Wide-ranging performance of different eGFR equations in stage determination of Chronic Kidney Disease patients from endemic areas for CKD in Sri Lanka


  • Athige R. N. Silva Department of Basic Sciences, Faculty of Allied Health Sciences, Ratmalana, Sri Lanka
  • J. M. Kithsiri B. Jayasekara 2Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Ratmalana, Sri Lanka
  • P. G. Chandra L. Nanayakkara Department of Anatomy, Faculty of Medicine, University of Ruhuna, Karapitiya, Sri Lanka
  • S. H. Nandana P. Gunawickrama Institute for Combinatorial Advanced Research and Education, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka




Chronic kidney disease, Chronic kidney disease of unknown etiology, Estimated glomerular filtration rate, Urine albumin to creatinine ratio


Background: Chronic kidney disease of unknown etiology (CKDu) is a public health issue at epidemic proportions in North Central, Uwa and other provinces of Sri Lanka. The initial diagnosis and stage determination of the disease are based on estimated glomerular filtration rate (eGFR), and urine albumin to creatinine ratio (UACR) particularly at community level screening. In this context, harmony and performance of pertaining equations were verified.

Methods: Three hundred and ninety-nine (399) volunteer CKD patients were recruited from select CKDu high prevalence areas (Padaviya, Girandurukotte, and Mahiyanganaya). Performance of kidney dysfunction determinants; serum creatinine (SCr), and serum Cystatin C (CysC), as well as markers; UACR, and eGFR variants; SCr based MDRD, SCr based EPI, serum CysC based EPI and SCr and CysC based EPI were scrutinized in terms of kidney disease improving global outcomes (KDIGO) heat-map guidelines.

Results: Notable deviation was observed between SCr-based and CysC-based equations at early development of the disease (stage G1) suggesting that the latter may tend to under estimate disease development initially. UACR successfully confirmed diagnosis from eGFR equations including G1 proteinuric subjects (G1).

Conclusions: Comparative study of marker performances should improve eGFR based identification of initial CKDu cases in Sri Lanka.


Andrew SL, Josef C, Ethan B, Annamaria TK, Adeera L, Michael WS, et al. National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Ann Intern Med. 2003;139.

Inker LA, Schmid CH, Tighiouart H, Eckfeldt JN, Feldman HI, Greene T, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012;367:20-9

Lopez-Giacoman S, Madero M. Biomarkers in chronic kidney disease, from kidney function to kidney damage. World J Nephrol. 2015;6;4(1):57-73.

Myers GL, Miller WG, Coresh J, Fleming J, Greenberg N, Greene T, et al. Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin Chem. 2006;52:5-18.

Poggio ED, Wang X, Green T, Van Lente F, Hall PM. Performance of the modification of diet in renal disease and Cockcroft-gault equation in the estimation of GFR in health and chronic kidney disease. J Am Soc Nephrol. 2005;16:459-66.

Jalaonmuhali M, Lim SK, Shah MNM, Peng Ng K. MDRD versus CKD-EPI in comparison to 51Vhromium EDTA: a cross-sectional study of Malaysian CKD cohort. BMC Nephrol. 2017;18:363.

Toffaletti JG. Clarifying the confusion of eGFRs, creatinine, and cystatin C. Available from: https://acutecaretesting.org/en/articles/clarifying-the-confusion-of-gfrs-creatinine-and-cystatin-c Accessed on 2 June 2019.

Kumaresan R, Giri P. A comparison of serum cystatin C and creatinine with glomerular filtration rate in Indian patients with chronic kidney disease (2011). Oman Med J. 2011;26(6)6421-5.

Karimzadeh I, Khalili H. Comparison between serum creatinine and a cystatin C-based glomerular filtration rate equation in patients receiving amphotericin B. DARU J Pharm Sci. 2016;24:16.

Royakkers AA, van Suijlen JD, Hofstra LS, Kuiper MA, Bouman CS, Spronk PE, et al. Serum cystatin C-A useful endogenous marker of renal function in intensive care unit patients at risk for or with acute renal failure? Curr Med Chem. 2007;14(21):2314-7.

Shlipak MG, Matsushita K, Arnlov J, Inker LA, Katz R, Polkinghorn KR, et al. Cystatin C versus creatinine determining risk based on kidney function. New Engl J Med. 2013;369(10):932-43.

Schaeffner ES, Ebert N, Delanaye P. Two novel equations to estimate kidney function in persons aged 70 years or older. Ann Intern Med. 2012;157:471-81.

Peralta CA, Shilpak MG, Judd S, Cushman M, McClellan W, Zakai NA, et al. Detection of chronic kidney disease with creatinine, cystatin C and urine albumin to creatinine ratio and association with progression to end stage renal disease and mortality. JAMA. 2011;305(15):1545-52.

Levin A, Stevens PE. Summary of KDIGO 2012 CKD Guideline: behind the scenes need for guidance and a framework for moving forward. Kidney Int. 2013;85:49-61.

Jayasekara JMKB, Dissanayake DM, Sivakanesan R, Ranasinghe A, Kumara P, Karunarathna RH. Epidemiology of chronic kidney disease with special emphasis on chronic kidney disease of uncertain etiology in the north central region of Sri Lanka. J Epidemiol. 2015;25(4):275-80.

Waad-Allah S. Mula-Abed, Rasadi KA, Al-Riyami D. Estimated glomerular filtration rate (eGFR): a serum creatinine-based test for the detection of chronic kidney disease and its impact on clinical practice. Oman Med J. 2012;27(2):108-13.

Jafar TH, Christopher H. Schmid CH, Levey AS. Serum creatinine as marker of kidney function in south Asians: a study of reduced GFR in adults in Pakistan. J Am Soc Nephrol. 2005;16:1413-9.

Teo BW, Xu H, Wang D, Li J, Sinha AK, Shuter B, et al. GFR Estimating equations in a multiethnic Asian Population. Am J Kidney Dis. 2011;58:56-63.

Shardlow A, Mcintyre NJ, Fraser SDS, Roderick P, Raftery J, Fluck RJ, et al. The clinical utility and cost impact of cystatin C measurement in the diagnosis and management of chronic kidney disease: A primary care cohort study. PLoS Med. 2017;14(10)

Stevens LA, Schmid CH, Greene T, Li L, Beck GJ, Joffe MM, et al. Factors other than glomerular filtration rate affect serum cystatin C levels. Kidney Int. 2009;75:652-60.

Mussap M, Vestra MD, Fioretto P, Saller A, Varagnolo M, Nosadini R, et al. Cystatin C is a more sensitive marker than creatinine for the estimation of GFR in type 2 diabetic patients. Kidney Int. 2002;61:1453-61.

Levey AS, Fan L, Eckfeldt JH, Inker LA. Cystatin C for glomerular filtration rate estimation: coming of age. Clin Chem. 2014;60(7):916-9.

Mingels A, Jacobs L, Kleijnen V, Wodzig W, van Dieijen-Visser M. Cystatin C a Marker for renal function after exercise. Int J Sports Med. 2009;30:668-71.




How to Cite

Silva, A. R. N., Jayasekara, J. M. K. B., Nanayakkara, P. G. C. L., & Gunawickrama, S. H. N. P. (2023). Wide-ranging performance of different eGFR equations in stage determination of Chronic Kidney Disease patients from endemic areas for CKD in Sri Lanka. International Journal Of Community Medicine And Public Health, 10(3), 937–942. https://doi.org/10.18203/2394-6040.ijcmph20230604



Original Research Articles