 2009 and 2021 CKD-EPI glomerular filtration estimating equations</atitle><jtitle>Journal of nephrology</jtitle><stitle>J Nephrol</stitle><addtitle>J Nephrol</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>37</volume><issue>3</issue><spage>681</spage><epage>693</epage><pages>681-693</pages><issn>1724-6059</issn><issn>1121-8428</issn><eissn>1724-6059</eissn><abstract>Background
The adoption of the 2021 CKD-EPIcr equation for glomerular filtration rate (GFR) estimation provided a race-free eGFR calculation. However, the discriminative performance for AKI risk has been rarely validated. We aimed to evaluate the differences in acute kidney injury (AKI) prediction or reclassification power according to the three eGFR equations.
Methods
We performed a retrospective observational study within a tertiary hospital from 2011 to 2021. Acute kidney injury was defined according to KDIGO serum creatinine criteria. Glomerular filtration rate estimates were calculated by three GFR estimating equations: 2009 and 2021 CKD-EPIcr, and EKFC. In three equations, AKI prediction performance was evaluated with area under receiver operator curves (AUROC) and reclassification power was evaluated with net reclassification improvement analysis.
Results
A total of 187,139 individuals, including 27,447 (14.7%) AKI and 159,692 (85.3%) controls, were enrolled. In the multivariable regression prediction model, the 2009 CKD-EPIcr model (continuous eGFR model 2, 0.7583 [0.755–0.7617]) showed superior performance in AKI prediction to the 2021 CKD-EPIcr (0.7564 [0.7531–0.7597], < 0.001) or EKFC model in AUROC (0.7577 [0.7543–0.761], < 0.001). Moreover, in reclassification of AKI, the 2021 CKD-EPIcr and EKFC models showed a worse classification performance than the 2009 CKD-EPIcr model. (− 7.24 [− 8.21–− 6.21], − 2.38 [− 2.72–− 1.97]).
Conclusion
Regarding AKI risk stratification, the 2009 CKD-EPIcr equation showed better discriminative performance compared to the 2021 CKD-EPIcr equation in the study population.
Graphical abstract</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>38345686</pmid><doi>10.1007/s40620-023-01883-7</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of nephrology, 2024-04, Vol.37 (3), p.681-693 |
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| subjects | Acute Kidney Injury - diagnosis Acute Kidney Injury - physiopathology Adult Aged Creatinine - blood Female Glomerular Filtration Rate Humans Male Medicine Medicine & Public Health Middle Aged Nephrology Original Original Article Predictive Value of Tests Renal Insufficiency, Chronic - diagnosis Renal Insufficiency, Chronic - physiopathology Retrospective Studies Risk Assessment Risk Factors ROC Curve Urology |
| title | Evaluation of risk stratification for acute kidney injury: a comparative analysis of EKFC, 2009 and 2021 CKD-EPI glomerular filtration estimating equations |
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