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Assessment of the Renal Function in Potential Donors of Living Kidney Transplants: Expanded Study
L B Macías1, M S Poblet1, N N Pérez1
1UGC-Nefrourológica, Hospital Virgen del Rocío, Sevilla, Spain.
Insights
Estimating kidney function in potential living kidney donors is crucial. The MDRD-4 and MDRD-6 formulas provide the best estimation of glomerular filtration rate (GFR) when direct measurement is unavailable.
Area of Science:
- Nephrology
- Transplant Surgery
- Medical Diagnostics
Background:
- Accurate renal function assessment is vital for living kidney donor selection, particularly for those with pre-existing risk factors.
- Identifying donors with compromised kidney function (CrCl <90 mL/m²/1.73 m²) or cardiovascular risks is essential to prevent long-term kidney disease.
Purpose of the Study:
- To compare direct glomerular filtration rate (GFR) measurement using EDTA-Cr51 with various creatinine-based estimated GFR (eGFR) methods.
- To evaluate the clinical utility of different eGFR formulas for assessing kidney function in potential living kidney donors.
Main Methods:
- Glomerular filtration rate (GFR) was directly measured in 105 potential kidney donors using the EDTA-Cr51 method.
- GFR results were compared against estimated GFR (eGFR) values derived from 24-hour urine creatinine clearance (CCr), Cockcroft-Gault, MDRD-4, MDRD-6, and CKD-EPI formulas.
Main Results:
- Bland Altman analysis indicated significant dispersion in eGFR results from 24-hour urine CCr and CKD-EPI compared to EDTA-Cr51.
- P διαγώνιος & Bablock analysis showed that MDRD-4 and MDRD-6 formulas demonstrated the highest approximation to the reference EDTA-Cr51 method.
Conclusions:
- The MDRD-4 and MDRD-6 formulas offer the best agreement with direct EDTA-Cr51 GFR measurement in potential kidney donors.
- These MDRD formulas are recommended as reliable alternatives when direct GFR measurement is not feasible.
Introduction:
It is very important to determine as accurately as possible the renal function in potential living renal transplant donors, especially those with limited renal function (CrCl <90 mL/m/1.73 m(2)), age older than 50 years, and cardiovascular risk factors that might favor the development of long-term kidney diseases.
Objective:
The objective of this study was to compare the direct measurement of glomerular filtration rate (GFR) using EDTA-Cr51 and the estimations based on creatinine (eGFR): Cr clearance (CCr) with 24-hour urine and estimated using Cockroft-Gault (adjusted by using body surface area-Mosteller formula-SC), MDRD-4, MDRD-6, and CKD-EPI to determine the usefulness of different methods from EDTA-Cr51to evaluate the kidney function.
Patients And Methods:
The kidney function evaluation has been made to 105 potential kidney donors using the EDTA-Cr51 method. The GFR obtained through the EDTA-Cr51 is compared with the CCr values in 24-hour urine and eGFR based on creatinine (Cockcroft-Gault, MDRD4, MDRD6, and CKD-EPI).
Results:
Using the Bland Altman graphic we have observed that the most dispersed results are obtained with the eGFR using CCr in 24-hour urine and CKD-EPI. By means of Pasing & Bablock, we realized that MDRD-4 and MDRD-6 show the highest approximation to the reference method proposed to be substituted, whereas CCr shows a high dispersion.
Conclusions:
eGFR using MDRD-4 and MDRD-6 formulas reveal the best adjustment to the measure by EDTA-Cr51. This might represent the best option if a direct eGFR measure is not available.
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