Assessing bias in GFR estimating equations: improper GFR stratification can yield misleading results.
Background: Assessing bias (estimated – measured) is key to evaluating glomerular filtration rate (GFR). Stratification by subgroups can indicate where equations perform differently. However, there is a fallacy in the assessment of two instruments (e.g., eGFR and mGFR) when stratifying on the level...
| Published in: | Pediatric Nephrology Vol. 39; no. 7; pp. 2139 - 2146 |
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| Main Authors: | , |
| Format: | equations & formulas research tables/charts Journal Article |
| Published: |
Springer Nature
Jul2024
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=177623357&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 177623357 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0931041X EF1 jtl: Pediatric Nephrology issn: 0931041X maglogo: N pubinfo: dt: Jul2024 vid: 39 iid: 7 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 177623357 175593493 177623357 177623357 10.1007/s00467-024-06318-4 177623357 ppf: 2139 ppct: 7 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Assessing bias in GFR estimating equations: improper GFR stratification can yield misleading results. aug: au: Ng, Derek K. Muñoz, Alvaro affil: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E7642, 21205, Baltimore, MD, USA sug: subj: Glomerular Filtration Rate Evaluation Renal Insufficiency, Chronic Diagnosis Bias (Research) Pediatrics Human Female Child Adolescence Models, Statistical Methods Kidney Physiology Creatinine Blood Kidney Function Tests Descriptive Statistics Comparative Studies Confidence Intervals Funding Source Child: 6-12 years Adolescent: 13-18 years Female ab: Background: Assessing bias (estimated – measured) is key to evaluating glomerular filtration rate (GFR). Stratification by subgroups can indicate where equations perform differently. However, there is a fallacy in the assessment of two instruments (e.g., eGFR and mGFR) when stratifying on the level of only one of those instruments. Here, we present statistical aspects of the problem and a solution for GFR stratification along with an empirical investigation using data from the CKiD study. Methods: Compared and contrasted biases (eGFR relative to mGFR) with 95% confidence intervals within strata of mGFR only, eGFR only, and the average of mGFR and eGFR using data from the Chronic Kidney Disease in Children (CKiD) study. Results: A total of 304 participants contributed 843 GFR studies with a mean mGFR of 48.46 (SD = 22.72) and mean eGFR of 48.67 (SD = 22.32) and correlation of 0.904. Despite strong agreement, eGFR significantly overestimated mGFR when mGFR < 30 (+ 6.2%; 95%CI + 2.9%, + 9.7%) and significantly underestimated when mGFR > 90 (–12.2%; 95%CI − 17.3%, − 7.0%). Significant biases in opposite direction were present when stratifying by eGFR only. In contrast, when stratifying by the average of eGFR and mGFR, biases were not significant (+ 1.3% and − 1.0%, respectively) congruent with strong agreement. Conclusions: Stratifying by either mGFR or eGFR only to assess eGFR biases is ubiquitous but can lead to inappropriate inference due to intrinsic statistical issues that we characterize and empirically illustrate using data from the CKiD study. Using the average of eGFR and mGFR is recommended for valid inferences in evaluations of eGFR biases. pubtype: Academic Journal doctype: equations & formulas research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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