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Predictive ability of creatinine clearance estimate models in pediatric bone marrow transplant patients
P Jacobson1, N West, R J Hutchinson
1University of Michigan College of Pharmacy, Bone Marrow Transplantation, Ann Arbor 48108, USA.
Insights
Pediatric creatinine clearance (CrCl) models inaccurately estimate renal function in children undergoing bone marrow transplantation. These models overestimated CrCl, proving unreliable for clinical use.
Area of Science:
- Pediatric Nephrology
- Pharmacokinetics
- Renal Function Assessment
Background:
- Accurate estimation of creatinine clearance (CrCl) is crucial for drug dosing in pediatric patients.
- Pediatric bone marrow transplantation (BMT) requires precise assessment of renal function.
- Existing pediatric CrCl estimation models need validation in specific patient populations.
Purpose of the Study:
- To evaluate the predictive performance of seven pediatric CrCl estimation models.
- To compare estimated CrCl with measured CrCl in pediatric patients undergoing BMT.
- To determine the reliability of these models as alternatives to measured CrCl.
Main Methods:
- Study included 32 pediatric patients (1-14 years) with stable renal function awaiting BMT.
- Collected 12-24 hour urine samples for measured CrCl.
- Calculated CrCl using seven established pediatric models: Traub and Johnson, Schwartz et al, Counahan et al, modified Counahan et al, Ghazali and Barratt, Shull et al, and Dechaux et al.
Main Results:
- Coefficients of determination (r2) ranged from 0.47 to 0.52, indicating poor correlation.
- Mean absolute percent errors were high, between 23.2% and 45.2%.
- Most models consistently overestimated CrCl in the majority of pediatric patients.
Conclusions:
- The evaluated pediatric CrCl estimation models demonstrated poor predictive accuracy.
- These models are not reliable alternatives to measured CrCl in pediatric patients undergoing BMT.
- Clinical decisions requiring accurate renal function assessment should not rely solely on these estimation methods.
Abstract:
The predictive performance of estimating creatinine clearance (CrCl) with pediatric clearance models was evaluated. Thirty-two pediatric patients with stable renal function between the ages of 1 and 14 years about to undergo bone marrow transplantation (BMT) who had 12-24 h urine collections for measurement of CrCl were studied. The measured CrCl was compared to CrCls calculated from seven models used to estimate CrCl in the pediatric population. The models used were Traub and Johnson, Schwartz et al, Counahan et al, modified Counahan et al, Ghazali and Barratt, Shull et al and Dechaux et al. Coefficients of determination (r2) between measured and estimated CrCls from models 1 to 7 were 0.47, 0.47, 0.47, 0.49, 0.47, 0.52, 0.47. The mean absolute percent errors for the models were 23.2-45.2%. In the majority of children, models overestimated CrCl. The tested models did not accurately predict CrCl and did not provide a reliable alternative to measured CrCl.