Comparison of low eGFR prevalence and prediction of all-cause and cardiovascular mortality using 2009 and 2021 CKD-EPI equations in Mexican adults

ABSTRACT

BACKGROUND Accurate estimation of glomerular filtration rate (eGFR) is essential for identifying and managing chronic kidney disease (CKD). The CKD-EPI 2021 equation removed the race coefficient from the 2009 version, but its impact in Mexican populations remains unclear.

OBJECTIVE To compare eGFR category prevalence and the prognostic performance of the CKD-EPI 2009 and 2021 creatinine-based eGFR equations in Mexican adults.

METHODS We evaluated 25,236 adults ≥20 years from the 2016-2023 cycles of the Mexican National Health and Nutrition Survey (ENSANUT) to estimate national CKD and eGFR category prevalence using both equations. We also assessed 10-year all-cause and cardiovascular mortality risk in 143,410 adults from the Mexico City Prospective Study (MCPS) using adjusted Cox regression models.

RESULTS In ENSANUT 2023, prevalence of eGFR <60mL/min/1.73m2 was lower with CKD-EPI 2021 (2.8% 95%CI 1.47-4.13) compared to 2009 (3.4% 95%CI 1.79-5.01). The 2021 equation resulted in upward reclassification of eGFR in 6.2% of adults, particularly among older adults and those with hypertension or diabetes, yielding a reduction in 496,362 adults identified with eGFR <60mL/min/1.73m2 compared to the 2009 equation. In MCPS, upward reclassification between eGFR categories occurred in 8.3% of participants, and both equations showed similar discrimination for 10-year all-cause (c-statistics: 0.672 for both) and cardiovascular mortality (0.686 vs. 0.685), with similar performance and calibration.

CONCLUSIONS The CKD-EPI 2021 equation yields lower prevalence of low eGFR but maintains similar predictive accuracy for mortality compared to the 2009 version. Findings support the use of the 2009 equation for population health monitoring in Mexico without compromising prognostic utility.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

FUNDING: This research was supported by Instituto Nacional de Geriatria in Mexico.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

All code and materials regarding ENSANUT are available for reproducibility of results http://github.com/oyaxbell/ckdepi_mcps_ensanut/. All ENSANUT data is fully anonymized and has been analyzed after being downloaded from the open repository, which can be found here: https://ensanut.insp.mx/. Data from the Mexico City Prospective Study are available to bona fide researchers. For more details, the study's Data and Sample Sharing policy may be downloaded (in English or Spanish) from https://www.ctsu.ox.ac.uk/research/mcps. Available study data can be examined in detail through the study's Data Showcase, available at https://datashare.ndph.ox.ac.uk/mexico/.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All code and materials regarding ENSANUT are available for reproducibility of results http://github.com/oyaxbell/ckdepi_mcps_ensanut/. Data from the Mexico City Prospective Study are available to bona fide researchers. For more details, the study's Data and Sample Sharing policy may be downloaded (in English or Spanish) from https://www.ctsu.ox.ac.uk/research/mcps. Available study data can be examined in detail through the study's Data Showcase, available at https://datashare.ndph.ox.ac.uk/mexico/.

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