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The performance of three serum creatinine-based formulas in estimating GFR in former kidney donors
H N Ibrahim1, T Rogers, A Tello
1Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota, USA. ibrah007@umn.edu
Insights
Former kidney donors maintain excellent kidney function. The Modification of Diet in Renal Disease (MDRD) formula is recommended for estimating their glomerular filtration rate (GFR), as it offers clinically acceptable accuracy.
Area of Science:
- Nephrology
- Transplantation Science
- Clinical Chemistry
Background:
- Long-term health monitoring of kidney donors is crucial.
- Existing serum creatinine-based formulas for estimating glomerular filtration rate (GFR) lack validation in former kidney donors.
- Accurate GFR assessment is vital for managing living kidney donors post-donation.
Purpose of the Study:
- To evaluate the performance of commonly used GFR estimating formulas (Cockcroft-Gault, MDRD, Mayo Clinic) in former kidney donors.
- To determine the most reliable formula for assessing kidney function in this specific population.
- To compare formula accuracy against measured iohexol glomerular filtration rate (iGFR).
Main Methods:
- A cohort of 112 randomly selected former kidney donors was studied.
- Serum creatinine levels were measured.
- Iohexol glomerular filtration rate (iGFR) was determined and compared with estimates from Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Mayo Clinic formulas.
Main Results:
- The majority of former donors (83.9%) exhibited a GFR >60 mL/min, indicating excellent kidney function.
- The CG formula overestimated iGFR, while the MDRD formula underestimated it; both showed some clinical acceptability.
- The Mayo Clinic equation demonstrated the highest bias and poorest agreement with measured iGFR.
Conclusions:
- Former kidney donors generally maintain robust kidney function long-term.
- The Modification of Diet in Renal Disease (MDRD) formula is the recommended model for estimating GFR in former kidney donors due to its acceptable accuracy.
- Routine GFR estimation using validated formulas is essential for monitoring donor health.
Abstract:
Studies addressing long-term consequences of living with one kidney have used serum creatinine-based formulas that have not been validated in former kidney donors. Therefore, we evaluated the performance of Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and Mayo Clinic formulas in predicting iohexol glomerular filtration rate (iGFR) after donation in 112 randomly selected former kidney donors. Mean time from donation was 12.2 +/- 8.5 years. Serum creatinine was 1.1 +/- 0.2 mg/dL and iohexol GFR was 72 +/- 12 mL/min/1.73 m(2). The majority, 83.9%, of donors had a GFR >60 mL/min. CG formula overestimated GFR by 3.35 +/- 13.6 mL/min and was within 10% of iohexol GFR in only 43.7% of cases. MDRD formula underestimated iohexol GFR by 6.45 +/- 9.5 mL/min and was within 10% of actual GFR in half of the cases. In contrast, the Mayo Clinic equation was the most biased at 14.71 +/- 12.3 mL/min and was within 10% of measured GFR in only a fifth of the cases. Only MDRD and CG formulas provide estimates of GFR in former kidney donors that are within a clinically acceptable range of actual GFR. In conclusion, the majority of former kidney donors have excellent kidney function and the MDRD formula should be the recommended GFR estimating model in this population.
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