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Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
The performance of three estimates of glomerular filtration rate before and after live donor nephrectomy
Adam D Barlow1, Alice H Taylor, Rose Elwell
1Department of Transplant Surgery, Leicester General Hospital, Leicester, UK. adambarlow@doctors.net.uk
Insights
Estimates of glomerular filtration rate (GFR) using serum creatinine are inaccurate before and after kidney donation surgery. Radioisotope GFR remains the most reliable method for assessing kidney function in these patients.
Area of Science:
- Nephrology
- Transplantation Surgery
- Renal Physiology
Background:
- Serum creatinine-based estimates of glomerular filtration rate (GFR) have limitations in accuracy, particularly in healthy individuals.
- Their use in assessing kidney function before live donor nephrectomy is restricted due to known inaccuracies.
- Limited data exist regarding the performance of these estimates after donor nephrectomy.
Purpose of the Study:
- To assess the accuracy of three common GFR estimating equations against radioisotope GFR (iGFR) in live kidney donors.
- To compare the performance of these estimates (eGFR, cgGFR, mcGFR) both preoperatively and postoperatively.
- To determine if any GFR estimate can reliably replace iGFR measurement in this patient population.
Main Methods:
- A cohort of 206 live kidney donors underwent iGFR measurement using Cr(51) EDTA before nephrectomy.
- 187 donors had iGFR re-measured 6-8 weeks after surgery.
- iGFR values were compared with estimated GFR (eGFR), Cockcroft-Gault (cgGFR), and Mayo Clinic equation (mcGFR) estimates.
Main Results:
- Preoperatively, all GFR estimates performed poorly against iGFR, with mcGFR being the most reliable. eGFR underestimated iGFR by 23.60 ml/min/1.73 m(2), cgGFR by 15.54 ml/min/1.73 m(2), and mcGFR overestimated by 0.72 ml/min/1.73 m(2).
- Postdonation, all estimates remained inaccurate but eGFR and mcGFR showed better performance than cgGFR. eGFR underestimated iGFR by 9.13 ml/min/1.73 m(2), mcGFR by 9.44 ml/min/1.73 m(2), and cgGFR overestimated by 6.42 ml/min/1.73 m(2).
- No tested GFR estimate was sufficiently accurate to replace iGFR measurement, either before or after donation. No correlation was found between the fall in iGFR and the fall in GFR estimates postdonation.
Conclusions:
- Serum creatinine-based GFR estimates are unreliable for assessing kidney function in live kidney donors, both before and after nephrectomy.
- Radioisotope GFR (iGFR) remains the gold standard for accurate GFR measurement in this cohort.
- Further research is needed to develop more accurate GFR estimation methods for kidney donors.
Abstract:
Serum creatinine-based estimates of glomerular filtration rate (GFR) are inaccurate in healthy individuals. Therefore, their use in assessment prior to live donor nephrectomy has been restricted. There are less data on their use postdonor nephrectomy. This study assessed three GFR estimates against Cr(51) EDTA radioisotope GFR (iGFR) in the same cohort of patients before and after donor nephrectomy. A total of 206 patients underwent iGFR measurement prior to donor nephrectomy and this was repeated in 187 patients 6-8 weeks postsurgery. The iGFR was compared with the modification of diet in renal disease (eGFR), Cockcroft-Gault (cgGFR) and Mayo Clinic equation (mcGFR) estimates of GFR. Preoperatively, all GFR estimates performed poorly against iGFR; however, mcGFR provided the most reliable estimate. The eGFR underestimated iGFR by 23.60 +/- 16.43 ml/min/1.73 m(2), cgGFR by 15.54 +/- 18.13 ml/min/1.73 m(2) and mcGFR overestimated by 0.72 +/- 18.11 ml/min/1.73 m(2). Postdonation, all estimates again performed poorly, but eGFR and mcGFR outperformed cgGFR. The eGFR underestimated iGFR by 9.13 +/- 10.11 ml/min/1.73 m(2), mcGFR by 9.44 +/- 13.80 ml/min/1.73 m(2) and cgGFR overestimated by 6.42 +/- 14.49 ml/min/1.73 m(2). No GFR estimate performed sufficiently well to supersede iGFR measurement prior to donor nephrectomy. Performance postdonation was little better. In addition, there was no correlation between fall in iGFR and fall in GFR estimates postdonation.
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