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Published on: May 10, 2013
Accuracy of different equations in estimating GFR in pediatric kidney transplant recipients
Vandréa de Souza1, Pierre Cochat2, Muriel Rabilloud3
1Universidade Federal do Rio Grande do Sul, Programa de Pós graduação em Saúde da Criança e do Adolescente, Porto Alegre, Brazil; Universidade de Caxias do Sul, Centro de Ciências da Saúde, Caxias do Sul, Brazil; Exploration Fonctionnelle Rénale et Métabolique, Groupement Hospitalier Edouard Herriot, Fellow CAPES-Foundation, Ministry of Education of Brazil, Brasilia/DF, Brazil;
Insights
The CKiD 2012 formula best estimates GFR in pediatric kidney transplant recipients with reduced function. Cystatin C-based formulas showed no advantage over creatinine-based ones for these patients.
Area of Science:
- Pediatric Nephrology
- Transplant Medicine
- Renal Function Assessment
Background:
- Accurate GFR estimation is vital for managing pediatric kidney transplant recipients.
- Commonly used plasma creatinine (PCr) and cystatin C (CystC) based formulas may be inaccurate due to medication interference (e.g., corticosteroids, trimethoprim, prednisone, calcineurin inhibitors).
Purpose of the Study:
- To evaluate the performance of six different GFR-predicting formulas in pediatric kidney transplant recipients.
- To compare PCr-based, CystC-based, and combined formulas against inulin clearance as a reference standard.
Main Methods:
- The study included 73 pediatric kidney transplant recipients with 199 measurements.
- Six formulas were evaluated: bedside Schwartz, Schwartz-Lyon (PCr-based); Hoek, Filler (CystC-based); and CKD in Children (CKiD) 2012, Zappitelli (combined).
- Formula performance was assessed using inulin clearance and categorized by CKD stages (GFR <60, <75, <90 ml/min/1.73 m²).
Main Results:
- The CKiD 2012 formula demonstrated the best performance for measured GFR (mGFR) <90 ml/min/1.73 m².
- At mGFR <60 ml/min/1.73 m², CKiD 2012 and Schwartz-Lyon showed the highest accuracy (P10 and P30).
- All formulas except Hoek and Filler showed high accuracy (AUC >90%) in discriminating renal dysfunction stages.
Conclusions:
- The CKiD 2012 formula is recommended for estimating GFR in pediatric kidney transplant recipients with mGFR <90 ml/min/1.73 m².
- Cystatin C-based formulas did not offer superior performance compared to PCr-based formulas in this population.
Background And Objective:
The knowledge of renal function is crucial for the management of pediatric kidney transplant recipients. In this population, the most commonly used plasma creatinine (PCr)-based or cystatin C (CystC)-based GFR-predicting formulas may underperform (e.g., corticosteroids and trimethoprim may affect PCr concentration, whereas prednisone and calcineurin inhibitors may affect CystC concentration). This study evaluated the performance of six formulas in pediatric kidney transplant recipients.
Design, Setting, Participants, & Measurements:
The study used PCr-based formulas (bedside Schwartz, Schwartz-Lyon), CystC-based formulas (Hoek, Filler), and combined PCr-CystC-based formulas (CKD in Children [CKiD] 2012 and Zappitelli). The performance of these formulas was compared using inulin clearance as reference and assessed according to CKD stages in a historical cohort that included 73 pediatric kidney transplant recipients (199 measurements). The ability of the formulas to identify GFRs<60, <75, and <90 ml/min per 1.73 m(2) was assessed.
Results:
At measured GFR (mGFR) ≥90 ml/min per 1.73 m(2) (nine patients; 23 measurements), the Zappitelli formula had the highest 30% accuracy (P30) (95% [95% confidence interval (95% CI), 87% to 100%]) and the bedside Schwartz had the highest 10% accuracy (P10) (56% [95% CI, 32% to 72%]). At mGFR≥60 and <90 ml/min per 1.73 m(2) (22 patients; 91 measurements), all formulas had P30 values >80%. However, only the CKiD 2012 formula had a P10 value >50%. At mGFR<60 ml/min per 1.73 m(2) (42 patients; 85 measurements), the CKiD 2012 and Schwartz-Lyon formulas had the highest P10 (45% [95% CI, 34% to 55%] and 43% [95% CI, 33% to 54%]) and P30 (90% [95% CI, 84% to 97%] and 91% [95% CI, 86% to 98%]). All studied equations except Hoek and Filler had areas under the receiver-operating characteristic curves significantly >90% in discriminating patients with renal dysfunction at various CKD stages (GFR<60, <75, and <90 ml/min per 1.73 m(2)).
Conclusions:
In pediatric kidney transplant recipients, the CKiD 2012 formula had the best performance at mGFRs<90 ml/min per 1.73 m(2). CystC-based formulas were not superior to PCr-based formulas.
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