R Code for Quantitative Analysis of a Novel Metabolite Panel to estimate GFR (panel eGFR) in Serum and Plasma using Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS), Clinical Chemistry (2025)
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R code for the statistical analysis of Quantitative Analysis of a Novel Metabolite Panel to estimate GFR (panel eGFR) in Serum and Plasma using Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS), Clinical Chemistry (2025). Background:Estimated GFR (eGFR) using creatinine, cystatin C, or both (eGFRcr, eGFRcys and eGFRcr-cys) is not sufficiently accurate in many settings, often due to non-GFR determinants of the filtration markers. In principle, using a panel of endogenous markers (panel eGFR) could reduce the impact of non-GFR determinants of each marker, improving accuracy of eGFR. Using global untargeted metabolomics, we previously identified 33 endogenous metabolites that correlate highly with measured GFR.Methods:A liquid chromatography tandem mass spectrometry (LC-MS/MS) measurement procedure was developed to quantify 11 endogenous metabolites from serum and plasma. The assay was evaluated in 99 participants with mGFR from two research studies, including a subgroup of 51 participants with large errors in eGFRcr and large discordance between eGFRcr and eGFRcys. Performance of eGFR models using single metabolites and all metabolites (panel eGFR-11) compared to mGFR, was assessed by leave-one-out cross-validated root mean square error (RMSE).Results:Assay CV for single metabolites ranged from 1.1 to 6.3% over the course of 21 days. RMSE of eGFR in single metabolite models ranged from 0.184 to 0.324. RMSEs for panel eGFR-11, eGFRcr, and eGFRcr-cys was 0.195, 0.251, and 0.201, respectively, and 0.155, 0.290, and 0.203, respectively, in the subgroup with large errors and large discordance.Conclusions:A precise metabolite (LC-MS/MS) measurement procedure shows promise for more accurate GFR estimation when eGFRcr is unreliable, offering a potential new confirmatory test for GFR evaluation.
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