Iothalamate versus estimated GFR in a Hispanic-dominant pediatric renal transplant population

Papez, Karen E.; Barletta, Gina‐Marie; Hsieh, Stephanie; Joseph, Mark; Morgenstern, Bruce Z.

doi:10.1007/s00467-013-2556-y

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…In conclusion, modified Schwartz is a valid bedside equation to assess GFR in pediatric renal transplant recipients. Good performance characteristics of the mod-Schwartz eGFR confirms clinical utility in both transplant and non-transplant CKD patients, with the exception of CKD stage I (490 ml/min/1.73 m 2 ) (10,13,(15)(16)(17)26), which provides the support for the current K/DOQI guidelines in CKD and KDIGO in transplant (8,30). Special attention, however, must be paid toward its specific limitations in various clinical settings, such as children with reduced muscle mass, hyperfiltration (GFR 4120 ml/min/1.73 m 2 ), and older than 15 years where a measured GFR or addition of other GFR markers may provide a better assessment.…”

Section: Discussionmentioning

confidence: 70%

“…The differences in our study cohort and the reported studies reflect the heterogeneity of the study populations, the improved precision using cystatin C, and also potential impact of residual kidney function. Although cystatin C-based formulae correlate better to measured GFR than SCr-based formulae in native kidneys, Papez et al demonstrated similar GFR correlation between mod-Schwartz and cystatin C-based formulae in 78 pediatric renal transplant recipients (15). Future studies are needed to clarify the use of cystatin C-based equations in a large cohort of pediatric transplant recipients, given the frequency of screening and additional cost.…”

Section: Discussionmentioning

confidence: 99%

“…Two recent large analyses (738 GFRs from 503 children with primarily non-CKD; 1,074 GFRs from 469 CKD children including 111 renal transplant recipients) demonstrate good agreement of mod-Schwartz to iothalamate nGFR and inulin clearance, respectively (12,13). In addition, a comparison to iothalamate clearance with cystatin C or creatinine eGFR-based measures among various ethnic groups demonstrated modest-to-good correlation overall (14)(15)(16). Although these studies strengthen the clinical utility of using the eGFR equation for both CKD and non-CKD patients, they did not address a large number of transplant recipients.…”

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confidence: 97%

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Validation of serum creatinine-based formulae in pediatric renal transplant recipients

et al. 2017

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BackgroundAccurate monitoring of kidney function is important post-renal transplant; however, the routine use of measured glomerular filtration rate (GFR) or addition of newer serum markers is prohibitively expensive for routine clinical use, especially in children. We validated the modified Schwartz formula in pediatric renal transplant recipients across a range of demographic and clinical characteristics.MethodsIn a retrospective cohort study with nested cross-sectional analysis, we compared 505 measurements of estimated GFR using serum creatinine to simultaneous diethylenetriaminepentaacetic acid (DTPA) nuclear GFR (nGFR) measurements from 173 pediatric kidney transplant recipients who were < 18 years of age from 1 January 2001 to 31 December 2012 accounting for repeated measures.ResultsAmong 173 children, 62% were males, 85% with nGFR of ≥60 ml/min/1.73 m, and the median age at transplant was 13.6 years (interquartile range 8.3-16 years). Overall, the modified Schwartz and Pottel formulae had better bias (0.07 and -0.03 ml/min/1.73 m, respectively) and accuracy within 30% (both 84.4%) in comparison to Lyon and Zappitelli formulae. The 30% accuracy varied for girls and children <5 and >15 years.ConclusionModified Schwartz is a practical, non-invasive, and a valid bedside tool that provides a valid measurement of GFR in pediatric kidney transplant recipients.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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confidence: 97%

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Validation of serum creatinine-based formulae in pediatric renal transplant recipients

et al. 2017

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Performance of the various serum creatinine-based GFR estimating equations in pediatric kidney transplant recipients, stratified by age and CKD staging

et al. 2021

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Relationships of Measured Iohexol GFR and Estimated GFR With CKD-Related Biomarkers in Children and Adolescents

Schwartz

Warady

et al. 2017

American Journal of Kidney Diseases

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Background Two valid and reliable estimated glomerular filtration rate (GFR) equations for the pediatric population have been developed from directly measured GFR data in the Chronic Kidney Disease in Children (CKiD) cohort: the full CKiD and bedside CKiD equations. While adult GFR estimating equations replicate relationships of measured GFR with biomarkers, it is unclear whether similar patterns exist among children and adolescents with chronic kidney disease (CKD). Study Design Prospective cohort study in children and adolescents. Settings & Participants 730 participants contributed 1539 study visits. Predictors Measured GFR by plasma iohexol disappearance (mGFR), estimated GFR by the full CKiD equation (eGFRCKiDfull; based on serum creatinine, cystatin C, serum urea nitrogen, height, and sex), and estimated GFR by the bedside CKiD equation (eGFRCKiDbed; calculated as 41.3 × height[m]/serum creatinine [mg/dL]) were predictors of CKD-related biomarkers. Deviations of mGFR from eGFRCKiDfull and deviations of eGFRCKiDfull from eGFRCKiDbed from linear regressions (i.e., residuals) were included in bivariate analyses. Outcomes & Measurements CKD-related biomarkers included urine protein-creatinine ratio, blood hemoglobin, serum phosphate, bicarbonate, potassium, systolic and diastolic blood pressure z scores, and height z scores. Results The median age of 730 participants with CKD was 12.5 years, with median mGFR, eGFRCKiDfull, and eGFRCKiDbed of 51.8, 54.0, and 53.2 ml/min/1.73 m2, respectively. eGFRCKiDfull demonstrated as strong or stronger associations with CKD-related biomarkers than mGFR; eGFRCKiDbed associations were significantly attenuated (i.e., closer to the null). Residual information in mGFR did not substantially increase explained variability. eGFRCKiDbed estimated faster GFR decline relative to mGFR and eGFRCKiDfull. Limitations Simple linear summaries of biomarkers may not capture non-linear associations. Conclusions eGFRCKiDfull closely approximated mGFR to describe relationships with CKD-severity indicators and progression in this pediatric CKD population. eGFRCKiDbed offered similar inferences, but the associations were attenuated and rate of progression was overestimated. The eGFRCKiDfull equation from 2012 is preferred for pediatric research purposes.

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Iothalamate versus estimated GFR in a Hispanic-dominant pediatric renal transplant population

Abstract: The authors recommend further prospective investigations to validate and identify factors contributing to these findings.

Cited by 4 publications

References 29 publications

Validation of serum creatinine-based formulae in pediatric renal transplant recipients

Validation of serum creatinine-based formulae in pediatric renal transplant recipients

Performance of the various serum creatinine-based GFR estimating equations in pediatric kidney transplant recipients, stratified by age and CKD staging

Relationships of Measured Iohexol GFR and Estimated GFR With CKD-Related Biomarkers in Children and Adolescents

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