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The Cockcroft-Gault formula should not be used in children
Guido Filler1, Jennifer Foster, Amy Acker
1Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. filler@cheo.on.ca
Insights
The Cockcroft-Gault formula is not suitable for estimating glomerular filtration rate (GFR) in children. A novel cystatin C-based method demonstrated the least error for pediatric GFR estimation.
Area of Science:
- Pediatric Nephrology
- Renal Function Assessment
Background:
- The Cockcroft-Gault formula, designed for adults, has been proposed for children aged 13 years and older.
- Accurate estimation of glomerular filtration rate (GFR) is crucial for managing pediatric renal conditions.
Purpose of the Study:
- To evaluate the feasibility of the Cockcroft-Gault formula in children compared to the standard Schwartz formula and a new cystatin C-based formula.
- To assess the accuracy of these formulas using measured GFR from (99)Tc DTPA renal scans.
Main Methods:
- A cohort of 262 children (aged 1-18 years) with renal pathologies underwent (99)Tc DTPA GFR scans.
- GFR was calculated using the Cockcroft-Gault and Schwartz formulas with both published and recalculated constants.
- A novel cystatin C-based GFR estimation was also performed.
- Agreement was analyzed using Bland and Altman methods.
Main Results:
- The Cockcroft-Gault formula exhibited the poorest agreement with measured GFR across all age groups and constant variations.
- The Schwartz formula showed moderate agreement, with average biases ranging from -1.1% to -12.8%.
- The cystatin C-based GFR estimation demonstrated the lowest average error, with values of -4.9% in adolescent boys and 2.4% for all ages.
Conclusions:
- The Cockcroft-Gault formula is not recommended for estimating GFR in pediatric populations.
- The cystatin C-based method offers a more accurate and reliable approach for pediatric GFR estimation.
- Further validation of cystatin C-based GFR estimation in diverse pediatric cohorts is warranted.
Background:
Although designed for adults, the Cockcroft-Gault formula was recently proposed for use in children > or =13 years of age.
Methods:
We compared the feasibility of the Cockcroft-Gault formula against the standard pediatric Schwartz formula and a novel cystatin C-based formula. Our patient cohort included 262 children aged 1 to 18 years with various renal pathologies, who underwent a 99-technetium diethylenetriaminepentaacetate ((99)Tc DTPA) glomerular filtration rate (GFR) renal scan. Calculations were performed in Systeme International (SI) units using published constants and recalculated constants from our patient population. Agreement was assessed using Bland and Altman analysis.
Results:
Published and recalculated constants for the Cockcroft-Gault formula were 1.23 and 0.96, respectively, for boys, and 1.05 and 0.90, respectively, for girls. The published and recalculated constants for the Schwartz formula were 48 and 49.9, respectively, for boys > or =13 years old, and 38 and 46.2, respectively, for all girls and for boys <13 years old. Using published constants, there was agreement between GFR and Cockcroft-Gault formula in boys > or =13 years old (average bias 5.0 +/- 23.5%) while there was an average error of -19.0%+/- 36.4% for all ages. Similarly, the average bias with Schwartz for boys > or =13 years old was -6.8 +/- 24.0% and for all patients was -12.8 +/- 24.2%. Using recalculated constants, the average bias with Cockcroft-Gault in boys > or =13 years old was -19.8 +/- 23.5% and for all patients was -38.5 +/- 35.2%. Similarly, the average bias with Schwartz for boys < or =13 years old was -1.1 +/- 24.3% and for all patients was 3.0 +/- 24.0%. The novel cystatin C-based GFR calculations showed an average error of -4.9 +/- 20.3% in the adolescent boys and 2.4 +/- 20.4% for all ages.
Conclusion:
Cockcroft-Gault formula showed the worst agreement with GFR, regardless of using published or recalculated constants. The cystatin C-based approach resulted in the least error, and should be used for estimation of GFR.
