Biological Variation of Creatinine, Cystatin C, and eGFR over 24 Hours

Hilderink, Judith M; Linden, Naomi van der; Kimenai, Dorien M; Litjens, Elisabeth J R; Klinkenberg, Lieke J.J.; Aref, Breshna M; Aziz, F K; Kooman, Jeroen P.; Rennenberg, Roger J M W; Bekers, Otto; Koopmans, Richard P.; Meex, Steven J.R.

doi:10.1373/clinchem.2017.282517

Cited by 30 publications

(51 citation statements)

References 38 publications

(49 reference statements)

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“…This change is in accordance with findings in other study populations exposed to heat stress such as sugarcane workers [31,32] and athletes in endurance competitions [33], but not under sedentary conditions [34]. Authors considered as potential mechanisms for the kidney function decrease observed in these investigations dehydration, volume depletion, rhabdomyolysis, systemic inflammation, and oxidative stress triggered by environmental heat and the extreme physical activity.…”

Section: Discussionsupporting

confidence: 90%

Hydration Status and Kidney Health of Factory Workers Exposed to Heat Stress: A Pilot Feasibility Study

et al. 2019

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Dehydration associated with heat stress increases the risk of workplace injury or illness, decreases productivity, and may contribute to the chronic kidney disease epidemic identified in outdoor workers from hot climates. There is limited research on the effects of chronic occupational heat stress among indoor workers. We aimed to test the feasibility of measuring markers of hydration and kidney function in foundry factory workers in Southern Brazil, exposed and not exposed to heat stress. Factory workers exposed to heat stress (wet bulb globe temperature ≥28.9) and not exposed to heat were identified by management and invited to participate. Clinical and biochemical markers of hydration and kidney function were evaluated before and after a single 8.5 h work shift (lunch time not included). Feasibility outcomes included rates of enrolment, % completion of study protocols, and time to complete data collection. This study was deemed feasible with 80% enrolment and 90% completion of the protocol. Among the preselected workers, the enrolment rate was 91%. All subjects completed the physiological measures and blood collection and 95% completed the urine studies. Mean time to complete data collection pre-shift was 19.1 ± 4.2 min and post-shift: 14.3 ± 4.0 min. Workers exposed to heat stress had a greater decline in estimated glomerular filtration rate compared to controls over the work shift (–13 ± 11 vs. –5 ± 7 mL/min; p < 0.01). We demonstrated the feasibility and challenges of conducting future hydration and kidney function research among indoor factory workers. Further study is needed to determine if exposure to indoor heat contributes to a decline in kidney function.

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Section: Discussionsupporting

confidence: 90%

Hydration Status and Kidney Health of Factory Workers Exposed to Heat Stress: A Pilot Feasibility Study

et al. 2019

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“…It could be argued that our results are caused by fluctuations of serum creatinine levels that are not due to changes in renal function. However, Hilderink et al showed that this spontaneous variability leads to fluctuations of eGFR of 13-20% 29 only, a value lower than many of our criteria used to define a group of individuals with a detrimental prognosis. Nonetheless we could not evaluate the stability of an eGFR decline of ≥ 45 or 50% as the patient number became low.…”

Section: Discussionmentioning

confidence: 57%

Intra-individual variability of eGFR trajectories in early diabetic kidney disease and lack of performance of prognostic biomarkers

Kerschbaum

Rudnicki

Dzien³

et al. 2020

Sci Rep

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Studies reporting on biomarkers aiming to predict adverse renal outcomes in patients with type 2 diabetes and kidney disease (DKD) conventionally define a surrogate endpoint either as a percentage of decrease of eGFR (e.g. ≥ 30%) or an absolute decline (e.g. ≥ 5 ml/min/year). The application of those study results in clinical practise however relies on the assumption of a linear and intra-individually stable progression of DKD. We studied 860 patients of the PROVALID study and 178 of an independent population with a relatively preserved eGFR at baseline and at least 5 years of follow up. Individuals with a detrimental prognosis were identified using various thresholds of a percentage or absolute decline of eGFR after each year of follow up. Next, we determined how many of the patients met the same criteria at other points in time. Interindividual eGFR decline was highly variable but in addition intra-individual eGFR trajectories also were frequently non-linear. For example, of all subjects reaching an endpoint defined as a decrease of eGFR by ≥ 30% between baseline and 3 years of follow up, only 60.3 and 45.2% lost at least the same amount between baseline and year 4 or 5. The results were similar when only patients on stable medication or subpopulations based on baseline eGFR or albuminuria status were analyzed or an eGFR decline of ≥ 5 ml/min/1.73m2/year was used. Identification of reliable biomarkers predicting adverse prognosis is a strong clinical need given the large interindividual variability of DKD progression. However, it is conceptually challenging in early DKD because of non-linear intra-individual eGFR trajectories. As a result, the performance of a prognostic biomarker may be accurate after a specific time of follow-up in a single population only.

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“…It provides the estimated glomerular filtration rate and is based on the child's height and values of serum creatinine, a by‐product of muscle metabolism eliminated through glomerular filtration . Unfortunately, estimated glomerular filtration rate and serum creatinine are both unreliable and inaccurate markers for monitoring of kidney function and detecting KI in pediatric populations for the following reasons: (1) approximately 50% of renal parenchymal loss must occur before serum creatinine changes can be detected; (2) serum creatinine can be influenced by muscle mass variation, nutrition, age, and sex; (3) during the first days of life, serum creatinine rather reflects the maternal kidney function instead of the kidney function of the neonate; (4) overestimation of kidney function is possible in patients with cachexia; and (5) serum creatinine does not allow the exact localization nor the extent of KI …”

Section: Overview Of Kidney Injury Biomarkers For Detecting Drug‐relamentioning

confidence: 99%

“…10 Unfortunately, estimated glomerular filtration rate and serum creatinine are both unreliable and inaccurate markers for monitoring of kidney function and detecting KI in pediatric populations for the following reasons: (1) approximately 50% of renal parenchymal loss must occur before serum creatinine changes can be detected; (2) serum creatinine can be influenced by muscle mass variation, nutrition, age, and sex; (3) during the first days of life, serum creatinine rather reflects the maternal kidney function instead of the kidney function of the neonate; (4) overestimation of kidney function is possible in patients with cachexia; and (5) serum creatinine does not allow the exact localization nor the extent of KI. [11][12][13][14][15][16][17][18][19][20][21][22][23] Understanding Age-Dependent Changes in Pediatrics Kidney function comprises 3 main processes: First, glomerular filtration is responsible for the filtration of the plasma across the glomerular membrane into the renal tubule. Second, tubular excretion transporters can increase the excretion of drug molecules by more actively transport from the plasma into the tubule.…”

mentioning

confidence: 99%

Age‐Dependent Changes of Kidney Injury Biomarkers in Pediatrics

Donge

Welzel

Atkinson

et al. 2019

The Journal of Clinical Pharma

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Currently used creatinine‐based parameters for monitoring kidney function are not reliable for early detection of kidney injury (KI), particularly tubular damage. Several KI biomarkers allow for early detection of glomerular and tubular damage and may help to prevent drug‐related chronic kidney diseases in pediatrics. This literature review describes the state of current research and investigates reference values for these KI biomarkers in neonates, infants, and children to better understand age‐related changes. A total of 12 of 237 screened studies fulfilled predefined criteria, including 219 preterm neonates, 70 neonates, 596 infants, and 1726 children. KI biomarkers were analyzed in urine (6 studies), in serum/plasma (5 studies) and in serum and urine (1 study). Four studies (n = 555) measured urinary kidney injury molecule‐1, whereas urinary neutrophil gelatinase‐associated lipocalin was assessed in 5 studies (n = 888), and 2 studies (n = 203) investigated serum cystatin C. This review of KI biomarkers in different pediatric age groups indicates that (1) the majority of KI biomarkers are measured in urine; (2) the 3 most commonly analyzed KI biomarkers are urinary neutrophil gelatinase‐associated lipocalin, urinary kidney injury molecule‐1, and serum cystatin C; (3) values of KI biomarkers appear to decrease from prematurity to infancy; and (4) there is an unmet need to further enhance knowledge on age‐dependent changes of KI biomarkers in pediatrics. Studies are needed to better characterize reference values for these key KI biomarkers in healthy pediatric populations and to evaluate the value of these markers in the early detection of drug‐related KI in neonates, infants, and children.

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Biological Variation of Creatinine, Cystatin C, and eGFR over 24 Hours

Abstract: Despite differences in CV of creatinine, the CV and RCV of the eGFR equations were relatively similar for people with or without CKD.

Cited by 30 publications

References 38 publications

Hydration Status and Kidney Health of Factory Workers Exposed to Heat Stress: A Pilot Feasibility Study

Hydration Status and Kidney Health of Factory Workers Exposed to Heat Stress: A Pilot Feasibility Study

Intra-individual variability of eGFR trajectories in early diabetic kidney disease and lack of performance of prognostic biomarkers

Age‐Dependent Changes of Kidney Injury Biomarkers in Pediatrics

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