Comparison between creatinine-based equations for estimating total creatinine clearance in peritoneal dialysis: a multicentre study

Virga, Giovambattista; Milia, Vincenzo La; Russo, Roberto; Bonfante, Luciana; Cara, M; Nordio, Maurizio

doi:10.1093/ndt/gfp391

Cited by 8 publications

(17 citation statements)

References 29 publications

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“…We will approach these two issues separately. First, the results of our analysis confirm those of Khosla and Steiner (18) and Virga et al (19) in that MDRDE estimates of CrCl provide an acceptable degree of correlation (i.e., precision) with 24-hour total mCrCl (Table 2 and Figure 3A). This is true irrespective of whether rCrCl is taken as the Kidney Disease Outcomes Quality Initiative recommended average of renal urea clearance and CrCl (21) or as pure "unadorned" CrCl.…”

Section: Discussionsupporting

confidence: 88%

“…Our evaluation was prompted by previ- ous investigations demonstrating agreement between formula-derived CrCl and mCrCl (18,19) and inferences by these investigators that MDRDEs be used to compare small-solute clearance across kidney replacement therapies (18) or as a simpler means to assess adequacy for individual PD patients (19). We will approach these two issues separately.…”

Section: Discussionmentioning

confidence: 99%

“…However, given that all studies normalized values to body surface area, the effect of size and ethnicity should be minimal. We also did not examine the value of the multiple creatininebased equations tested by Virga et al (19) in their ability to estimate mCrCl or to predict survival. However, we would expect comparable results because any creatinine-based equation will be subject to similar limitations as those for seen with MDRDEs.…”

Section: Discussionmentioning

confidence: 99%

“…Khosla and Steiner demonstrated a correlation between MDRDE-estimated creatinine clearance (CrCl) and measured creatinine clearance (mCrCl) from 24-hour urine and dialysate collections of patients treated with peritoneal dialysis (PD) (18). Virga et al also found a correlation between various GFR-estimating equations and mCrCl during PD and suggested that such equations could provide a simple means to assess adequacy in PD patients (19). On the basis of concern that practicing nephrologists and PD clinics might adopt MDRDE estimates of CrCl (eCrCl) as an alternative to the current gold standard of measured 24-hour collections of urine and spent dialysate, we explored the agreement between these two measures in another cohort of PD patients.…”

Section: Introductionmentioning

confidence: 99%

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Assessing Creatinine Clearance from Modification of Diet in Renal Disease Study Equations in the ADEMEX Cohort

Sloand

Leypoldt

Culleton

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Twenty-four-hour urine and dialysate collections provide accepted means to assess adequacy in peritoneal dialysis (PD). Recent publications suggest that creatinine clearance (CrCl) estimated from the Modification of Diet in Renal Disease (MDRD) equations (eCrCl) accurately approximates measured CrCl (mCrCl) derived from 24-hour collections of urine and dialysate and might serve as an alternative means to assess small-solute clearance and adequacy in PD. Design, setting, participants, & measurementsPost hoc analysis of data from patients enrolled in ADEMEX was used to assess agreement between mCrCl and eCrCl derived by four-and six-variable MDRD equations (4V-MDRDE and 6V-MDRDE, respectively). Additionally, associations among mCrCl, eCrCl, and survival were determined.Results Acceptable precision was observed between mCrCl and 4V-MDRDE-eCrCl and 6V-MDRDE-eCrCl for the entire cohort. Precision was markedly diminished when analysis was limited to functionally anuric patients with mCrCl Ͻ 12 ml/min per 1.73 m 2 . Although there was no association between survival and mCrCl, for every 1-ml/min per 1.73 m 2 increase in 4V-and 6V-MDRDE-eCrCl, there was a 6% and 4% increase in risk of death, respectively. There was a negative association between MDRDE-eCrCl and creatinine appearance rates, suggesting MDRDE-eCrCl is significantly confounded by individual differences in muscle mass.Conclusions MDRDE-eCrCl provides demographically comparable values to 24-hour urine and dialysate collections across the ADEMEX cohort. However, MDRDEs should not be used to assess small-solute removal or adequacy in individual PD patients or to predict outcome in any cohort of patients over narrow ranges of limited clearance.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessing Creatinine Clearance from Modification of Diet in Renal Disease Study Equations in the ADEMEX Cohort

Sloand

Leypoldt

Culleton

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…GFR was not measured directly, but estimated using the MDRD formula. This has however been validated for the GFR range used in this study, and has also been validated for severely uremic peritoneal dialysis patients [16]. The data are retrospective, and the study population is non-selected.…”

Section: Discussionmentioning

confidence: 99%

Uraemia Progression in Chronic Kidney Disease Stages 3–5 Is Not Constant

Heaf

Mortensen²

2011

Nephron Clin Pract

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Introduction: Chronic kidney disease (CKD) is a progressive disease leading to loss of glomerular filtration rate (ΔGFR, measured in ml/min/1.73 m²/year). ΔGFR is usually assumed to be constant, but the hyperfiltration theory suggests that it accelerates in severe uraemia. A retrospective analysis of estimated GFR (eGFR) calculated from the Modification of Diet in Renal Disease equation was performed to evaluate whether ΔGFR is constant or accelerating. Methods: 1,441 patients attending a nephrology clinic over a 21-year period, with an initial eGFR <60 ml/min/1.73 m² and an observation period ≧2 years, were included. eGFR was calculated from all creatinine measurements. 420 patients developed end-stage renal disease (ESRD). First- and second-order polynomial regression analysis of eGFR against time was performed for each patient individually. Patients had accelerating uraemia progression if the second-order term coefficient was negative. Results: The initial eGFR was 30.8 ±15.1 ml/min/1.73 m². The second-order coefficient was median –0.15 ml/min/1.73 m²/year² (interquartile range –0.92, +0.34). Significantly more patients had an accelerating loss (62%, p < 0.001). Acceleration was mainly seen when eGFR was <30 ml/min. ΔGFR was mean 1.47 ± 4.5 ml/min/1.73 m²/year (male 1.67, female 1.22). ESRD patients lost 5.4 ± 5.4 ml/min/year/1.73 m² during the last year before ESRD. Accelerating loss was seen for all diagnoses except polycystic disease. Diagnoses with higher ΔGFR were polycystic renal disease (3.3 ml/min/1.73 m²/year), hypertensive nephropathy (2.1 ml/min/1.73 m²/year) and diabetic nephropathy (2.6 ml/min/ 1.73 m²/year). There was no evidence of improvement in overall uraemia progression during the period of observation. Conclusions: Uraemia progression in CKD stages 3–5 is not linear, but shows an accelerating trend. This suggests that hyperfiltration mechanisms play a role in CKD progression. ESRD cannot thus be predicted from previous ΔGFR alone.

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Calculation of the clearance requirements for the development of a hemodialysis‐based wearable artificial kidney

Lee

Joo

et al. 2015

Hemodialysis International

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Wearable artificial kidney (WAK) has been considered an alternative to standard hemodialysis (HD) for many years. Although various novel WAK systems have been recently developed for use in clinical applications, the target performance or standard dose of dialysis has not yet been determined. To calculate the appropriate clearance for a HD-based WAK system for the treatment of patients with end-stage renal disease with various dialysis conditions, a classic variable-volume two-compartment kinetic model was used to simulate an anuric patient with variable target time-averaged creatinine concentration (TAC), daily water intake volume, daily dialysis pause time, and patient body weight. A 70-kg anuric patient with a HD-based WAK system operating for 24 h required dialysis clearances of creatinine of at least 100, 50, and 25 mL/min to achieve TACs of 1.0, 2.0, and 4.0 mg/dL, respectively. The daily water intake volume did not affect the clearance required for dialysis under various conditions. As the pause time per day for the dialysis increased, higher dialysis clearances were required to maintain the target TAC. The present study provided theoretical dialysis doses for an HD-based WAK system to achieve various target TACs through relevant mathematical kinetic modeling. The theoretical results may contribute to the determination of the technical specifications required for the development of a WAK system.

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Comparison between creatinine-based equations for estimating total creatinine clearance in peritoneal dialysis: a multicentre study

Abstract: Fluid collection remains the gold standard for assessing PD adequacy. Our study ascertained how 12 Cr-based equations performed in estimating totCrCL in PD patients with a view to enabling the most accurate and precise among them to be chosen for use in approximately assessing totCrCL.

Cited by 8 publications

References 29 publications

Assessing Creatinine Clearance from Modification of Diet in Renal Disease Study Equations in the ADEMEX Cohort

Assessing Creatinine Clearance from Modification of Diet in Renal Disease Study Equations in the ADEMEX Cohort

Uraemia Progression in Chronic Kidney Disease Stages 3–5 Is Not Constant

Calculation of the clearance requirements for the development of a hemodialysis‐based wearable artificial kidney

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