Comparison between creatinine-based equations for estimating total creatinine clearance in peritoneal dialysis: a...

Area of Science:

• Nephrology
• Dialysis Technology
• Renal Function Assessment

Background:

• Peritoneal dialysis (PD) adequacy significantly impacts patient outcomes.
• Current 24-hour fluid and urine collection for PD adequacy assessment is burdensome.
• A simpler, cost-effective method for rapid PD adequacy evaluation is needed.

Purpose of the Study:

• To evaluate the performance of 12 creatinine (Cr)-based equations for estimating total Cr clearance (totCrCL) in PD patients.
• To identify the most accurate and precise equations for approximating totCrCL in PD.
• To provide a practical tool for assessing PD adequacy.

Main Methods:

• 355 PD patients across four Italian dialysis centers participated.
• 2916 fluid collections were analyzed.
• Performance metrics including accuracy (MAPE), precision (RMSE), agreement (k), and ROC curves (AUC) were calculated for 12 Cr-based equations against measured totCrCL.

Main Results:

• The Gates, Virga, and 4-MDRD equations demonstrated superior global performance in accuracy, precision, and AUC.
• These top-performing equations showed MAPE of 14.1%, 16.3%, and 15.9% respectively.
• The Cockcroft-Gault formula exhibited lower reliability compared to other tested equations.

Conclusions:

• While fluid collection remains the gold standard for PD adequacy.
• The study identified specific Cr-based equations (Gates, Virga, 4-MDRD) as reliable for approximating totCrCL in PD.
• These findings facilitate the selection of accurate and precise methods for routine PD adequacy assessment.