Impact of errors of creatinine and cystatin C equations in the selection of living kidney donors.
estimated GFR
living kidney donation
measured GFR
Journal
Clinical kidney journal
ISSN: 2048-8505
Titre abrégé: Clin Kidney J
Pays: England
ID NLM: 101579321
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
09
08
2018
entrez:
5
10
2019
pubmed:
5
10
2019
medline:
5
10
2019
Statut:
epublish
Résumé
Reliable determination of glomerular filtration rate (GFR) is crucial in the evaluation of living kidney donors. Although some guidelines recommend the use of measured GFR (mGFR), many centres still rely on estimated GFR (eGFR) obtained through equations or 24-h creatinine clearance. However, eGFR is neither accurate nor precise in reflecting real renal function. We analysed the impact of eGFR errors on evaluation and decision making regarding potential donors. We evaluated 103 consecutive living donors who underwent mGFR via iohexol plasma clearance and eGFR by 51 creatinine- and/or cystatin C-based equations. The cut-off for living donation in our centre is GFR > 80 mL/min for donors >35 years of age or 90 mL/min for those <35 years of age. We analysed the misclassification of donors based on the cut-off for donation-based eGFR. Ninety-three subjects (90.3%) had mGFR values above (donors) and 10 [9.7% (95% confidence interval 5.4-17)] below (non-donors) the cut-off. In non-donors, most of the equations gave eGFR values above the cut-off, so donation would have been allowed based on eGFR. All non-donors were female with reduced weight, height and body surface. In donors, up to 32 cases showed eGFR below the cut-off, while mGFR was actually higher. Therefore an important number of donors would not have donated based on eGFR alone. The misclassification of donors around the cut-off for donation is very common with eGFR, making eGFR unreliable for the evaluation of living kidney donors. Whenever possible, mGFR should be implemented in this setting.
Sections du résumé
BACKGROUND
BACKGROUND
Reliable determination of glomerular filtration rate (GFR) is crucial in the evaluation of living kidney donors. Although some guidelines recommend the use of measured GFR (mGFR), many centres still rely on estimated GFR (eGFR) obtained through equations or 24-h creatinine clearance. However, eGFR is neither accurate nor precise in reflecting real renal function. We analysed the impact of eGFR errors on evaluation and decision making regarding potential donors.
METHODS
METHODS
We evaluated 103 consecutive living donors who underwent mGFR via iohexol plasma clearance and eGFR by 51 creatinine- and/or cystatin C-based equations. The cut-off for living donation in our centre is GFR > 80 mL/min for donors >35 years of age or 90 mL/min for those <35 years of age. We analysed the misclassification of donors based on the cut-off for donation-based eGFR.
RESULTS
RESULTS
Ninety-three subjects (90.3%) had mGFR values above (donors) and 10 [9.7% (95% confidence interval 5.4-17)] below (non-donors) the cut-off. In non-donors, most of the equations gave eGFR values above the cut-off, so donation would have been allowed based on eGFR. All non-donors were female with reduced weight, height and body surface. In donors, up to 32 cases showed eGFR below the cut-off, while mGFR was actually higher. Therefore an important number of donors would not have donated based on eGFR alone.
CONCLUSION
CONCLUSIONS
The misclassification of donors around the cut-off for donation is very common with eGFR, making eGFR unreliable for the evaluation of living kidney donors. Whenever possible, mGFR should be implemented in this setting.
Identifiants
pubmed: 31584569
doi: 10.1093/ckj/sfz012
pii: sfz012
pmc: PMC6768301
doi:
Types de publication
Journal Article
Langues
eng
Pagination
748-755Commentaires et corrections
Type : ErratumIn
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA.
Références
Scand J Clin Lab Invest. 1972 Nov;30(3):271-4
pubmed: 4629674
Kidney Int. 2010 Dec;78(12):1305-11
pubmed: 20844470
Clin J Am Soc Nephrol. 2009 Oct;4(10):1677-84
pubmed: 19713294
Am J Kidney Dis. 2016 Jan;67(1):40-8
pubmed: 26362696
PLoS Med. 2016 Mar 29;13(3):e1001979
pubmed: 27023756
Nephron. 2018;140(1):1-8
pubmed: 29772565
N Engl J Med. 2017 Jun 15;376(24):2349-2357
pubmed: 28614683
Nephrol Dial Transplant. 2018 Sep 1;33(9):1597-1603
pubmed: 29211858
Nephrol Dial Transplant. 2015 Nov;30(11):1790-7
pubmed: 25007790
Kidney Int. 2006 Feb;69(4):671-8
pubmed: 16395270
Am J Transplant. 2016 Oct;16(10):3024-3032
pubmed: 27273845
Nutrition. 1989 Sep-Oct;5(5):303-11; discussion 312-3
pubmed: 2520314
Am J Kidney Dis. 2013 Feb;61(2):279-84
pubmed: 23141866
Am J Clin Nutr. 1983 Mar;37(3):478-94
pubmed: 6829490
Nephrol Dial Transplant. 2014 Jun;29(6):1195-203
pubmed: 24449101
Nephrol Dial Transplant. 2011 May;26(5):1553-8
pubmed: 20961892
Nephrol Dial Transplant. 2013 Jul;28(7):1628-30
pubmed: 23262435
J Nutr. 1975 Apr;105(4):428-38
pubmed: 1113209
Transplantation. 2015 Dec;99(12):2625-33
pubmed: 26247554
Am J Transplant. 2016 Jan;16(1):171-80
pubmed: 26594819
Clin Kidney J. 2016 Oct;9(5):682-99
pubmed: 27679715
Transplantation. 2017 Aug;101(8S Suppl 1):S1-S109
pubmed: 28742762
Am J Transplant. 2006 Jul;6(7):1653-9
pubmed: 16827867
Nephrol Dial Transplant. 2013 Oct;28(10):2518-26
pubmed: 23904399
PLoS One. 2013;8(3):e57240
pubmed: 23526939
Ann Intern Med. 2004 Dec 21;141(12):929-37
pubmed: 15611490
Clin Chem. 1992 Oct;38(10):1933-53
pubmed: 1394976
Diabetologia. 2011 Dec;54(12):2987-94
pubmed: 21947381
Nephron. 2017;136(4):287-291
pubmed: 27978513
Clin Kidney J. 2016 Oct;9(5):700-4
pubmed: 27679716
Nefrologia. 2010;30 Suppl 2:47-59
pubmed: 21183963
Transplantation. 2005 Mar 27;79(6 Suppl):S53-66
pubmed: 15785361
J Am Soc Nephrol. 2010 Jun;21(6):898-910
pubmed: 20150537
Kidney Int. 2003 Jun;63(6):2113-22
pubmed: 12753298
Nephron. 2017;136(1):3-49
pubmed: 28319949
Nucl Med Commun. 2005 Jan;26(1):61-5
pubmed: 15604949
Am J Kidney Dis. 2004 Jan;43(1):112-9
pubmed: 14712434
Am J Nephrol. 2010;31(1):53-7
pubmed: 19887788
Clin Chim Acta. 2014 Mar 20;430:84-5
pubmed: 24389053
J Lab Clin Med. 1962 Jun;59:945-55
pubmed: 13869979