Determination of the best method to estimate glomerular filtration rate from serum creatinine in adult patients with sickle cell disease: a prospective observational cohort study

Arlet, Jean‐Benoît; Ribeil, Jean‐Antoine; Châtellier, Gilles; Eladari, Dominique; Seigneux, Sophie de; Souberbielle, Jean‐Claude; Friedlander, Gérard; Montalembert, M. De; Pouchot, J.; Prié, Dominique; Courbebaisse, Marie

doi:10.1186/1471-2369-13-83

Cited by 79 publications

(76 citation statements)

References 29 publications

(40 reference statements)

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“…Among sickle cell disease patients in SubSaharan Africa and the French West Indies, the CKD-EPI and MDRD equations without race coefficients better predicted the GFR by iohexol clearance as compared with the traditional CKD-EPI and MDRD equations. 33 As in our study, Peralta et al showed that the diagnosis of low eGFR in Blacks was very sensitive to the race coefficient used in the GFR estimating equation in the bi-racial CARDIA cohort of young adults living in the United States. the CKD-EPI and MDRD better predicted iohexol derived GFRs when the race coefficient was removed 20 and similar results were recently described in a South African population as well.…”

Section: Discussionmentioning

confidence: 68%

Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults

Anker¹,

Scherzer²,

Peralta³

et al. 2016

Ethn Dis

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Objective: The aim of our study was to investigate whether current eGFR equations in clinical use might systematically overestimate the kidney function, and thus misclassify CKD status, of Black Americans with HIV. Specifically, we evaluated the impact of removing the race coefficient from the MDRD and CKD-EPI equations on comparisons between Black and White HIV-infected veterans related to: 1) the prevalence of reduced eGFR; 2) the distribution of eGFR values; and 3) the relationship between eGFR and all-cause mortality.Design: Retrospective cohort study.Setting: The Department of Veterans Affairs (VA) HIV Clinical Case Registry (CCR), which actively monitors all HIV-infected persons receiving care in the VA nationally.Patients/Participants: 21,905 treatmentnaïve HIV-infected veterans.Main Outcome Measures: Estimated glomerular filtration rate (eGFR) using the abbreviated Modification of Diet in Renal Disease (MDRD) formula with and without (MDRD-RCR) the race coefficient and allcause mortality.Results: Persons with eGFR <45 mL/ min/1.73m2 had a higher risk of death compared with those with eGFR >80 mL/ min/1.73m2 among both Blacks (HR=2.8, 95%CI: 2.4-3.3) and Whites (HR=1.9, 95%CI: 1.4-2.6), but the association appeared to be stronger in Blacks (P=.038, test for interaction). Blacks with eGFR 45- 60 mL/min/1.73m2 also had a higher risk of death (HR=1.7, 95%CI: 1.4-2.1) but Whites did not (HR=0.86, 95%CI: .67- 1.10; test for interaction: P<.0001). Racial differences were substantially attenuated when eGFR was re-calculated without the race coefficient.Conclusions: Our findings suggest that clinicians may want to consider estimating glomerular filtration rate without the race coefficient in Blacks with HIV. Ethn Dis. 2016;26(2):213-220; doi:10.18865/ ed.26.2.213

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Section: Discussionmentioning

confidence: 68%

Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults

Anker¹,

Scherzer²,

Peralta³

et al. 2016

Ethn Dis

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“…The estimated glomerular filtrations were calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the four-value Modification of Diet in Renal Disease (MDRD) equation (16)(17)(18). Microalbuminuria is a 30-300 mg/g urinary albumin-tourinary creatinine ratio.…”

Section: Definitionsmentioning

confidence: 99%

Kidney Disease among Patients with Sickle Cell Disease, Hemoglobin SS and SC

Drawz

Ayyappan

Nouraie

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Sickle cell disease (SCD) is an inherited anemia that afflicts millions worldwide. Kidney disease is a major contributor to its morbidity and mortality. We examined contemporary and historical SCD populations to understand how renal disease behaved in hemoglobin SS (HbSS) compared with HbSC. . Macroalbuminuria was seen in 20% of participants with SCD (HbSS or HbSC; P=0.45; Walk-PHaSST Trial), but microalbuminuria was more prevalent in HbSS (44% versus 23% in HbSC; P,0.002). In the Walk-PHaSST Trial, albuminuria was associated with hemolysis (higher lactate dehydrogenase, P,0.001; higher absolute reticulocyte count, P,0.02; and lower Hb, P=0.07) and elevated systolic BP (P,0.001) in HbSS. One half of all participants with HbSS (20 of 39) versus one fifth without (41 of 228) elevated tricuspid regurgitant jet velocity ($3 m/s; adverse prognostic indicator in SCD) had macroalbuminuria (P,0.001). In the CSSCD, overt proteinuria, detected (less sensitively) by urine dipstick, associated with higher 3-year mortality (odds ratio, 2.48; 95% CI, 1.07 to 5.77). Serum bicarbonate was lower in HbSS (23.8 versus 24.8 mEq/dl in HbSC; P,0.05) and associated with reticulocytopenic anemia and decreased renal function.Conclusions In SCD, albuminuria or proteinuria was highly prevalent, in HbSS more than in HbSC. Proteinuria associated with mortality in HbSS. Older individuals had a lower than expected eGFR, and this was more prominent in HbSS. Current management does not routinely address renal complications in SCD, which could plausibly reduce morbidity and mortality.

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“…However, their Scr level was 0.5 mg/dl, suggesting a possible overestimation of GFR. Overestimation of GFR by estimating methods was also reported in patients with sickle cell anemia (36).…”

Section: Discussionmentioning

confidence: 87%

GFR in Patients with β-Thalassemia Major

Milo

Nevo

Pazgal

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Patients with b-thalassemia major (TM) may have tubular dysfunction and glomerular dysfunction, primarily hyperfiltration, based on eGFR. Assessment of GFR based on serum creatinine concentration may overestimate GFR in these patients. This study sought to determine GFR by using inulin clearance and compare it with measured creatinine clearance (Ccr) and eGFR.Design, setting, participants & measurements Patients followed up in an Israeli thalassemia clinic who had been regularly transfused for years and treated with deferasirox were included in the study. They were studied by inulin clearance, Ccr, the CKD Epidemiology Collaboration and the Modification of Diet in Renal Disease equations for eGFR, and the Cockcroft-Gault estimation for Ccr. Expected creatinine excretion rate and tubular creatinine secretion rate were calculated.Results Nine white patients were studied. Results, given as medians, were as follows: serum creatinine was 0.59 mg/dl (below normal limits); GFR was low (76.6 ml/min per 1.73 m 2 ) and reached the level of CKD; Ccr was 134.9 ml/min per 1.73 m 2 , higher than the GFR because of a tubular creatinine secretion rate of 30.3 ml/min per 1.73 m 2 (this accounted for 40% of the Ccr); and eGFR calculated by the CKD Epidemiology Collaboration and Modification of Diet in Renal Disease equations and Cockcroft-Gault-estimated Ccr were 133, 141, and 168 ml/min per 1.73 m 2 , respectively. These latter values were significantly higher than the GFR, reaching the hyperfiltration range, and indicated that the estimation techniques were clinically unacceptable as a method for measuring kidney function compared with the GFR according to Bland and Altman analyses.Conclusions Contrary to previous reports, patients in this study with TM had normal or reduced GFR. The estimating methods showed erroneous overestimation of GFR and were clinically unacceptable for GFR measurements in patients with TM by Bland and Altman analysis. Therefore, more accurate methods should be used for early detection of reduced GFR and prevention of its further decline toward CKD in these patients.

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Determination of the best method to estimate glomerular filtration rate from serum creatinine in adult patients with sickle cell disease: a prospective observational cohort study

Cited by 79 publications

References 29 publications

Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults

Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults

Kidney Disease among Patients with Sickle Cell Disease, Hemoglobin SS and SC

GFR in Patients with β-Thalassemia Major

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