Performance of Creatinine Clearance and Estimated GFR in Assessing Kidney Function in Living Donor Candidates.
Adolescent
Adult
Aged
Body Weight
/ physiology
Contrast Media
/ administration & dosage
Creatinine
/ blood
Donor Selection
/ methods
Female
Glomerular Filtration Rate
/ physiology
Humans
Iodine Radioisotopes
/ administration & dosage
Iothalamic Acid
/ administration & dosage
Kidney Function Tests
/ methods
Living Donors
Male
Middle Aged
Renal Elimination
/ physiology
Retrospective Studies
Sex Factors
Young Adult
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
pubmed:
18
6
2019
medline:
2
10
2020
entrez:
18
6
2019
Statut:
ppublish
Résumé
Glomerular filtration rate (GFR) assessment is a key aspect in the evaluation of living kidney donor candidates; however, data on performance of commonly used methods are limited. We examined 769 living kidney donor candidates with 24-hour urine collections assessed as accurate by comparing measured creatinine excretion rate (CER) to CER estimated using a 4-variable equation previously developed and validated using robust methodology. Of all collections, 42.6% would have been deemed inaccurate, mostly under-collections, using the conventional weight- and gender-based CER estimation. Creatinine clearance (CrCl) overestimated I-iothalamate GFR (iGFR), estimated GFR (eGFR), underestimated iGFR, and their average [Avg (CrCl and eGFR)] essentially eliminated the GFR bias (median bias = +2.2, -5.4, and -1.0 mL/min/1.73 m, respectively; P < 0.001). This held true for all subgroups except blacks, where all 3 measures overestimated iGFR. Avg (CrCl and eGFR) also offered modestly improved accuracy compared with CrCl alone, as measured by the proportion of values falling within 10% (50.7% versus 45.3%; P = 0.009) and 30% of iGFR (94.5% versus 89.3%; P < 0.001). When measured GFR is unavailable, the Avg (CrCl and eGFR) provides a better estimate of kidney function in kidney donor candidates than either measure alone, although in blacks the estimates are neither better nor worse.
Sections du résumé
BACKGROUND
Glomerular filtration rate (GFR) assessment is a key aspect in the evaluation of living kidney donor candidates; however, data on performance of commonly used methods are limited.
METHODS
We examined 769 living kidney donor candidates with 24-hour urine collections assessed as accurate by comparing measured creatinine excretion rate (CER) to CER estimated using a 4-variable equation previously developed and validated using robust methodology.
RESULTS
Of all collections, 42.6% would have been deemed inaccurate, mostly under-collections, using the conventional weight- and gender-based CER estimation. Creatinine clearance (CrCl) overestimated I-iothalamate GFR (iGFR), estimated GFR (eGFR), underestimated iGFR, and their average [Avg (CrCl and eGFR)] essentially eliminated the GFR bias (median bias = +2.2, -5.4, and -1.0 mL/min/1.73 m, respectively; P < 0.001). This held true for all subgroups except blacks, where all 3 measures overestimated iGFR. Avg (CrCl and eGFR) also offered modestly improved accuracy compared with CrCl alone, as measured by the proportion of values falling within 10% (50.7% versus 45.3%; P = 0.009) and 30% of iGFR (94.5% versus 89.3%; P < 0.001).
CONCLUSIONS
When measured GFR is unavailable, the Avg (CrCl and eGFR) provides a better estimate of kidney function in kidney donor candidates than either measure alone, although in blacks the estimates are neither better nor worse.
Identifiants
pubmed: 31205262
doi: 10.1097/TP.0000000000002797
pii: 00007890-202003000-00025
doi:
Substances chimiques
Contrast Media
0
Iodine Radioisotopes
0
Iothalamic Acid
16CHD79MIX
Creatinine
AYI8EX34EU
Iodine-125
GVO776611R
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
575-582Références
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