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However, empirical evidence and solutions remain insufficient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective cohort study, we compared the performance of equation methods for predicting all\u2010cause mortality; we used 24\u2010h creatinine clearance (24\u2010h CrCl), equation\u2010based eGFRs, and a new eGFR estimating equation weighting for population 24\u2010h urine creatinine excretion rate (U\u2010CER). From 2003 to 2018, we identified 4986 patients whose data constituted the first 24\u2010h CrCl measurement data in the Clinical Research Data Repository of China Medical University Hospital and were followed up for at least 5\u00a0years after careful exclusion. Three GFR estimation equations [the Chronic Kidney Disease Epidemiology Collaboration (CKD\u2010EPI), Modification of Diet in Renal Disease (MDRD) Study, and Taiwanese MDRD], 24\u2010h CrCl, and 24\u2010h U\u2010CER\u2013adjusted eGFR were used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A high correlation was observed among the eGFR levels derived from the equation methods (0.995\u20131.000); however, the correlation decreased to 0.895\u20130.914 when equation methods were compared with the 24\u2010h CrCl or 24\u2010h U\u2010CER\u2013adjusted equation\u2010based eGFR. In the Bland\u2013Altman plots, the average discrepancy between the equation methods and the 24\u2010h CrCl method was close to zero (maximal bias range: 5.12 for the Taiwanese MDRD equation vs. 24\u2010h CrCl), but the range in limit of agreement was wide, from \u00b143.7\u00a0mL\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup> for the CKD\u2010EPI equation to \u00b154.3\u00a0mL\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup> for the Taiwanese MDRD equation. A J\u2010shaped dose\u2013response relationship was observed between all equation\u2010based eGFRs and all\u2010cause mortality. Only 24\u2010h CrCl exhibited a non\u2010linear negative dose\u2013response relationship with all\u2010cause mortality. After adjustment for 24\u2010h U\u2010CER in the statistical model, the paradoxical increase in mortality risk for an eGFR of &gt;90\u00a0mL\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup> returned to null. When 24\u2010h U\u2010CER was used directly to correct eGFR, the monotonic non\u2010linear negative relationship with all\u2010cause mortality was almost identical to that of 24\u2010h CrCl.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The 24\u2010h U\u2010CER\u2013adjusted eGFR and 24\u2010h CrCl are viable options for informing mortality risk. The 24\u2010h U\u2010CER adjustment method can be practically implemented to eGFR\u2010based care and effectively mitigate the inherent confounding biases from individual's muscle mass amount due to both sex and racial differences.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.12951","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T09:50:31Z","timestamp":1646646631000},"page":"1704-1716","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Paradoxical mortality of high estimated glomerular filtration rate reversed by 24\u2010h urine creatinine excretion rate adjustment: sarcopenia matters"],"prefix":"10.1002","volume":"13","author":[{"given":"Pei\u2010Yu","family":"Kao","sequence":"first","affiliation":[{"name":"Division of Chest Surgery, Department of Surgery China Medical University Hospital and College of Medicine, China Medical University  Taichung 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