Diagnostic Accuracy of Creatinine-Based Equations for eGFR Estimation in Pakistanis: Evaluation of the European Kidney Function Consortium Equation vs the CKD-EPI Pakistan Equation

Introduction Chronic Kidney Disease (CKD) is prevalent in Pakistan, necessitating accurate diagnostic methods. This study evaluates the CKD-EPI 2009, CKD-EPI 2021, CKD-EPI Pak, MDRD, and EKFC equations against creatinine clearance (CrCl) to determine their diagnostic accuracy for CKD in the Pakistani population. Methods n a retrospective cross-sectional study, data from 2,310 participants aged 18-70 were analyzed at The Aga Khan University in Karachi. Serum creatinine (SCr) and CrCl were recorded, and eGFR was calculated using five equations. Statistical analyses compared eGFR equations with CrCl, assessing sensitivity, specificity, and predictive values. Results EPI-Pak exhibited the highest sensitivity (95.15%) and agreement (94.85%) followed by EPI-2009 and EPI-2021 which showed the closest agreement with CrCl. Bland-Altman plots also indicated that EPI-Pak had the best agreement with CrCl. Discussion EPI-Pak outperformed other equations in estimating eGFR for the Pakistani population, aligning with previous recommendations for South Asians. EKFC, although highly specific, was less effective overall. Conclusion EPI-Pak is the most accurate equation for diagnosing CKD in the Pakistani population. Its clinical implementation could improve CKD diagnosis and patient outcomes. Future studies should further validate these findings with larger, diverse samples.