Extracellular fluid volume and glomerular filtration rate in 1878 healthy potential renal transplant donors: effects of age, gender, obesity and scaling

Peters, A. M.; Perry, Laura J.; Hooker, Claire A.; Howard, Bethany; Neilly, Mark; Seshadri, Nagabhushan; Sobnack, R.; Irwin, A. G.; Snelling, Hayley; Grüning, Thomas; Patel, Neva; Lawson, Richard; Shabo, Gregory; Williams, Nigel; Dave, Surendra; Barnfield, Mark C.

doi:10.1093/ndt/gfr479

Cited by 56 publications

(61 citation statements)

References 29 publications

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“…The mean GFR of 107 ml/min/1.73 m 2 was first suggested by original data obtained by Piepsz et al [29,30] ferent from 107 ml/min/1.73 m 2 but this difference is clearly not relevant from a clinical point of view, as the mean mGFR was 104.9 ml/min/1.73 m 2 . Moreover, the study by Peters et al [15] has the largest impact (weight) on the meta-analysis results, since this is the study with the largest number of subjects, but at the same time, this study consistently showed the lowest mean mGFR values for all age groups. Without the Peters data, the mean mGFR in the 30-40 years age group becomes 105.6 with a 95% CI of 103.4-107.8, which includes 107.…”

Section: Discussionmentioning

confidence: 69%

“…In the age groups 20-30, 30-40, 50-60 and 60-70 years, the largest influence was obtained from the study of Peters et al [15] , with a significant decrease in heterogeneity I 2 when omitted. In the age group of 40-50 years, the study of Poggio et al [9] showed the largest influence, and when omitted, heterogeneity I 2 = 90.3% decreased to 82.2%.…”

Section: Sensitivity Analysismentioning

confidence: 95%

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Glomerular Filtration Rate in Healthy Living Potential Kidney Donors: A Meta-Analysis Supporting the Construction of the Full Age Spectrum Equation

Pottel

Hoste

Yayo

et al. 2016

Nephron

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Background: Normal kidney function or, more specifically, normal glomerular filtration rate (GFR) in men and women and its decline with age is still much debated today. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation has gender (and race) multiplication factors, accounts for a decline that starts at very young age and assumes that the mean GFR is as high as 120-130 ml/min/1.73 m² from a young age. The full age spectrum (FAS) estimated mean GFR is about 107 ml/min/1.73 m² at a young age and remains constant until the age of 40 years and then starts to decline both in men and women. The aim of this research study was to give more insight into ‘normal' GFR levels and the physiological decrease of kidney function with age and to use a meta-analysis to evaluate the mathematical construction of the FAS and the CKD-EPI equation. Methods: We conducted a meta-analysis of published GFR measurements in healthy Caucasian living potential kidney donors (n = 5,482, 46.8% men). Only publications dating from 2000 were selected to avoid the possible influence of body surface area changes in the last decades on the indexed GFR, expressed in ml/min/1.73 m². Results: We found that the mean GFR ≈ 107 ml/min/1.73 m² up to the age of 40 years, but renal decline begins beyond 40 years. No evidence could be found for any difference between men and women in the separate age groups. Conclusions: The current meta-analysis supports the mathematical form of the FAS equation, which matches the age/sex dependency of measured GFR for healthy potential living kidney donors.

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Section: Discussionmentioning

confidence: 69%

Section: Sensitivity Analysismentioning

confidence: 95%

Glomerular Filtration Rate in Healthy Living Potential Kidney Donors: A Meta-Analysis Supporting the Construction of the Full Age Spectrum Equation

Pottel

Hoste

Yayo

et al. 2016

Nephron

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“…In one study, healthy men and women of the same SA had similar levels of GFR (29), although in another study GFR/SA was slightly (4.5%) higher in men than in women. Still, GFR scaled to SA between men and women is more similar than GFR scaled to V (29,30). For this reason, it has been suggested that V-based dialysis dosing be rescaled to SAN-stdKt/V (6).…”

Section: Discussionmentioning

confidence: 99%

Dialysis Dose Scaled to Body Surface Area and Size-Adjusted, Sex-Specific Patient Mortality

Ramirez

Kapke

Port

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives When hemodialysis dose is scaled to body water (V), women typically receive a greater dose than men, but their survival is not better given a similar dose. This study sought to determine whether rescaling dose to body surface area (SA) might reveal different associations among dose, sex, and mortality.Design, setting, participants, & measurements Single-pool Kt/V (spKt/V), equilibrated Kt/V, and standard Kt/V (stdKt/V) were computed using urea kinetic modeling on a prevalent cohort of 7229 patients undergoing thriceweekly hemodialysis. Data were obtained from the Centers for Medicare & Medicaid Services 2008 ESRD Clinical Performance Measures Project. SA-normalized stdKt/V (SAN-stdKt/V) was calculated as stdKt/V 3 ratio of anthropometric volume to SA/17.5. Patients were grouped into sex-specific dose quintiles (reference: quintile 1 for men). Adjusted hazard ratios (HRs) for 1-year mortality were calculated using Cox regression.Results spKt/V was higher in women (1.760.3) than in men (1.560.2; P,0.001), but SAN-stdKt/V was lower (women: 2.360.2; men: 2.560.3; P,0.001). For both sexes, mortality decreased as spKt/V increased, until spKt/V was 1.6-1.7 (quintile 4 for men: HR, 0.62; quintile 3 for women: HR, 0.64); no benefit was observed with higher spKt/V. HR for mortality decreased further at higher SAN-stdKt/V in both sexes (quintile 5 for men: HR, 0.69; quintile 5 for women: HR, 0.60).Conclusions SA-based dialysis dose results in dose-mortality relationships substantially different from those with volume-based dosing. SAN-stdKt/V analyses suggest women may be relatively underdosed when treated by V-based dosing. SAN-stdKt/V as a measure for dialysis dose may warrant further study.

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“…Corresponding median values in the current prospective renal transplant donors were both 0.18 l/kg [11].…”

Section: Resultsmentioning

confidence: 83%

“…There has been much discussion recently about the shortcomings of BSA for physiological scaling, especially in children in whom the BSA is relatively large in relation to body mass and gives a value of scaled GFR that is significantly lower in relation to the rate constant of the terminal exponential of the plasma clearance curve (α 2 ) [6]. Moreover, it is interesting to note that values of mECV in healthy adult donors when scaled to BSA were 13.0 and 12.0 l/1.73 m 2 [11], respectively, which are much higher than those in children (see Table 1) and the reverse of the difference between adults and children seen with scaling to weight. The equation of Bird et al (Eq.…”

Section: Discussionmentioning

confidence: 99%

Estimation of extracellular fluid volume in children

Peters

2012

Pediatr Nephrol

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Extracellular fluid volume and glomerular filtration rate in 1878 healthy potential renal transplant donors: effects of age, gender, obesity and scaling

Abstract: There are several significant differences in GFR and ECV between healthy men and women.

Cited by 56 publications

References 29 publications

Glomerular Filtration Rate in Healthy Living Potential Kidney Donors: A Meta-Analysis Supporting the Construction of the Full Age Spectrum Equation

Glomerular Filtration Rate in Healthy Living Potential Kidney Donors: A Meta-Analysis Supporting the Construction of the Full Age Spectrum Equation

Dialysis Dose Scaled to Body Surface Area and Size-Adjusted, Sex-Specific Patient Mortality

Estimation of extracellular fluid volume in children

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