RESEARCH ARTICLE Comparison of Various Equations for Estimating GFR in Malawi: How to Determine Renal Function in Resource Limited Settings?

Background Chronic kidney disease (CKD) is a probably underrated public health problem in Sub-Saha-ran-Africa, in particular in combination with HIV-infection. Knowledge about the CKD preva-lence is scarce and in the available literature different methods to classify CKD are used impeding comparison and general prevalence estimates. Methods This study assessed different serum-creatinine based equations for glomerular filtration rates (eGFR) and compared them to a cystatin C based equation. The study was conducted in Lilongwe, Malawi enrolling a population of 363 adults of which 32 % were HIV-positive. Results Comparison of formulae based on Bland-Altman-plots and accuracy revealed best perfor-mance for the CKD-EPI equation without the correction factor for black Americans. Analyz-ing the differences between HIV-positive and –negative individuals CKD-EPI systematically overestimated eGFR in comparison to cystatin C and therefore lead to underestimation o