Development of a formula for estimated glomerular filtration rate in pregnant women from physiological hyperfiltration of serum creatinine

Abstract

Increased body fluids during pregnancy complicates the application of estimated glomerular filtration rate (eGFR) formulas that are based on body surface area. Furthermore, gestational renal dysfunction cannot be identified if the serum creatinine (SCr) concentration is within the non-pregnant reference interval (RI) despite inadequate pregnancy-related renal hyperfiltration. 1484 SCr measurements from 957 healthy pregnant women were collected. The average SCr value of gestational week (GW) 0–3 was the representative SCr value of non-pregnant status. While the distribution of SCr measurements varied across GWs, it was transformed into a normal distribution using the bootstrap resampling method. A polynomial linear regression method was applied to achieve a continuous and smooth transformation of values. The normally distributed SCr values of each GW were compared to the non-pregnant status, leading to the calculation of SCr hyperfiltration. The final equation, (2 − SCr (μmol/L)$$/$$ / 55.25)$$\times$$ × 103.1 $$\times$$ × 55.25/(56.7 − 0.223 $$\times$$ × GW − 0.113 $$\times$$ × GW2$$+$$ + 0.00545 $$\times$$ × GW3 − 0.0000653 $$\times$$ × GW4), and reference intervals for both SCr and eGFR for each GW were obtained. These RIs and novel equations can be effectively used to monitor renal dysfunction in pregnant women.