Age-dependent reference intervals for estimated and measured glomerular filtration rate

Pottel, Hans; Delanaye, Pierre; Weekers, Laurent; Selistre, Luciano; Goffin, Karolien; Gheysens, Olivier; Dubourg, Laurence

doi:10.1093/ckj/sfx026

Cited by 72 publications

(75 citation statements)

References 29 publications

(42 reference statements)

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“…In the AKX program, in addition to require an uncorrected mGFR ≥80 ml/min for donor candidates to be accepted, the program strictly excludes patients with urinary protein/creatinine ratio >20 mg/mmol, age ≥70 years, BMI >35 kg/m 2 , diabetes mellitus, treated hypertension requiring >2 agents to control, which differs from the risk-profile of the general donor population in Australia [35], and, consequently, our data may not be sufficiently generalizable. Nevertheless, in relation to age and GFR our cohort is similar to many other previously studied cohorts of healthy individuals [36][37][38]. In conclusion, data from the Australian KPD living donor cohort, selected based on a raw mGFR of at least 80 ml/min, demonstrates that kidney donation has acceptable short-term functional consequences, even for donors with low predonation eGFR (<80 ml/ min/1.73 m 2 ), with 75% of donors showing a drop of ≤35% in postdonation eGFR compared with predonation and 70% having an eGFR ≥60 ml/min/1.73 m 2 at 1-year postdonation.…”

Section: Discussionsupporting

confidence: 80%

Pre- and postdonation kidney function in donors of a kidney paired donation with unique criteria for donor glomerular filtration rate - a longitudinal cohort analysis

et al. 2018

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Summary Baseline predonation estimated GFR (eGFR) appears to predict the risk of postdonation chronic kidney disease in live donors. New KIDGO guidelines recommend an eGFR ≥90 ml/min/1.73 m2 as an acceptable level of glomerular filtration rate (GFR) for kidney donation. In the Australian Paired Kidney Exchange (AKX) program, all donors with a raw measured GFR (mGFR) ≥80 ml/min are deemed suitable for donation, but the significance of this selection indicator is unclear. We analysed the first 129 live donors in the AKX program with at least 1‐year follow‐up linking records in the AKX database and ANZDATA. There were 73 male and 56 female donors; mean (±SD) age was 53 ± 11 years. Predonation eGFR was 94 ± 13 ml/min/1.73 m2, mGFR 99 ± 17 ml/min/1.73 m2 and raw mGFR 108 ± 18 ml/min. Baseline eGFR was <80 ml/min/1.73 m2 in 19 donors, and <90 ml/min/1.73 m2 in 42 donors. At 1 year postdonation eGFR was 68 ± 15 ml/min/1.73 m2 and the predicted eGFR at 30 years postdonation was on average 50 (29–83) ml/min/1.73 m2. The hypothetical mean age at end‐stage kidney disease was estimated to be 145 (95% CI 120–263) years. Over 30% of AKX live donors would have been excluded from donation using KDIGO guidelines. Using AKX donor guidelines, the majority of donors with predicted eGFR <30 ml/min/1.73 m2 30‐year postdonation were aged ≥50 years. Long‐term outcome data on AKX donors with low eGFR will need careful monitoring.

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Section: Discussionsupporting

confidence: 80%

Pre- and postdonation kidney function in donors of a kidney paired donation with unique criteria for donor glomerular filtration rate - a longitudinal cohort analysis

et al. 2018

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“…Figure 2 demonstrates that percentiles of normal GFR in healthy African subjects matched with those in Whites, both in Ivory Coast and in the Democratic Republic of Congo (DRC). 18,26…”

Section: Percentiles Of Normal Mgfrmentioning

confidence: 99%

Performance of creatinine- or cystatin C–based equations to estimate glomerular filtration rate in sub-Saharan African populations

Bukabau

Yayo

Gnionsahé

et al. 2019

Kidney International

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Glomerular filtration rate (GFR) is the best index for kidney function; however, the applicability of GFR estimating equations in sub-Saharan African populations remains unclear. In a cross-sectional study of adults living in Kinshasa, Democratic Republic of Congo (n[210) and Abidjan, Ivory Coast (n[284), we evaluated the performance of creatinine and cystatin C-based equations using plasma clearance of iohexol as the reference standard. The race coefficient did not improve the performance of creatinine-based GFR estimates; in fact, both the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology (CKD-EPI) equations performed better without the race coefficient in participants with GFR ‡60 mL/min/1.73m 2. The CKD-EPI and Full Age Spectrum (FAS) equations were unbiased and had similar precision (SD of 17.9 versus 19 mL/min/1.73 m 2) and accuracy within 30% (P30, 86.7% versus 87.4%) in participants with GFR ‡60 mL/min/1.73m 2. Both equations performed poorly in the subgroup with measured GFR < 60 mL/min/1.73m 2 (n[80), but the FAS equation had smaller bias (L4.8 mL/min/1.73m 2 versus L7.7 mL/min/1.73m 2 for CKD-EPI) and higher P30 (56.3% versus 31.3% for CKD-EPI). The corresponding equations including cystatin C alone or in combination with creatinine had similar performance. In a sub-Saharan African population, adjustment for race did not improve the performance of GFR estimating equations. The creatinine-based FAS and CKD-EPI equations performed reasonably well and were comparable when GFR was ‡ 60 mL/min/1.73m 2. Cystatin C did not improve performance. The FAS equation may be preferable when GFR is < 60 mL/min/1.73m 2 , but this should be confirmed in larger studies.

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“…Pottel et al reported that GFR measured by gold standard method had decreasing trend in GFR with increasing age. He also reported lower GFR in older females compared to matched males.…”

Section: Discussionmentioning

confidence: 99%

Cystatin C measurement leads to lower metformin dosage in elderly type 2 diabetic patients

Skalický

Adamíková

2018

Basic Clin Pharma Tox

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The aim of this study was to provide evidence for the hypothesis that estimated glomerular filtration rate from serum Cystatin C (eGFRcys) is better to be determined for all elderly type 2 diabetes mellitus (T2DM) patients based on eGFRcys upward and downward reclassification rate for hypothetical metformin dose reduction by eGFRcys at the GFR decision point of 45 mL/min/1.73 m . A total of 265 consecutive T2DM elderly patients (age range 65-91 years) from outpatient diabetic clinic were included in the study. The Kidney Disease Improving Global Outcomes (KDIGO) guidelines for metformin dosing were strictly followed. Estimated glomerular filtration rate from serum creatinine (eGFRcrea) led to results of metformin eligibility. Each of the results of eGFRcrea-based eligibility was further compared to eGFRcys-based eligibility. Creatinine was measured by enzymatic method standardized against international reference material SRM 967. Cystatin C was determined by method traceable to DA ERM 471 international standard. eGFRcrea and eGFRcys were calculated according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. A downward reclassification rate was higher than upward reclassification rate (31 vs 3, respectively; P < 0.0001). The median (IQR) eGFRcrea was higher than eGFRcys (73 (58-85) vs 63 (50-75) mL/min/1.73 m , respectively; P < 0.0001). eGFRcys reclassified significant proportion of patients with T2DM from metformin eligible CKD stages to less or non-eligible stages. The downward reclassification was more frequent in patients older than 80 years (P < 0.01). Cystatin C-based eGFR selects more complicated patients, where lower doses of metformin are possibly advisable. We recommend calculating both eGFRcrea and eGFRcys for metformin dosing in elderly patients with T2DM.

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Age-dependent reference intervals for estimated and measured glomerular filtration rate

Cited by 72 publications

References 29 publications

Pre- and postdonation kidney function in donors of a kidney paired donation with unique criteria for donor glomerular filtration rate - a longitudinal cohort analysis

Pre- and postdonation kidney function in donors of a kidney paired donation with unique criteria for donor glomerular filtration rate - a longitudinal cohort analysis

Performance of creatinine- or cystatin C–based equations to estimate glomerular filtration rate in sub-Saharan African populations

Cystatin C measurement leads to lower metformin dosage in elderly type 2 diabetic patients

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