Impact of errors of creatinine and cystatin C equations in the selection of living kidney donors

González-Rinne, Ana; Luis-Lima, Sergio; Eugenia, Beatríz; Negrín-Mena, Natalia; Ramírez, Ana I.; Morales, Adelaida; Vega, N; García, Patricia J.; Cabello, Elisa; Marrero-Miranda, Domingo; Aldea-Perona, Ana; Álvarez, Alejandra Boto; Abad, M.R.; Pérez-Tamajón, Lourdes; González‐Rinne, Federico; González-Delgado, Alejandra; Martin, Laura Díaz; Jiménez-Sosa, Alejandro; Torres, Armando

doi:10.1093/ckj/sfz052

Cited by 4 publications

(5 citation statements)

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“…Normal estimates of the GFR might not be actually that normal. In patients of higher eGFR, eGFR formula showed low accuracy and great degree of overestimation, which is consistent with reports from studies consisting of population with normal renal function, such as kidney donors [29,30]. Most of the eGFR equations were derived from subjects with kidney disease, or in combined healthy/diseased populations.…”

Section: Discussionsupporting

confidence: 85%

A novel nomogram to predict the reliability of estimated glomerular filtration rate formulae in oncology patients

et al. 2020

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Background: Formulae of estimated glomerular filtration rate (eGFR) based on serum creatinine (Scr) are routinely used in oncology patients, however, they are inaccurate in some populations. Our aim was to assess the agreement of eGFR formulae and thereby build a nomogram to predict the reliability of estimates. Methods: Measured GFR (mGFR) using isotope from 445 oncology patients were compared with eGFR from six formulae (Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), modified MDRD formulae for Chinese (C-MDRD), Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration, Wright and full age spectrum (FAS)). Bias, precision and accuracy of eGFR formulae were examined. We also evaluated statistics of agreement: the total deviation index (TDI), the concordance correlation coefficient (CCC) and the coverage probability (CP). Multivariate logistic regression was applied to identify characteristics associated with inaccurate eGFR and construct a predictive nomogram. Results: All eGFR formulae tended to overestimate the eGFR. The percentage of patients with eGFR within 30% the mGFR ranged from 38.0 to 62.8%. Cockcroft-Gault and MDRD showed low bias and high precision. The MDRD formula exhibited lowest TDI, meaning that 90% of estimations ranged from − 36 to 36% of mGFR. Multivariate logistic regression showed that inaccuracy of MDRD was found in elderly patients or in patients with eGFR greater than 120 ml/min. A nomogram was constructed to help oncologists to predict the risk of inaccuracy of eGFR. The calibration curve showed good agreement. Conclusions: Our results suggest that the error of eGFR by any formulae was common and wide in Chinese oncology patients. Our nomogram may assist oncologists in decision-making when mGFR is needed.

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Section: Discussionsupporting

confidence: 85%

A novel nomogram to predict the reliability of estimated glomerular filtration rate formulae in oncology patients

et al. 2020

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“…Normal estimates of the GFR might not be actually that normal. In patients of higher eGFR, eGFR formula showed low accuracy and great degree of overestimation, which is consistent with reports from studies consisting of population with normal renal function, such as kidney donors [27,28]. Most of the eGFR equations were derived from subjects with kidney disease, or in combined healthy/diseased populations.…”

Section: Bun/scr Ratio May Be An Indicator Of the Accuracy Of Egfr Fosupporting

confidence: 85%

A novel nomogram to predict the reliability of estimated glomerular filtration rate formula in oncology patients

Cheng

Huang

Han

et al. 2020

Preprint

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Background: Formulae of estimated glomerular filtration rate (eGFR) based on serum creatinine (Scr) are routinely used in oncology patients, however, they are inaccurate in some populations. Our aim was to assess the agreement of eGFR formulae and thereby build a nomogram to predict the reliability of estimates. Methods: Measured GFR (mGFR) using isotope from 445 oncology patients were compared with eGFR from six formulae (Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), modified MDRD formulae for Chinese (C-MDRD), Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration, Wright and full age spectrum (FAS)). Bias, precision and accuracy of eGFR formulae were examined. We also evaluated statistics of agreement: the total deviation index (TDI), the concordance correlation coefficient (CCC) and the coverage probability (CP). Multivariate logistic regression was applied to identify characteristics associated with inaccurate eGFR and construct a predictive nomogram. Results: All eGFR formulae tended to overestimate the eGFR. The percentage of patients with eGFR within 30% the mGFR ranged from 38.0% to 62.8%. Cockcroft-Gault and MDRD showed low bias and high precision. The MDRD formula exhibited lowest TDI, meaning that 90% of estimations ranged from -36 to 36% of mGFR. Multivariate logistic regression showed that inaccuracy of MDRD was found in elderly patients or in patients with eGFR greater than 120 ml/min. A nomogram was constructed to help oncologists to predict the risk of inaccuracy of eGFR. The calibration curve showed good agreement. Conclusions: Our results suggest that the error of eGFR by any formulae was common and wide in Chinese oncology patients. Our nomogram may assist oncologists in decision-making when mGFR is needed.

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“…25 While this method is widely used for screening of renal function because of its simplicity, it has the limitations in terms of precision. 26 In particular, it is known that there is a relatively large difference from GFR in populations with good renal function, 7 and the use of eGFR alone is not recommended in key clinical situations such as to determine the suitability of living donors for kidney Performances of conventionally-used eGFRs were shown as references. Bias, absolute value of residual.…”

Section: Discussionmentioning

confidence: 99%

“…5 Endogenous molecules that potentiate the precise assessment of kidney function with small biases is still necessary for important clinical decisions, including drug administration design, transplant donor selection, and CKD stage classification. 6,7 D-Serine is a candidate biomarker of kidney function. Land D-amino acids are mirror-image enantiomers of serine, and L-amino acids have been regarded as exclusively present in the human body until recently.…”

Section: Introductionmentioning

confidence: 99%

Measurement of glomerular filtration rate using endogenous d-serine clearance in living kidney transplant donors and recipients

et al. 2022

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Background Endogenous molecules that provide an unbiased and a precise evaluation of kidney function are still necessary. We explored the potential of clearance of D-serine, a rare enantiomer of serine and a biomarker of kidney function, as a measure of glomerular filtration rate (GFR).Methods This was a cross-sectional observational study of 200 living kidney transplant donors and recipients enrolled between July 2019 and December 2020 in a single Japanese center, for whom GFR was measured by clearance of inulin (C-in). Clearance of D-serine (C-DSer) was calculated based on blood and urine levels of D-serine, as measured by two-dimensional high-performance liquid chromatography. Analytical performance was assessed by calculating biases. Utilizing data from 129 participants, we developed equations for C-in based on C-DSer and C-cre using a linear regression model, and the performance was validated in 68 participants.Findings The means of C-in and C-DSer were 66.7 and 55.7 mL/min/1.73 m 2 of body surface area, respectively, in the entire cohort. C-DSer underestimated C-in with a proportional bias of 22.0% (95% confidence interval, 14.2 −29.8%) and a constant bias of -1.24 (-5.78−3.31), whereas the proportional bias was minor to that of C-cre (34.6% [31.1−38.2%] and 2.47 (-1.18−6.13) for proportional and constant bias, respectively). Combination of C-DSer and Ccre measured C-in with an equation of 0.391 £ C-DSer + 0.418 £ C-cre + 3.852, which reduced the proportional bias (6.5% [-0.2−13.1%] and -4.30 [-8.87−0.28] for proportional and constant bias, respectively). In the validation dataset, this equation performed well with median absolute residual of 3.5 [2.3−4.8], and high ratio of agreement (ratios of 30% and 15% different from C-in [P 30 and P 15 ] of 98.5 [91.4−100] and 89.7 [80.0−95.2], respectively).Interpretation The smaller proportional bias compared to that of C-cre is an advantage of C-DSer as a measure of Cin. Combinational measurement of D-serine and creatinine, two endogenous molecules, has the potential to serve as a measure of GFR with precision and minor biases and can support important clinical decisions.

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Impact of errors of creatinine and cystatin C equations in the selection of living kidney donors

Cited by 4 publications

References 0 publications

A novel nomogram to predict the reliability of estimated glomerular filtration rate formulae in oncology patients

A novel nomogram to predict the reliability of estimated glomerular filtration rate formulae in oncology patients

A novel nomogram to predict the reliability of estimated glomerular filtration rate formula in oncology patients

Measurement of glomerular filtration rate using endogenous d-serine clearance in living kidney transplant donors and recipients

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