Nefrologia · 2026
What is the clinical impact of using EKFC equation for estimating glomerular filtration rate by creatinine in kidney transplant recipients?
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Martínez-Belotto Miguel, Ortega María José, López Del Moral Covadonga, Valero Rosalía, Ruiz Juan Carlos, Valentín María de la Oliva, Rodrigo Emilio
Аннотация
BACKGROUND AND OBJECTIVE: Chronic kidney disease (CKD) is a prevalent condition, typically assessed using indirect markers such as estimated glomerular filtration rate (eGFR). The CKDEPI-2009 equation has been the most widely used estimation equation over the past decade. However, due to its limitations, alternative formulas aiming for greater accuracy compared to measured GFR (mGFR) have been developed. In 2020, the European Kidney Function Consortium (EKFC) validated a new, more precise equation covering the full age spectrum, which has been studied in various populations but remains underexplored in kidney transplant recipients. Our objectives were to evaluate the impact of changing estimation equations in this population, to measure comorbidity prediction and to check CKD reclassification.
MATERIALS AND METHODS: We conducted a retrospective observational study including all kidney transplant recipients at our center from 2006 to 2022 with graft survival greater than one year. We analyzed differences between CKD-EPI 2009 and EKFC across the entire cohort and within subgroups based on diabetes mellitus, sex, and age. We compared the prediction of CKD-related comorbidities, including anemia, acidosis, hyperkalemia, and hyperphosphatemia. We assessed concordance and reclassification across CKD stages based on KDIGO criteria.
RESULTS: In a cohort of 616 kidney transplant recipients, EKFC and CKD-EPI 2009 showed a high correlation with excellent agreement across all subgroups (Intraclass Correlation Coefficient = 0.9945). EKFC provided significantly lower estimates than CKD-EPI 2009 (-0.2 mL/min/1.73 m²), particularly in CKD stages 1-3a, in women (-0.6 mL/min/1.73 m2), and in patients over 60 years (-1.4 mL/min/1.73 m²). Concordance in KDIGO staging was very good (weighted κ = 0.946). EKFC reclassified 6.5% of patients into a different CKD stage, mainly in earlier stages and more frequently in patients over 60. ROC curve analysis showed no clinically significant differences in predicting CKD-related comorbidities.
CONCLUSIONS: In kidney transplant recipients, EKFC and CKD-EPI 2009 show high correlation and are largely interchangeable. EKFC yields slightly lower eGFR values, particularly in women, older patients, and those with mild CKD, but the magnitude of these differences is small and of limited clinical relevance. These findings are consistent with the literature in this underrepresented population.
MATERIALS AND METHODS: We conducted a retrospective observational study including all kidney transplant recipients at our center from 2006 to 2022 with graft survival greater than one year. We analyzed differences between CKD-EPI 2009 and EKFC across the entire cohort and within subgroups based on diabetes mellitus, sex, and age. We compared the prediction of CKD-related comorbidities, including anemia, acidosis, hyperkalemia, and hyperphosphatemia. We assessed concordance and reclassification across CKD stages based on KDIGO criteria.
RESULTS: In a cohort of 616 kidney transplant recipients, EKFC and CKD-EPI 2009 showed a high correlation with excellent agreement across all subgroups (Intraclass Correlation Coefficient = 0.9945). EKFC provided significantly lower estimates than CKD-EPI 2009 (-0.2 mL/min/1.73 m²), particularly in CKD stages 1-3a, in women (-0.6 mL/min/1.73 m2), and in patients over 60 years (-1.4 mL/min/1.73 m²). Concordance in KDIGO staging was very good (weighted κ = 0.946). EKFC reclassified 6.5% of patients into a different CKD stage, mainly in earlier stages and more frequently in patients over 60. ROC curve analysis showed no clinically significant differences in predicting CKD-related comorbidities.
CONCLUSIONS: In kidney transplant recipients, EKFC and CKD-EPI 2009 show high correlation and are largely interchangeable. EKFC yields slightly lower eGFR values, particularly in women, older patients, and those with mild CKD, but the magnitude of these differences is small and of limited clinical relevance. These findings are consistent with the literature in this underrepresented population.