Glomerular Filtration Rate Estimation in Chronic Kidney Disease
Summary
The glomerular filtration rate (GFR) is the principal index of kidney function, connoting the volume of plasma cleared by the glomerular capillaries per unit time. Precise measurement of GFR via clearance techniques is resource-intensive; therefore, clinical practice relies upon estimating equations that incorporate biomarkers, chiefly serum creatinine and cystatin C, alongside demographic factors. Accurate estimation of GFR underpins diagnosis, staging and management of chronic kidney disease (CKD), informing decisions on drug dosing, referral for specialist care and timing of renal replacement therapy. However, variations in muscle mass, diet, inflammation and demographic diversity challenge the universality of contemporary equations. Recent efforts to refine these equations have targeted removal of race coefficients, integration of dual biomarkers and regional validation in under-studied populations. As the global burden of CKD rises, international collaboration seeks to harmonise estimation approaches, enhance equity in clinical assessment and improve prognostic precision across diverse patient groups.
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Glomerular Filtration Rate Estimation in Chronic Kidney Disease publication trend
The graph below shows the total number of articles in glomerular filtration rate estimation in chronic kidney disease across all publications each year (not limited to Nature Index journals).
Technical terms
Glomerular filtration rate (GFR): The volume of plasma filtered by the renal glomeruli per minute, reflecting kidney function.
Estimated GFR (eGFR): A calculated approximation of GFR derived from serum biomarkers and demographic variables using established equations.
Serum creatinine: A metabolite of creatine processed by muscles, used as a surrogate marker for filtering capacity but influenced by muscle mass.
Cystatin C: A low-molecular-weight protein produced by all nucleated cells, freely filtered by the glomerulus and independent of muscle mass.
CKD-EPI equation: A widely used eGFR formula developed by the Chronic Kidney Disease Epidemiology Collaboration, incorporating creatinine, cystatin C or both, and demographic factors without race coefficients in its 2021 revision.
References
- Use of Race in Kidney Function Estimation: Lessons Learned and the Path Toward Health Justice. Annual Review of Medicine (2023).
- Creatinine, cystatin C, muscle mass, and mortality: Findings from a primary and replication population‐based cohort. Journal of Cachexia Sarcopenia and Muscle (2024).
- National Kidney Foundation Laboratory Engagement Working Group Recommendations for Implementing the CKD-EPI 2021 Race-Free Equations for Estimated Glomerular Filtration Rate: Practical Guidance for Clinical Laboratories. Clinical Chemistry (2021).
- Measurement of kidney function in Malawi, South Africa, and Uganda: a multicentre cohort study. The Lancet Global Health (2022).
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