Charumathi Sabanayagam, MD, MMed; Tien Y. Wong, MD, PhD; E. Shyong Tai, MBChB
Potential Conflicts of Interest: None disclosed.
Sabanayagam C., Wong T., Tai E.; The CKD-EPI Equation and MDRD Study Equation Find Similar Prevalence of Chronic Kidney Disease in Asian Populations. Ann Intern Med. 2009;151:892-893. doi: 10.7326/0003-4819-151-12-200912150-00014
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Published: Ann Intern Med. 2009;151(12):892-893.
TO THE EDITOR:
Levey and colleagues (1) presented a new equation for estimating glomerular filtration rate (GFR), the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and compared the prevalence of chronic kidney disease (CKD) in the U.S. population estimated by the new equation with the prevalence estimated by the MDRD (Modification of Diet in Renal Disease) Study equation. The authors reported that the new CKD-EPI equation gives a lower estimated prevalence of CKD than the MDRD Study equation and suggested testing this new equation in other ethnic groups. Recent studies in Asian populations show that the epidemiologic pattern and the relative contribution of some of the known CKD risk factors, such as blood pressure (2) and body mass index (3), differ between Asian and Western populations. We examined the prevalence of CKD as estimated by the MDRD Study equation (4) and by the new CKD-EPI equation (1) in a multiethnic Asian population (n = 4498) comprising Chinese (66.7%), Malay (17.5%), and Indian (15.8%) participants aged 24 years or older who participated in the Singapore Prospective Study Programme, a population-based, cross-sectional study in Singapore (5). We defined CKD as an estimated GFR less than 60 mL/min per 1.73 m2 or micro- or macroalbuminuria (urinary albumin–creatinine ratio ≥17 mg/g for men and ≥25 mg/g for women). In keeping with the results from Levey and colleagues, the median estimated GFR by CKD-EPI was 3.7 mL/min per 1.73 m2 higher than that estimated by MDRD; however, both equations yielded a similar prevalence of CKD (21.5% with CKD-EPI vs. 21.7% with MDRD), with a prevalence of 18.5% with CKD-EPI versus 18.6% with MDRD in Chinese, 28.5% versus 28.6% in Malay, and 26.7% versus 27.0% in Indian participants. However, compared with MDRD, the CKD-EPI equation leads to a higher prevalence of stage 1 CKD (7.1% vs. 6.5%), a lower prevalence of stage 2 CKD (8.3% vs. 9.1%), and a similar prevalence of stage 3 or higher CKD (6.1% vs. 6.2%)—a pattern seen in all 3 Asian ethnic groups. Although we did not have a gold standard measurement for GFR to compare the performance of the 2 equations, our study indicates that the new CKD-EPI equation is broadly useful for estimating CKD prevalence in 3 common racial ethnic groups in Asia.
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