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Updated: Apr 26, 2026
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Renal function assessment in child and adolescent heart transplant recipients during routine cardiac catheterization
Kimberly Y Lin1, Susan L Furth, George J Schwartz
1Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Accurate kidney function assessment in pediatric heart transplant recipients is crucial for identifying chronic kidney disease (CKD). A modified iohexol clearance method and the CKiD formula show promise for improved GFR measurement and CKD detection in this population.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Accurate glomerular filtration rate (GFR) estimation is vital for identifying chronic kidney disease (CKD) post-pediatric heart transplantation (PHT).
- Existing GFR estimating equations may lack precision in PHT recipients.
Purpose of the Study:
- To evaluate a modified iohexol clearance protocol for measuring GFR in PHT recipients.
- To compare the performance of the CKiD formula against other estimating equations for GFR in PHT survivors.
Main Methods:
- A cross-sectional study involving 31 PHT recipients (ages 2-18 years) undergoing coronary angiography.
- GFR was measured using a modified iohexol clearance protocol, calculating GFR from iohexol levels post-infusion.
- Agreement between measured GFR (iGFR) and estimated GFR (eGFR) from various equations was assessed.
Main Results:
- The modified iohexol clearance method was successfully implemented.
- Over half (52%) of the PHT recipients had an iGFR <90 mL/min/1.73 m², suggesting potential CKD.
- The full CKiD formula demonstrated the best performance with low bias, high accuracy, and the strongest correlation with iGFR.
Conclusions:
- A novel modified iohexol clearance method can assess GFR in PHT recipients.
- A significant proportion of PHT recipients may have reduced GFR, indicating a need for CKD screening.
- The CKiD formula is a superior GFR estimating equation in this specific patient group.
Abstract:
CKD identification after pediatric heart transplantation (PHT) is limited by inaccuracies in estimates of GFR. We hypothesized that GFR can be measured by a modified iohexol clearance protocol in PHT recipients and that the CKiD formula provides a better estimate of GFR than other estimating equations. A cross-sectional study of PHT recipients, ages 2-18 yr, undergoing coronary angiography was undertaken. The angiography dose of iohexol was divided by the area under the curve from three iohexol levels post-infusion to calculate GFR. Agreement between iGFR and multiple estimating equations (eGFR) was assessed. In 31 subjects, median age was 15.0 yr (IQR 7.6, 16.6). Mean iGFR was 93.8 (s.d. 22.5) mL/min/1.73 m(2) ; 16 (52%) had an iGFR <90 mL/min/1.73 m(2) . The full CKiD formula (mean eGFR 88.9, s.d. 14.9) had low bias (-5.0), narrowest 95% limits of agreement (-42.0, 32.1), highest 30% (94%) and 10% (52%) accuracy, and highest correlation coefficient (0.576) relative to iGFR. We describe a novel modified iohexol clearance method to assess GFR after PHT. Over half of the cohort had an iGFR <90, suggesting CKD. The full CKiD formula performs best with respect to bias, accuracy, and correlation.
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