Hyperfiltration Affects Accuracy of Creatinine eGFR Measurement

Huang, Shih‐Han S.; Sharma, Ajay; Yasin, Abeer; Lindsay, Robert M.; Clark, William F.; Filler, Guido

doi:10.2215/cjn.02760310

Cited by 63 publications

(40 citation statements)

References 34 publications

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“…Consequently, nuclear medicine tests, such as the 99m technetium diethylenetriamine penta-acetic acid ( 99m Tc DTPA) renal scan, are often used to measure GFR (3), although these pose other drawbacks, because they are cumbersome, are invasive, and expose patients to radiation (2). Endogenous markers for estimating GFR, such as serum creatinine (Cr), cystatin C (CysC), and b-trace protein (BTP), carry no radiation risk but can be imprecise (4)(5)(6)(7)(8). Of these, Cr is the most commonly used marker in clinical practice, but the significant influence of muscle mass (9) on this marker results in substantial interpatient variability (10).…”

Section: Introductionmentioning

confidence: 99%

Estimation of GFR Using β-Trace Protein in Children

Witzel

Huang

Braam

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Sex may affect the performance of small molecular weight proteins as markers of GFR because of differences in fat mass between the two sexes. The hypothesis was that the diagnostic performance of b-trace protein, a novel marker of GFR, would be significantly better in boys than in girls.Design, setting, participants, & measurements GFR, height, weight, serum creatinine, and b-trace protein were measured in 755 children and adolescents (331 girls) undergoing 99 technetium diethylenetriamine penta-acetic acid renal scans from July of 1999 to July of 2006. Boys and girls were separated into formula generation cohorts (284 boys and 220 girls) and formula validation cohorts (140 boys and 111 girls). GFRestimating formulas on the basis of b-trace protein, creatinine, and height were derived using stepwise linear regression analysis of log-transformed data. The slope of the regression lines of the sex-specific eGFRs were compared. Bland-Altman analysis was used for testing agreement between 99 technetium diethylenetriamine penta-acetic acid GFR and calculated GFR both with this equation in boys and girls as well as previously established Benlamri, White, and Schwartz formulas. ResultsIn the stepwise regression analysis, b-trace protein (R 2 =0.73 for boys and R 2 =0.65 for girls) was more important than creatinine (which increased R 2 to 0.81 for boys and R 2 to 0.75 for girls) and height (which increased R 2 to 0.88 for boys and R 2 to 0.80 for girls) in the data generation groups. GFR can be calculated using the following formulas: Bland-Altman analysis showed better performance in boys than in girls. The new formulas performed significantly better than the previous Benlamri, White, and Schwartz formulas with respect to bias, precision, and accuracy.Conclusions Improved and sex-specific formulas for the estimation of GFR in children on the basis of b-trace protein, serum creatinine, and height are now available.

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Section: Introductionmentioning

confidence: 99%

Estimation of GFR Using β-Trace Protein in Children

Witzel

Huang

Braam

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Against the gold standard evaluation, which is inulin clearance, precision and accuracy of creatinine clearance, isotope clearance, and formulas greatly vary (17). This is especially true with high GFR values or high filtration fraction (18). Both the Modification of Diet in Renal Disease Study and the Cockcroft-Gault formulas systematically underestimate GFR, especially at high levels (.60 ml/min per 1.73 m 2 ), which might particularly compromise their suitability in patients with incipient kidney disease and hyperfiltration (19).…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Glomerular Hyperfiltration Assessment and Definition in the Medical Literature

Cachat

Combescure

Cauderay³

et al. 2015

Clinical Journal of the American Society of Nephrology

153

138

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Background and objectives Evaluation of glomerular hyperfiltration (GH) is difficult; the variable reported definitions impede comparisons between studies. A clear and universal definition of GH would help in comparing results of trials aimed at reducing GH. This study assessed how GH is measured and defined in the literature.Design, setting, participants, & measurements Three databases (Embase, MEDLINE, CINAHL) were systematically searched using the terms "hyperfiltration" or "glomerular hyperfiltration". All studies reporting a GH threshold or studying the effect of a high GFR in a continuous manner against another outcome of interest were included.Results The literature search was performed from November 2012 to February 2013 and updated in August 2014. From 2013 retrieved studies, 405 studies were included. Threshold use to define GH was reported in 55.6% of studies. Of these, 88.4% used a single threshold and 11.6% used numerous thresholds adapted to participant sex or age. In 29.8% of the studies, the choice of a GH threshold was not based on a control group or literature references. After 2004, the use of GH threshold use increased (P,0.001), but the use of a control group to precisely define that GH threshold decreased significantly (P,0.001); the threshold did not differ among pediatric, adult, or mixedage studies. The GH threshold ranged from 90.7 to 175 ml/min per 1.73 m 2 (median, 135 ml/min per 1.73 m 2 ).Conclusion Thirty percent of studies did not justify the choice of threshold values. The decrease of GFR in the elderly was rarely considered in defining GH. From a methodologic point of view, an age-and sex-matched control group should be used to define a GH threshold.

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“…As previously discussed, we were not able to test Scr or CrCL as a covariate on drug clearance. However, the use of Scr and CrCL as markers for renal function have some major disadvantages, especially in children, as they are sensitive to changes in age, muscle mass, feeding, and disease status (23,24). Moreover, in younger children, Scr is generally underestimated when using the standardized Jaffe analysis method (25).…”

Section: Discussionmentioning

confidence: 99%

Augmented Renal Clearance Implies a Need for Increased Amoxicillin-Clavulanic Acid Dosing in Critically Ill Children

Cock

Standing

Barker

et al. 2015

Antimicrob Agents Chemother

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There is little data available to guide amoxicillin-clavulanic acid dosing in critically ill children. The primary objective of this study was to investigate the pharmacokinetics of both compounds in this pediatric subpopulation. Patients admitted to the pediatric intensive care unit (ICU) in whom intravenous amoxicillin-clavulanic acid was indicated (25 to 35 mg/kg of body weight every 6 h) were enrolled. Population pharmacokinetic analysis was conducted, and the clinical outcome was documented. A total of 325 and 151 blood samples were collected from 50 patients (median age, 2.58 years; age range, 1 month to 15 years) treated with amoxicillin and clavulanic acid, respectively. A three-compartment model for amoxicillin and a two-compartment model for clavulanic acid best described the data, in which allometric weight scaling and maturation functions were added a priori to scale for size and age. In addition, plasma cystatin C and concomitant treatment with vasopressors were identified to have a significant influence on amoxicillin clearance. The typical population values of clearance for amoxicillin and clavulanic acid were 17.97 liters/h/70 kg and 12.20 liters/h/70 kg, respectively. In 32% of the treated patients, amoxicillin-clavulanic acid therapy was stopped prematurely due to clinical failure, and the patient was switched to broader-spectrum antibiotic treatment. Monte Carlo simulations demonstrated that four-hourly dosing of 25 mg/kg was required to achieve the therapeutic target for both amoxicillin and clavulanic acid. For patients with augmented renal function, a 1-h infusion was preferable to bolus dosing. Current published dosing regimens result in subtherapeutic concentrations in the early period of sepsis due to augmented renal clearance, which risks clinical failure in critically ill children, and therefore need to be updated. (This study has been registered at Clinicaltrials.gov as an observational study [NCT02456974].)

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Hyperfiltration Affects Accuracy of Creatinine eGFR Measurement

Cited by 63 publications

References 34 publications

Estimation of GFR Using β-Trace Protein in Children

Estimation of GFR Using β-Trace Protein in Children

A Systematic Review of Glomerular Hyperfiltration Assessment and Definition in the Medical Literature

Augmented Renal Clearance Implies a Need for Increased Amoxicillin-Clavulanic Acid Dosing in Critically Ill Children

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