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Tailored Predictive Formulas for Glomerular Filtration Rate for Early Detection of Deteriorating Renal Function After
Toshihiro Yasui1, Tatsuya Suzuki, Fujio Hara
1From the Department of Pediatric Surgery, Fujita Health University, Toyoake, Aichi,Japan.
Insights
Formulas tailored for Japanese children help detect kidney dysfunction in pediatric liver transplant patients. These race-based equations offer earlier detection of declining renal function compared to standard methods.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Biomarkers
Background:
- Renal dysfunction is a significant challenge in pediatric liver transplant recipients, complicating patient management.
- Accurate assessment of kidney function is crucial for timely intervention and improved outcomes.
- Existing predictive equations may not accurately reflect renal function in diverse pediatric populations.
Purpose of the Study:
- To evaluate the performance of different estimated glomerular filtration rate (eGFR) formulas in Japanese children post-living-donor liver transplant (LDLT).
- To compare race-specific formulas with the standard Schwartz formula for eGFR calculation.
- To determine the utility of cystatin C-based formulas in assessing renal function in this cohort.
Main Methods:
- Retrospective analysis of data from 26 pediatric patients (<16 years) undergoing LDLT.
- Measurement of serum creatinine and cystatin C levels.
- Comparison of eGFR using Schwartz, polynomial, simple, and cystatin C formulas via paired t tests and Bland-Altman plots.
Main Results:
- Formulas tailored for Japanese children yielded significantly lower eGFR values than the Schwartz formula (P < .01).
- The cystatin C formula showed significant differences in eGFR between biliary atresia and other diseases.
- Average eGFR values were 143.46 (Schwartz), 122.90 (polynomial), 121.58 (simple), and 123.31 (cystatin C).
Conclusions:
- Race-specific eGFR formulas may offer improved early detection of renal function decline in pediatric liver transplant patients.
- Utilizing tailored equations can enhance the monitoring and management of kidney health post-transplant.
- Further validation of these race-based formulas is warranted for broader clinical application.
Objectives:
In pediatric patients, renal dysfunction after living-donor liver transplant is a major issue that is difficult to evaluate. Recently, predictive equations for Japanese children have been introduced.
Materials And Methods:
We conducted a retrospective study by prospectively collecting data on 26 patients under 16 years old who underwent living-donor liver transplant between June 2004 and March 2015. Serum creatinine and cystatin C levels were measured. Paired t tests and Bland-Altman plots were used to compare the following formulas for estimated glomerular filtration rate: the Schwartz formula and 3 formulas that were matched with Japanese children (polynomial, simple, and cystatin C formulas).
Results:
Average estimated glomerular filtrations rates (in mL/min/1.73 m2) were 143.46, 122.90, 121.58, and 123.31 using the Schwartz, polynomial, simple, and cystatin C formulas, respectively. The estimated glomerular filtrations rate for biliary atresia was 141.53 ± 31.37 versus 109.95 ± 19.52 for other diseases, with significant differences only noted with the cystatin C formula. The formulas tailored for Japanese children showed significantly lower estimated glomerular filtrations rates than those obtained using the Schwartz formula (P < .01).
Conclusions:
The use of formulas for measuring estimated glomerular filtrations rates that are based on race may allow early detection of deteriorating renal function.
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