New method for estimating kidney function improves accuracy and precision compared with commonly use

Below please find summaries of new articles that will be published in the next issue of

Annals of Internal Medicine

. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. New method for estimating kidney function improves accuracy and precision compared with commonly used methods

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Editorial:

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A new equation for estimating glomerular filtration rate, or GFR, a measure of kidney function, shows improved accuracy and precision compared with commonly used equations. Developed and tested by the European Kidney Function Consortium (EKFC), the new equation addresses the limitations of currently recommended equations designed to target specific populations. Findings from a cross-sectional analysis are published in

Annals of Internal Medicine

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Creatinine-based equations are commonly used in daily clinical practice to estimate GFR and many of them are refined to target specific populations. The most commonly used among them are the Chronic Kidney Disease in Children Study (CKiD) equation for children and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for adults. Both of these equations have limitations, and the full age spectrum (FAS) equation was designed to overcome some of them. However, that method also overestimates GFR at low serum creatinine values and in patients with chronic kidney disease.

Researchers from KU Leuven Kulak, Belgium developed and sought to validate a modified FAS serum creatinine-based equation combining design features of the FAS and CKD-EPI equations. The equation was developed in a study population of 11,251 participants in 7 studies and was validated in a separate study population of 8,378 participants in 6 studies. All of the study participants were white. The EKFC equation was found to be unbiased across all age groups, and accuracy was high in both children and adults. Performance was better for the EKFC than the CKiD equation in children and the CKD-EPI equation in young adults and older adults, but not in middle-aged adults.

The authors of an accompanying editorial from Tufts Medical Center suggest that the EKFC equation is a conceptual advance over the FAS equation and say that the development of an estimated GFR equation that can be used in children and adults is a worthy goal. As the authors noted, the performance of such equations should also be evaluated in a population that is more racially and ethnically diverse.

Media contacts: For an embargoed PDF, please contact Lauren Evans at

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. The corresponding author, Hans Pottel, PhD, can be reached at

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. To reach the lead author of the editorial, Andrew S. Levey, MD, please contact

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2. Group summarizes key recommendations to guide management of patients with diabetes and CKD

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The latest clinical practice guideline from the Kidney Disease: Improving Global Outcomes (KDIGO) organization offers advice for treating patients with diabetes and chronic kidney disease (CKD). A synopsis published in

Annals of Internal Medicine

focuses on the key recommendations pertinent to the following issues: comprehensive care, glycemic monitoring and targets, lifestyle interventions, antihyperglycemic therapies, and educational and integrated care approaches to management.

The KDIGO guideline is based upon literature searches last conducted in October 2018, supplemented with additional evidence through September 2019 and updated in February 2020. Expert judgment was used to develop consensus practice points supplementary to the evidence-based graded recommendations. The guideline underwent open public review and comments from all audiences were considered before the document was finalized.

Authors from the KDIGO Work Group summarized the guidelines for ease of reference in clinical practice. The guidelines recommend:

• Comprehensive care including smoking cessation in patients who use tobacco products and treatment with an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB) in patients with diabetes, hypertension, and albuminuria.
• Glycemic monitoring and targets using hemoglobin A1c (HbA1c) to monitor glycemic control to an individualized HbA1c target ranging from <6.5% to <8% in patients with diabetes and CKD.
• Lifestyle Interventions, including specific diet recommendations for sodium and protein and recommendations for regular moderate-intensity physical activity.
• Treatment with antihyperglycemic therapies with metformin and SGLT2 inhibitor in patients with type 2 diabetes, CKD, and eGFR ?30 ml/min per 1.73m2 and use of a long-acting GLP-1 RA is recommended in patients who have not achieved individualized glycemic targets despite use of metformin and SGLT2i, or who are unable to use those medications.
• Approaches to management through a structured self-management educational programs and team-based, integrated care.

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The full clinical guidelines can be accessed at

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Media contacts:

For an embargoed PDF, please contact Lauren Evans at

[email protected]

. The corresponding author, Kamlesh Khunti, can be reached at

[email protected]