Performance of GFR Estimation in Finnish Children and Adolescents
4 affiliations
- 1Faculty of Medicine, University of Helsinki, Helsinki, Finland
- 2Department of Pediatric Nephrology and Transplantation, New Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- 3Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
- 4Department of Clinical Chemistry, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Abstract
Introduction: The accuracy of estimating glomerular filtration rate (GFR) using endogenous biomarkers has been widely studied, and many GFR estimating equations have been proposed. In this study, we compared the performance of these equations in a Finnish population and evaluated their accuracy in different age groups and categories based on measured GFR (mGFR).
Methods: Our study included patients under the age of 20 years whose GFR was measured between September 2014 and April 2025. Patient information was collected retrospectively from the Helsinki University Hospital electronic data lake. GFR was estimated with multiple equations, using either a single analyte or a combination of analytes, and was compared with mGFR in terms of bias, precision, and accuracy.
Results: Our cohort consisted of 516 patients aged from 0.8 to 19.9 years with a history of solid organ transplantation, malignancy, or suspected kidney impairment. In general, creatinine-cystatin C-based combination equations exhibited better performance than single-analyte equations. Despite developed using cystatin C not calibrated to International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) reference material, the Chronic Kidney Disease in Children (CKiD) (2012) combination equation had the lowest median bias (0.1 ml/min per 1.73 m2), interquartile range (IQR; 14.6 ml/min per 1.73 m2), and the highest P10 and P30 accuracies (47.3% and 94.6%, respectively). Moreover, it surpassed the P30 threshold of 90% in all age groups. Other combination equations showed similar median bias (between 2.6 and 4.0 ml/min per 1.73 m2) and P30 accuracy (between 86.4% and 90.1%), with overlapping 95% confidence intervals (CIs).
Conclusion: Combination equations provided more accurate estimates of GFR than single-analyte equations. Selected combination equations accurately estimated GFR across all age groups, a finding that is likely population dependent.
Related
- Associations of rope-skipping and endurance running performance with myopia and spherical equivalent refraction in children and adolescents: a cross-sectional study
- Performance of a 15-Day Continuous Glucose Monitoring System in Children and Adolescents With Diabetes.
- Excessive Internet Use among Finnish Adolescents - Prevalence in 2017 - 2023 and Associations with Well-being
- The FINRISK cardiovascular risk calculator: Strong predictive performance in a Finnish population
- Beyond Fertility: Ethical and Psychosocial Dimensions of Fertility Preservation in Children and Adolescents
BibTeX
@article{hiltunen2026performance,
title = {{Performance of GFR Estimation in Finnish Children and Adolescents}},
author = {Elmeri Hiltunen and Pauliina M. Mäkelä and Jukka Schildt and Kari Pulkki and Tapio Lahtiharju and Timo Jahnukainen},
journal = {Kidney International Reports},
year = {2026},
month = sep,
doi = {10.1016/j.ekir.2026.107082},
url = {https://doi.org/10.1016/j.ekir.2026.107082},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Performance of GFR Estimation in Finnish Children and Adolescents
AU - Elmeri Hiltunen
AU - Pauliina M. Mäkelä
AU - Jukka Schildt
AU - Kari Pulkki
AU - Tapio Lahtiharju
AU - Timo Jahnukainen
PY - 2026
DA - 2026/09/17
JO - Kidney International Reports
DO - 10.1016/j.ekir.2026.107082
UR - https://doi.org/10.1016/j.ekir.2026.107082
AB - Introduction: The accuracy of estimating glomerular filtration rate (GFR) using endogenous biomarkers has been widely studied, and many GFR estimating equations have been proposed. In this study, we compared the performance of these equations in a Finnish population and evaluated their accuracy in different age groups and categories based on measured GFR (mGFR). Methods: Our study included patients under the age of 20 years whose GFR was measured between September 2014 and April 2025. Patient information was collected retrospectively from the Helsinki University Hospital electronic data lake. GFR was estimated with multiple equations, using either a single analyte or a combination of analytes, and was compared with mGFR in terms of bias, precision, and accuracy. Results: Our cohort consisted of 516 patients aged from 0.8 to 19.9 years with a history of solid organ transplantation, malignancy, or suspected kidney impairment. In general, creatinine-cystatin C-based combination equations exhibited better performance than single-analyte equations. Despite developed using cystatin C not calibrated to International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) reference material, the Chronic Kidney Disease in Children (CKiD) (2012) combination equation had the lowest median bias (0.1 ml/min per 1.73 m2), interquartile range (IQR; 14.6 ml/min per 1.73 m2), and the highest P10 and P30 accuracies (47.3% and 94.6%, respectively). Moreover, it surpassed the P30 threshold of 90% in all age groups. Other combination equations showed similar median bias (between 2.6 and 4.0 ml/min per 1.73 m2) and P30 accuracy (between 86.4% and 90.1%), with overlapping 95% confidence intervals (CIs). Conclusion: Combination equations provided more accurate estimates of GFR than single-analyte equations. Selected combination equations accurately estimated GFR across all age groups, a finding that is likely population dependent.
SN - 2468-0249
ER -