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Estimation of creatinine clearance in children: comparison of six methods
Insights
The Traub and Johnson method accurately estimates creatinine clearance (a measure of kidney function) in children. This method proved most reliable compared to five others, offering unbiased results for pediatric kidney function assessment.
Area of Science:
- Pediatric Nephrology
- Clinical Chemistry
- Biomarker Validation
Background:
- Accurate estimation of creatinine clearance is vital for pediatric kidney function assessment.
- Existing methods for estimating creatinine clearance from serum creatinine in children vary in accuracy.
- A need exists to identify the most reliable method for clinical use.
Purpose of the Study:
- To evaluate and compare the accuracy of six published methods for estimating creatinine clearance in children.
- To determine which method provides the most accurate and least biased results.
Main Methods:
- Retrospective review of medical records for 59 pediatric patients (ages 1-18).
- Comparison of 142 actual 24-hour urine creatinine determinations against estimated values from six different formulas.
- Statistical analysis of absolute and standard errors for each method.
Main Results:
- All six methods showed good correlation with calculated creatinine clearance.
- The Traub and Johnson method demonstrated the least average absolute and standard errors.
- The Traub and Johnson method's error was significantly smaller than Schwartz et al., Counahan et al., and modified Counahan et al. methods (p < 0.05).
- The Traub and Johnson method showed no significant bias towards over- or underestimation, performing well across various patient demographics except for children under 107 cm height.
Conclusions:
- The Traub and Johnson method is the most accurate and nonbiased for estimating creatinine clearance from serum creatinine in children.
- This validated method offers improved reliability for pediatric kidney function monitoring.
- Clinical guidelines may benefit from adopting the Traub and Johnson method for pediatric populations.
Abstract:
An evaluation and comparison of the accuracy of six published methods for estimating creatinine clearance from serum creatinine concentration in children are presented. The medical records of 59 patients were reviewed. The patients ranged from 1 to 18 years in age and had one or more 24-hour urine creatinine determinations completed. A total of 142 creatinine-clearance determinations were compared with the estimated creatinine clearances using each of six methods. All methods correlated well with calculated creatinine clearance. The average absolute and standard errors were greatest with the modified method of Counahan et al. and least with the method of Traub and Johnson. The error made by the method of Traub and Johnson was significantly smaller (p less than 0.05) than the error made by the methods of Schwartz et al., Counahan et al., and the modified method of Counahan et al. The method of Traub and Johnson also showed an equal tendency to overestimate and underestimate creatinine clearance. This method performed well regardless of the patients' weight, sex, or age; the method was not as accurate in children less than 107 cm in height. It is concluded that the method of Traub and Johnson for estimating creatinine clearance from serum creatinine concentration is the most accurate and nonbiased of the evaluation methods.