Estimated GFR for Living Kidney Donor Evaluation

Huang, Naya; Foster, Meredith C.; Lentine, Krista L.; Garg, Amit X.; Poggio, Emilio D.; Kasiske, Bertram L.; Inker, Lesley A.; Levey, Andrew S.

doi:10.1111/ajt.13540

Cited by 40 publications

(34 citation statements)

References 20 publications

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“…Pretest and posttest probabilities were calculated using the web‐based application, available on the CKD‐EPI website (http://ckdepi.org/equations/donor-candidate-gfr-calculator/). The web‐based application allows the user to alter the pretest probability according to the familial medical history of the donor . We did not modify the pretest probabilities to calculate the posttest probabilities.…”

Section: Methodsmentioning

confidence: 99%

“…We checked the validity of the web‐based calculator in our main cohort by stratifying pretest probabilities according to age and sex as previously done by Huang et al . Our goal was to identify all the donors with an mGFR <80 mL/min/1.73 m 2 , a threshold considered by some guidelines as a contraindication to donation .…”

Section: Methodsmentioning

confidence: 99%

“…There is a need for a strategy to identify potential donors who should undergo GFR measurement. Recently, Huang et al developed a new tool to help transplantation centers estimate the probability that a potential donor will have a measured GFR (mGFR) higher or lower than a defined threshold . The authors suggest that this application could be used to identify donors requiring GFR measurement.…”

Section: Introductionmentioning

confidence: 99%

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Estimated or Measured GFR in Living Kidney Donors Work-up?

Gaillard

Flamant

Lemoine

et al. 2016

American Journal of Transplantation

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The value of estimated glomerular filtration rate (eGFR) in living kidney donors screening is unclear. A recently published web-based application derived from large cohorts, but not living donors, calculates the probability of a measured GFR (mGFR) lower than a determined threshold. Our objectives were to validate the clinical utility of this tool in a cohort of living donors and to test two other strategies based on chronic kidney disease epidemiology collaboration (CKD-EPI) and on MDRD-eGFR. GFR was measured using Cr- ethylene-diamine tetraacetic acid urinary clearance in 311 potential living kidney donors (178 women, mean age 50 ± 11.6 years). The web-based tool was used to predict those with mGFR< 80 mL/min/1.73 m . Inputs to the application were sex, age, ethnicity, and plasma creatinine. In our cohort, a web-based probability of mGFR <90 mL/min/1.73 m higher than 2% had 100% sensitivity for detection of actual mGFR <80 mL/min/1.73 m . The positive predictive value was 0.19. A CKD-EPI-eGFR threshold of 104 mL/min/1.73 m and an MDRD-eGFR threshold of 100 mL/min/1.73 m had 100% sensitivity to detect donors with actual mGFR <80 mL/min/1.73 m . We obtained similar results in an external cohort of 354 living donors. We confirm the usefulness of the web-based application to identify potential donors who should benefit from GFR measurement.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Estimated or Measured GFR in Living Kidney Donors Work-up?

Gaillard

Flamant

Lemoine

et al. 2016

American Journal of Transplantation

View full text Add to dashboard Cite

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“…Using pretest probabilities from the National Health and Nutrition Examination Survey for mGFR thresholds based on age, sex and race, and likelihood ratios for eGFRcr and eGFRcr-cys categories versus mGFR thresholds, we computed the post-test probability that mGFR for a donor candidate is above or below the threshold for decision making. [27] This method was validated in a separate cohort. [28] Table 2 shows how this information can be used to make decisions to accept or decline a donor candidate based on the eGFR or to require further evaluation with a clearance measurement.…”

Section: Our Perspective: Implementationmentioning

confidence: 99%

Strategies for Assessing GFR and Albuminuria in the Living Kidney Donor Evaluation

2017

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Purpose of review The international guideline development group Kidney Disease Improving Global Outcomes (KDIGO) recently published a comprehensive set of recommendations for living donor evaluation which contains a new framework for decision making in the evaluation of kidney donor candidates. Recent Findings The guidelines recommend that decisions to accept or decline a candidate donor should be based on incorporation of multiple sources of information pertaining to the donor candidate's likelihood of serious adverse outcomes after donation. Two central components of assessment of risk are glomerular filtration rate (GFR) and albuminuria. We describe strategies for clinical decision making in assessment of GFR and albuminuria in the evaluation of living kidney donor candidates. Our premise is that all measurements will contain error; no single test result should lead to a decision to accept or decline a donor candidate. Summary A structured apporach to use of information from multiple sources (e.g. estimated and measured GFR, estimated and measured albuminuria) aids in test interpretation and can lead to increased accuracy of testing and efficiency of evaluation strategies.

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“…Recommendations for topics that are not addressed in the formal evidence review were based on other published evidence, newly generated evidence, 9,10 and work group consensus; these guideline statements are “not graded.” When recommendations from other KDIGO work groups were adapted for this guideline, the guideline statements were also not graded, because they were not part of the current evidence review for this guideline.…”

mentioning

confidence: 99%

Summary of Kidney Disease

et al. 2017

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Kidney Disease: Improving Global Outcomes (KDIGO) engaged an evidence review team and convened a work group to produce a guideline to evaluate and manage candidates for living kidney donation. The evidence for most guideline recommendations is sparse and many “ungraded” expert consensus recommendations were made to guide the donor candidate evaluation and care before, during, and after donation. The guideline advocates for replacing decisions based on assessments of single risk factors in isolation with a comprehensive approach to risk assessment using the best available evidence. The approach to simultaneous consideration of each candidate’s profile of demographic and health characteristics advances a new framework for assessing donor candidate risk and for defensible shared decision making.

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Estimated GFR for Living Kidney Donor Evaluation

Cited by 40 publications

References 20 publications

Estimated or Measured GFR in Living Kidney Donors Work-up?

Estimated or Measured GFR in Living Kidney Donors Work-up?

Strategies for Assessing GFR and Albuminuria in the Living Kidney Donor Evaluation

Summary of Kidney Disease

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