Evaluating CKD-EPI Pakistan Against Standard Equations Using Diethylenetriaminepentaacetic Acid-Measured Glomerular Filtration Rate.

Authors

Muhammad Shahzil, Nayyar Saleem, Muhammad Rashid Asghar, Aimon Riaz, Noor Ul Ain, Ahmed Sheraz

Published in

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. Volume 36. Issue 11. Pages 1468-1473.

Abstract

To evaluate and compare the accuracy of creatinine-based equations, including the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Pakistan, CKD-EPI 2021, and Modification of Diet in Renal Disease (MDRD) equations, against gold-standard diethylenetriaminepentaacetic acid (DTPA) clearance for estimating glomerular filtration rate (GFR) in healthy Pakistani adults.
A descriptive, cross-sectional study. Place and Duration of the Study: Department of Nephrology, Multan Institute of Kidney Diseases, Multan, Pakistan, from January 2021 to June 2025.
This study retrospectively analysed data from 223 healthy adults who underwent routine donor screening for kidney transplantation. GFR values estimated using CKD-EPI Pakistan, CKD-EPI 2021, and MDRD equations were compared to DTPA-measured GFR. Pearson correlation coefficients were used to assess correlation, Bland-Altman analysis was used to assess agreement, and precision was assessed using mean absolute error (MAE) and root mean square error (RMSE).
All equations demonstrated a tendency to overestimate GFR compared with DTPA (mean GFR values: MDRD 123.8 ± 28.56, CKD-EPI 2021 119.94 ± 11.72, CKD-EPI Pakistan 109.16 ± 11.28 vs. DTPA 99.92 ± 12.61 mL/min/1.73 m2). CKD-EPI Pakistan demonstrated the smallest bias (9.24 mL/min; limits of agreement (LOA): -21.92 to 40.39 mL/min) and greatest precision (MAE 14.15; RMSE 18.38), whereas MDRD had the largest bias (23.88 mL/min; LOA: -36.66 to 84.42 mL/min) and poorest precision (MAE 29.27; RMSE 39.04). Correlation with DTPA was weak for all equations. CKD-EPI Pakistan showed the best agreement overall.
The CKD-EPI Pakistan equation provided the most accurate and reliable GFR estimates among healthy Pakistani adults, indicating the benefit of region-specific calibration. However, international validation studies are required to confirm broader applicability and support global clinical guideline adjustments.
Glomerular filtration rate, Creatinine, Radionuclide imaging, Kidney function tests, Technetium Tc 99m pentetate.

PMID:
43016085
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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