Original InvestigationPathogenesis and Treatment of Kidney DiseaseEstimation of GFR in South Asians: A Study From the General Population in Pakistan
Section snippets
Study Design and Participants
Participants were drawn from 2 sources. The first was a population-based sample from 10 randomly selected low- to middle-income communities in Karachi. Because the general population was expected to have few people with decreased kidney function, we enriched our sample with 40 patients with a serum creatinine level ≥ 2.0 mg/dL from the renal clinic (Fig S1, available as online supplementary material), so that 20% of our study sample would have a GFR < 60 mL/min/1.73 m2 (ie, CKD stage 3 or worse).
Participant Characteristics
Characteristics of the study population are described in Table 1. Of 581 enrolled participants, 50% were men. Median mGFR, eGFRMDRD, and creatinine-based eGFRCKD-EPI values were 91.0 (IQR, 36.7), 100.5 (IQR, 40.4), and 104.4 (IQR, 25.4) mL/min/1.73 m2, respectively. Participants with mGFR < 60 mL/min/1.73 m2 were older than those with higher mGFRs (P < 0.001) and had greater waist circumference (P = 0.02), lower lean body mass (P = 0.007), lower hemoglobin level (P < 0.001), and higher systolic blood
Discussion
The new KDIGO CKD guideline recommends using the CKD-EPI creatinine equation to report eGFR unless an alternative equation has been shown to be more accurate in the local population.21 This is the first report of the performance of existing GFR estimating equations in the general population from a South Asian country using a directly measured GFR method as a reference. Using urinary inulin clearance as the gold standard, we found that the CKD-EPI creatinine equation is significantly more
Acknowledgements
The abstracts based on this work were presented at the Joint Statistical Meetings on August 6, 2013, in Montreal, Canada; World Congress of Nephrology on June 2, 2013 in Hong Kong, and 44th Annual Renal Week on November 11, 2011, in Philadelphia, PA.
We thank all research staff for their assistance and acknowledge the cooperation of Mr Ibrahim Mustafa at the Aga Khan University Hospital for logistical assistance with the GFR clinic for research participants and Dr Lise Thibaudin for inulin
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Because an author of this manuscript is an editor for AJKD, the peer-review and decision-making processes were handled entirely by an Associate Editor (Kunitoshi Iseki, MD) who served as Acting Editor-in-Chief. Details of the journal’s procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.