Assessment of Changes in Kidney Allograft Function Using Creatinine-Based Estimates of Glomerular Filtration Rate

Gera, Manish; Slezak, Jeffrey M.; Rule, Andrew D.; Larson, Timothy S.; Stegall, Mark D.; Cosio, Fernando G.

doi:10.1111/j.1600-6143.2006.01690.x

Cited by 70 publications

(46 citation statements)

References 26 publications

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“…First, we as well as Gera et al [10] have demonstrated the relatively low precision and accuracy of eGFR slopes in transplant patients. In our previous work on 72 patients, we reported a high sensitivity, less within-patient variability but low specificity of the CG and MDRD-IDMS equations to estimate rates of decline in transplant GFR.…”

Section: Discussionmentioning

confidence: 99%

“…Many investigators have stressed the general limitations of estimated GFR (eGFR) equations [2] and the performance of such equations has been demonstrated to vary in patients with different degrees of renal dysfunction [9]. Indeed, several researchers have documented the substantial variability of the current GFR equations at different time points after transplantation [10,11]. It was suggested that these equations were less accurate within the first year of transplantation and that they were quite limited in assessing GFR decline over time [12,13].…”

Section: Introductionmentioning

confidence: 99%

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Measurement Error in Estimated GFR Slopes across Transplant Chronic Kidney Disease Stages

Hossain¹,

Attia²,

Shoker³

2009

Am J Nephrol

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Background: This study examines if transplant glomerular filtration rate (GFR) slope prediction is affected by the degree of transplant chronic kidney disease (CKDT) stage. Methods: Serial changes in estimated GFR (ΔeGFR) by Cockcroft-Gault (CG) and Modified Diet in Renal Disease-Isotope Dilution Mass Spectrometry (MDRD-IDMS) equations were compared to simultaneous changes in isotope GFR (ΔiGFR) in renal transplant patients who had at least four scans. Results: Total number of patients (iGFR scans) was 99 (772) while the corresponding numbers in CKDT stages 1–4 were 33 (103), 69 (239), 75 (316) and 37 (96), respectively. Measurement error [(ΔeGFR – ΔiGFR) × 100/ΔiGFR] (median ± IQR, interquartile range) estimated from CG and MDRD-IDMS slopes were –414.29 ± 276.16% and –342.86 ± 210.18% (stage 1); –350.00 ± 301.22% and –300.00 ± 525.00% (stage 2); –26.02 ± 404.38% and –26.58 ± 423.13% (stage 3); 10.26 ± 142.18% and –76.92 ± 145.64% (stage 4), respectively. The proportion of patients with CG measurement error ≤1-fold in stages 1 and 2 of 12 and 14.5% was significantly (p < 0.05) lower than that of 36.3 and 52.8% at stages 3 and 4, respectively. Similar measurement errors were observed for MDRD-IDMS. Conclusions: Transplant GFR slope prediction is affected by the degree of renal dysfunction. Errors in slope prediction are much higher in those with better function and thus add another limitation for eGFR use in longitudinal studies on progressive graft dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Measurement Error in Estimated GFR Slopes across Transplant Chronic Kidney Disease Stages

Hossain¹,

Attia²,

Shoker³

2009

Am J Nephrol

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“…Several studies have reported a low accuracy of the MDRD equation for kidney transplant [7,8,35,36]. Serum creatinine is affected by several factors that are independent of GFR, such as age, race, muscle mass, gender, medication use and catabolic state.…”

Section: Discussionmentioning

confidence: 99%

Suitability of the IDMS-Traceable MDRD Equation Method to Estimate GFR in Early Postoperative Renal Transplant Recipients

Yeo¹,

Han²,

Moon

et al. 2009

Nephron Clin Pract

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Background/Aims: Accurate measurement of glomerular filtration rate (GFR) is critical for the management of kidney transplant recipients. Comparison of creatinine and cystatin C in renal transplant recipients gave conflicting results. We aimed to compare the performance of creatinine- and cystatin C-based equations and creatinine clearance in 102 early postoperative Korean renal transplant patients. Methods: We measured ⁵¹Cr-EDTA clearance using a 2-compartment model and considered this the reference GFR. Then, we estimated GFR using 13 creatinine- and 7 cystatin C-based equations. Serum creatinine value was calibrated to isotope-dilution mass spectrometry (IDMS). Results: The mean reference GFR was 76.77 ± 17.01 ml/min/1.73 m². The IDMS-traceable MDRD (IDMS-MDRD) equation had the highest accuracy (94.12 within 30% of the reference; 99.02 within 50% of the reference) with a bias of 0.33 ml/min/1.73 m² and a precision of 12.57 ml/min/1.73 m². The Mayo Clinic equation also performed well (92.16% within 30% of the reference; 99.02% within 50% of the reference; bias: –0.19 ml/min/1.73 m²). As for cystatin C-based equations, the Filler equation had the least bias (0.03 ml/min/1.73 m²) but low accuracy (78.43% within 30% of the reference). Conclusions: We conclude that the IDMS-MDRD equation provided the best estimate of GFR in our early postoperative Korean renal transplant patients.

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“…Renal function after transplantation was assessed using the estimated glomerular filtration rate (eGFR), which was calculated with the abbreviated Modification of Diet in Renal Disease equation [7][8][9]. eGFR rate at 1 year after transplantation and the rate of decline in eGFR thereafter were studied as measures of kidney function.…”

Section: Donor and Recipient Datamentioning

confidence: 99%

Kidneys from uncontrolled donors after cardiac death: which kidneys do worse?

et al. 2013

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SummaryKidneys from uncontrolled donors after cardiac death (DCD) expand the donor pool, but are associated with more primary nonfunction (PNF) and delayed graft function (DGF) compared with more conventional donor kidneys. It remains unclear, which factors influence outcome of uncontrolled donation. Therefore, we studied which donor, graft, and recipient characteristics are associated with PNF in a large cohort study. The association between different characteristics and short-term graft function was analyzed for kidneys procured in the Maastricht region from 1 January 1981 to 1 July 2009. Patients were followed until 7 January 2010. A total of 135 uncontrolled donor kidneys were included in this study. The incidence of PNF and DGF was 22% and 61%, respectively. Increasing donor age is an independent risk factor for graft failure in a univariate analysis (OR 1.035, 95% CI 1.004-1.068, P = 0.028). Donor age remains strongly associated with PNF in a multivariate analysis (OR 1.064, 95% CI 1.013-1.118, P = 0.014). However, the predictive value of donor age alone is poor (AURC 0.640, 95% CI 0.553-0.721). Increasing donor age of uncontrolled DCD donors is a major risk factor for PNF. Other clinically relevant variables were not associated with PNF. Donor age is strongly associated with PNF and remains an important parameter in donor selection.

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Assessment of Changes in Kidney Allograft Function Using Creatinine-Based Estimates of Glomerular Filtration Rate

Cited by 70 publications

References 26 publications

Measurement Error in Estimated GFR Slopes across Transplant Chronic Kidney Disease Stages

Measurement Error in Estimated GFR Slopes across Transplant Chronic Kidney Disease Stages

Suitability of the IDMS-Traceable MDRD Equation Method to Estimate GFR in Early Postoperative Renal Transplant Recipients

Kidneys from uncontrolled donors after cardiac death: which kidneys do worse?

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