{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T20:21:42Z","timestamp":1789158102399,"version":"build-2803163510"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2023-01807"],"award-info":[{"award-number":["2023-01807"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01DK115534"],"award-info":[{"award-number":["R01DK115534"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Swedish Heart and Lung Foundation","award":["20230371"],"award-info":[{"award-number":["20230371"]}]},{"DOI":"10.13039\/501100002997","name":"Dutch Kidney Foundation","doi-asserted-by":"publisher","award":["22OK2026"],"award-info":[{"award-number":["22OK2026"]}],"id":[{"id":"10.13039\/501100002997","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Karolinska Institutet Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The European Kidney Function Consortium (EKFC) 2021 equation to estimate GFR performs as well or better than the CKD-EPI 2009 equation in predominantly White adult European populations, with less bias and greater accuracy against measured GFR. This study explores how changing from the CKD-EPI to the EKFC equation in a large European health system may affect disease distribution, prognosis, and clinical decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We studied &amp;gt;1.7 million adults in Stockholm undergoing routine care during 2006\u20132021. We compared eGFR values and reclassification across KDIGO GFR categories when changing from the CKD-EPI to EKFC equation and examined associations of eGFR and reclassification with risk for kidney failure with replacement therapy (KFRT), mortality, and major adverse cardiovascular events (MACE) using Cox models. We also modeled the impact of eGFR equation change on clinical decisions such as nephrology referral or medication eligibility\/contraindication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>EKFC yielded modestly lower eGFR values than CKD-EPI by a median (IQR) of \u22124.9 (\u22128.3 to \u22122.2) ml\/min\/1.73 m\u00b2. As a result, CKD G3\u2013G5 prevalence rose from 4.5% to 6.2%. Both equations strongly predicted KFRT, mortality, and MACE. Participants reclassified to lower eGFR categories were older; after adjustment for age, participants had similar risks of mortality and MACE to those not reclassified and a lower risk of KFRT. Changing to the EKFC equation would impact clinical decisions at low eGFR thresholds, such as nephrology referrals (22% higher), eligibility for SGLT2 is (39% higher), or contraindication for spironolactone in heart failure (26% higher).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adopting the EKFC equation in this Northern European health system would modestly lower eGFR estimates, increasing the prevalence of moderate\/severe CKD and affecting clinical classification and decisions. eGFR by both equations strongly predicted outcomes, but individuals reclassified to a lower eGFR category by EKFC did not have consistent associations across outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfaf148","type":"journal-article","created":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T11:37:38Z","timestamp":1754739458000},"page":"275-285","source":"Crossref","is-referenced-by-count":14,"title":["Changing from the CKD-EPI to the EKFC creatinine equation to estimate glomerular filtration rate in adults in a Northern European health system"],"prefix":"10.1093","volume":"41","author":[{"given":"William A","family":"Russel","sequence":"first","affiliation":[{"name":"Karolinska Institutet Department of Medical Epidemiology and Biostatistics, , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9698-6825","authenticated-orcid":false,"given":"Edouard L","family":"Fu","sequence":"additional","affiliation":[{"name":"Karolinska Institutet Department of Medical Epidemiology and Biostatistics, , Stockholm ,","place":["Sweden"]},{"name":"Leiden University Medical Center Department of Clinical Epidemiology, , Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6498-0257","authenticated-orcid":false,"given":"Antoine","family":"Creon","sequence":"additional","affiliation":[{"name":"Karolinska Institutet Department of Medical Epidemiology and Biostatistics, , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6716-1157","authenticated-orcid":false,"given":"Anne-Laure","family":"Faucon","sequence":"additional","affiliation":[{"name":"Karolinska Institutet Department of Medical Epidemiology and Biostatistics, , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6019-9342","authenticated-orcid":false,"given":"Aurora","family":"Caldinelli","sequence":"additional","affiliation":[{"name":"Karolinska Institutet Department of Medical Epidemiology and Biostatistics, , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9977-8637","authenticated-orcid":false,"given":"Pim","family":"Bouwmans","sequence":"additional","affiliation":[{"name":"Karolinska Institutet Department of Medical Epidemiology and Biostatistics, , Stockholm ,","place":["Sweden"]},{"name":"Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley A","family":"Inker","sequence":"additional","affiliation":[{"name":"Tufts Medical Center Division of Nephrology, Department of Internal Medicine, , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1480-5761","authenticated-orcid":false,"given":"Pierre","family":"Delanaye","sequence":"additional","affiliation":[{"name":"University of Li\u00e8ge Department of Nephrology-Dialysis-Transplantation, , CHU Sart Tilman, Li\u00e8ge ,","place":["Belgium"]},{"name":"H\u00f4pital Universitaire Car\u00e9meau, Universit\u00e9 de Montpellier Department of Nephrology-Dialysis-Apheresis, , N\u00eemes ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Pottel","sequence":"additional","affiliation":[{"name":"KULeuven Campus Kulak Kortrijk Department of Public Health and Primary Care, , Leuven,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9805-9523","authenticated-orcid":false,"given":"Alberto","family":"Ortiz","sequence":"additional","affiliation":[{"name":"IIS-Fundacion Jimenez Diaz UAM Department of Nephrology and Hypertension, , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew S","family":"Levey","sequence":"additional","affiliation":[{"name":"Tufts Medical Center Division of Nephrology, Department of Internal Medicine, , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4763-2024","authenticated-orcid":false,"given":"Juan J","family":"Carrero","sequence":"additional","affiliation":[{"name":"Karolinska Institutet Department of Medical Epidemiology and Biostatistics, , Stockholm ,","place":["Sweden"]},{"name":"Karolinska Institutet, Danderyd Hospital Division of Nephrology, Department of Clinical Sciences, , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"2026013001374211800_bib1","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1038\/s41581-024-00823-3","article-title":"Drug stewardship in chronic kidney disease to achieve effective and safe medication use","volume":"20","author":"Hall","year":"2024","journal-title":"Kidney Int"},{"key":"2026013001374211800_bib2","doi-asserted-by":"publisher","first-page":"S117","DOI":"10.1016\/j.kint.2023.10.018","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"105","author":"Stevens","year":"2024","journal-title":"Kidney Int"},{"key":"2026013001374211800_bib3","first-page":"1","article-title":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"3","author":"Levin","year":"2013","journal-title":"Kidney Int Suppl"},{"key":"2026013001374211800_bib4","doi-asserted-by":"publisher","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"2026013001374211800_bib5","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.1093\/ckj\/sfad039","article-title":"New and old GFR equations: a European perspective","volume":"16","author":"Delanaye","year":"2023","journal-title":"Clin Kidney J"},{"key":"2026013001374211800_bib6","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.7326\/L21-0248","article-title":"Development and validation of a modified full age spectrum creatinine-based equation to estimate glomerular filtration rate","volume":"174","author":"Pottel","year":"2021","journal-title":"Ann Intern Med"},{"key":"2026013001374211800_bib7","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1093\/ndt\/gfac241","article-title":"Performance of creatinine-based equations to estimate glomerular filtration rate in white and black populations in Europe, Brazil and Africa","volume":"38","author":"Delanaye","year":"2023","journal-title":"Nephrol Dial Transplant"},{"key":"2026013001374211800_bib8","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1093\/ndt\/gfad219","article-title":"Accuracy of GFR estimating equations based on creatinine, cystatin C or both in routine care","volume":"39","author":"Fu","year":"2024","journal-title":"Nephrol Dial Transplant"},{"key":"2026013001374211800_bib9","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1515\/cclm-2024-1082","article-title":"Recommendations for European laboratories based on the KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"63","author":"Cavalier","year":"2025","journal-title":"Clin Chem Lab Med"},{"key":"2026013001374211800_bib10","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfaf054","article-title":"Comparison of estimated glomerular filtration rate equations on prediction of mortality, kidney failure, and acute kidney injury","author":"Veltkamp","year":"2025","journal-title":"Nephrol Dial Transplant"},{"key":"2026013001374211800_bib11","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1111\/joim.13418","article-title":"The Stockholm CREAtinine Measurements (SCREAM) project: fostering improvements in chronic kidney disease care","volume":"291","author":"Carrero","year":"2022","journal-title":"J Intern Med"},{"key":"2026013001374211800_bib12","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C-based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med"},{"key":"2026013001374211800_bib13","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1001\/jama.2012.3954","article-title":"Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate","volume":"307","author":"Matsushita","year":"2012","journal-title":"JAMA"},{"key":"2026013001374211800_bib14","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1093\/ije\/dyab256","article-title":"Lessons learnt when accounting for competing events in the external validation of time-to-event prognostic models","volume":"51","author":"Ramspek","year":"2022","journal-title":"Int J Epidemiol"},{"key":"2026013001374211800_bib15","volume-title":"NHS England National Programmes of Care and Clinical Reference Groups","author":"NHS England"},{"key":"2026013001374211800_bib16","doi-asserted-by":"publisher","first-page":"3075","DOI":"10.2337\/dci22-0027","article-title":"Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"45","author":"de Boer","year":"2022","journal-title":"Diabetes Care"},{"key":"2026013001374211800_bib17","article-title":"Use of metformin to treat diabetes now expanded to patients with moderately reduced kidney function","author":"European Medicines Agency","year":"2016"},{"key":"2026013001374211800_bib18","article-title":"Spironolactone: summary of product characteristics","author":"European Medicines Agency","year":"2023"},{"key":"2026013001374211800_bib19","article-title":"Apixaban: summary of product characteristics","author":"European Medicines Agency","year":"2024"},{"key":"2026013001374211800_bib20","doi-asserted-by":"publisher","first-page":"1953","DOI":"10.1681\/ASN.0000000000000227","article-title":"CKD-EPI and EKFC GFR estimating equations: performance and other considerations for selecting equations for implementation in adults","volume":"34","author":"Inker","year":"2023","journal-title":"J Am Soc Nephrol"},{"key":"2026013001374211800_bib21","doi-asserted-by":"publisher","first-page":"e0143205","DOI":"10.1371\/journal.pone.0143205","article-title":"A risk assessment of the Jaffe vs enzymatic method for creatinine measurement in an outpatient population","volume":"10","author":"Schmidt","year":"2015","journal-title":"PLoS ONE"},{"key":"2026013001374211800_bib22","first-page":"1672","article-title":"New equations for estimating the GFR without race. Reply","volume":"386","author":"Inker","year":"2022","journal-title":"N Engl J Med"},{"key":"2026013001374211800_bib23","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1053\/j.ajkd.2015.08.020","article-title":"Discordance between iothalamate and iohexol urinary clearances","volume":"67","author":"Seegmiller","year":"2016","journal-title":"Am J Kidney Dis"},{"key":"2026013001374211800_bib24","article-title":"Population by age and sex. Year 1860-2024 [Excel file]","author":"Statisics Sweden","journal-title":"Statistikdatabasen"},{"key":"2026013001374211800_bib25","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.kint.2022.09.020","article-title":"Defining measures of kidney function in observational studies using routine health care data: methodological and reporting considerations","volume":"103","author":"Carrero","year":"2023","journal-title":"Kidney Int"}],"container-title":["Nephrology Dialysis Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ndt\/advance-article-pdf\/doi\/10.1093\/ndt\/gfaf148\/64014212\/gfaf148.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/41\/2\/275\/64014212\/gfaf148.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/41\/2\/275\/64014212\/gfaf148.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T06:37:54Z","timestamp":1769755074000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ndt\/article\/41\/2\/275\/8230998"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,11]]},"references-count":25,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,8,11]]},"published-print":{"date-parts":[[2026,1,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ndt\/gfaf148","relation":{},"ISSN":["0931-0509","1460-2385"],"issn-type":[{"value":"0931-0509","type":"print"},{"value":"1460-2385","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2025,8,11]]}}}