Correspondence
Need to Rethink
;
The publication of population-based data from the DEGS1 adds scientific value. These data supplement population-based data from Germany which have already systematically been used by European (1) and other global consortia (Chronic Kidney Disease Prognosis Consortium) (2). The available data show that the estimated prevalence, especially among the relevant age groups, is significantly higher when the glomerular filtration rate is estimated (eGFR) solely on the basis of creatinine-based methods. Consequently, a significant number of, especially older, patients is classed incorrectly. In the age group 70–79 years, prevalence can easily be overestimated by factor two to three (3). The DEGS1 already followed the recommendations of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) working group and used the combination of serum creatinine levels and serum cystatin C levels (2). This method has not yet found the widespread adoption into both clinical practice and research it deserves. However, according to recent data, estimating GFR based on cystatin C levels results in a more accurate classification, regardless whether it used alone or in combination with creatinine levels (2, 3). This level of accuracy is required, on the one hand, to arrive at a valid estimate of the burden of renal failure in the population and, on the other hand, to support patients in diagnostic and therapeutic decision making. It is true that the creatinine-based diagnosis of renal failure has a long tradition and is very cost-effective, but, according to the extensive available data, the time appears to be ripe for combining cystatin C, for which a globally defined reference standard is now available, with the traditional method in certain situations.
DOI: 10.3238/arztebl.2016.0505a
Prof. Dr. med. Dietrich Rothenbacher, MPH
Institut für Epidemiologie und Med. Biometrie,
Universität Ulm
dietrich.rothenbacher@uni-ulm.de
Prof. Dr. med. Wolfgang Koenig
Klinik für Herz- & Kreislauferkrankungen
Deutsches Herzzentrum München,
Technische Universität München, Germany
| 1. | Brück K, Stel VS, Gambaro G, et al.: Chronic kidney disease prevalence varies across European general population. J Am Soc Nephrol 2015 Dec 23. pii: ASN.2015050542. [Epub ahead of print]. |
| 2. | Shlipak MG, Matsushita K, Ärnlöv J, et al.: Cystatin C versus creatinine in determining risk based kidney function. N Engl J Med 2013; 369: 932–43 CrossRef MEDLINE PubMed Central |
| 3. | Rothenbacher D, Klenk J, Denkinger M, Karakas M, Nikolaus T, Peter R, Koenig W: Prevalence and determinants of chronic kidney disease in community-dwelling elderly by various estimating equations. BMC Public Health 2012; 12: 343 CrossRef MEDLINE PubMed Central |
| 4. | Girndt M, Trocchi P, Scheidt-Nave C, Markau S, Stang A: The prevalence of renal failure—results from the German Health Interview and Examination Survey for Adults, 2008–2011 (DEGS1). Dtsch Arztebl Int 2016; 113: 85–91 VOLLTEXT |
