Original Article
Estimated glomerular filtration rate and functional status among older people: A systematic review

https://doi.org/10.1016/j.ejim.2018.05.030Get rights and content
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Highlights

  • The association CKD-frailty/disability may be affected by the eGFR equation used.

  • Only few cross-sectional and longitudinal studies compared different equations.

  • Cystatin C- but not creatinine-eGFR may be associated with functional status.

  • Studies including recent eGFR equations developed for older people are lacking.

  • Evidence does not allow to prove which eGFR equation may better predict function.

Abstract

Background

The association between chronic kidney disease (CKD) and functional status may change as a function of the equation used to estimate glomerular filtration rate (eGFR). We reviewed the predictive value of different eGFR equations in regard to frailty and disability outcomes.

Methods

We searched Pubmed from inception to March 2018 for studies investigating the association between eGFR and self-reported and/or objective measures of frailty or disability. Cross-sectional and longitudinal studies were separately analysed.

Results

We included 16 studies, one of which reporting both cross-sectional and longitudinal data. Three out of 7 cross-sectional studies compared different eGFR equations in regard to their association with functional status: two studies showed that cystatin C-based, but not creatinine-based eGFR may be associated with hand-grip strength or frailty; another study showed that two different creatinine-based eGFR equations may be similarly associated with disability. Four out of 10 longitudinal studies provided comparative data: two studies reported similar association with disability for different creatinine-based eGFR equations; one study showed that creatinine-based eGFR was not associated with frailty, but a not significant trend for association was observed with cystatin C-based eGFR; one study showed that cystatin C-based but not creatinine-based eGFR may predict incident mobility disability, while both methods may predict gait speed decline. High heterogeneity was observed in regard to confounders included in reviewed studies. None of them included the most recently published equations.

Conclusion

Available data do not support the superiority of one of the eGFR equations in terms of measuring or predicting functional decline.

Keywords

Estimated glomerular filtration rate (eGFR)
Creatinine
Cystatin C
Frailty
Disability

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