Is Body Surface Area the Appropriate Index for Glomerular Filtration Rate?

Hoste, Liesbeth; Pottel, Hans

doi:10.5772/26328

Cited by 7 publications

(5 citation statements)

References 51 publications

(46 reference statements)

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“…It has long been recognized that there is not a constant relationship between BSA, weight, and height (28). There is considerable controversy regarding the necessity or preferable methodology for indexing GFR by BSA (29). Scaling GFR to BSA may be fraught with inaccuracy in children and obese and very thin patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to ^99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

Haddadin

Lee

Conlin

et al. 2017

J. Nucl. Med. Technol.

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Glomerular filtration rate (GFR) measurements are critical in patients with hepatic cirrhosis but potentially erroneous when based on serum creatinine. New equations for estimated GFR (eGFR) have shown variable performance in cirrhotics, possibly because of inaccuracies in reference methods for measured GFR (mGFR). The primary objective was to compare the performance of 4 improved eGFR equations with a 1-compartment, 2-sample plasma slope intercept 99m Tc-DTPA mGFR method to determine whether any of the eGFR calculations could replace plasma 99m Tc-DTPA mGFR in patients with cirrhosis. The secondary objective was to test the hypothesis that mGFR using voluntary voided urine collections introduces error compared with plasmaonly methods. Methods: Fifty-four patients with hepatic cirrhosis underwent mGFR determinations from 2 plasma samples at 1 and 3 h after intravenous administration of 185 MBq of 99m Tc-DTPA. GFR was also generated by a UV/P calculation derived from blood and urine samples. These mGFRs were compared with the eGFRs generated by 4 estimating equations: MDRD (Modified Diet in Renal Disease), CKD-EPI (Chronic Kidney Disease-Epidemiology Collaboration) (serum creatinine [SCr]), CKD-EPI (cystatin [CysC]), and CKD-EPI (CysC1SCr). eGFRs were compared with mGFRs by Pearson correlation, precision, bias, percentage bias, and accuracy (eGFRs varying by ,10% [p10], ,20% [p20] or ,30% [p30] from the corresponding mGFR). Results: All eGFRs showed poorer performance when the UV/P 99m Tc-DTPA mGFR was used as the reference than when the plasma 99m Tc-DTPA mGFR was used. When compared with the plasma 99m Tc-DTPA mGFR method, the performance of all eGFR equations was superior to most published reports. There was a moderately good positive correlation between eGFRs and mGFRs. When compared with plasma 99m Tc-DTPA mGFR, precision of eGFRs was in the range of 14-20 mL/min and showed a negligible bias. Compared with the plasma 99m Tc-DTPA mGFR, CKD-EPI (CysC1SCr) showed the best overall performance and accuracy, at 85.19% (p30), 75.93% (p20), and 42.59% (p10). Conclusion: Estimating equations for measuring eGFR performed better than in most published reports, attributable to use of the plasma 99m Tc-DTPA mGFR method as a reference. CKD-EPI (CysC1SCr) eGFR showed the best overall performance. However, more discriminating methods may be required when accurate GFR measurements are necessary. mGFR measurements using urine collections may introduce error compared with plasma-only methods.

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Section: Discussionmentioning

confidence: 99%

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to ^99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

Haddadin

Lee

Conlin

et al. 2017

J. Nucl. Med. Technol.

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“…The high correlation coefficient between k r and BSAindexed GFR that was observed by Rabito et al 18 suggests that BSA-indexed GFR, which is the standard method of reporting GFR in the clinic is substantially equivalent to indexing by volume of distribution. The topic of the most appropriate method of indexing GFR has been a matter of some debate in the clinical community, [25][26][27] and may be worth further exploration once sufficient clinical data have been collected to test the different proposed indexing methods.…”

Section: Standard Deviation (Min)mentioning

confidence: 99%

Transdermal optical renal function monitoring in humans: development, verification, and validation of a prototype device

Debreczeny

Dorshow

2018

J. Biomed. Opt.

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A prototype medical device for monitoring kidney function by transdermal measurement of the clearance rate of the exogenous fluorescent tracer agent MB-102 (administered intravenously) was developed. Verification of the device with an in vitro protocol is described. The expected renal clearance of the agent was mimicked by preparing a dilution series of MB-102 in the presence of a scattering agent. The slope of a linear fit to the logarithm of fluorescence intensity as a function of dilution step agreed with predictions within 5%, a level of accuracy that would be adequate in assessment of GFR to prevent misdiagnosis of kidney disease. Transdermal measurement was validated using a rat model. A two-compartment pharmacokinetic dependence was observed, with equilibration of the fluorescent agent between the vascular space into which it was injected and the extracellular space into which it subsequently diffused. The best observed signal-to-noise ratios were about 150, allowing determination of the renal clearance time with 5% precision using a 10-min fitting window. Based on the verification and validation methods for transdermal fluorescence detection described herein, the instrument has been approved by the FDA for a first-in-human clinical study, and a first transdermal clearance curve in a human is presented herein.

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“…The first known formula used to estimate BSA was published in 1879, by replacing volume in the traditional surface area equation (SA = volume 2/3 ) with the weight of the subject. With this principle, the BSA of 6 adults and 10 children was measured to derive the BSA equation: BSA = (0.1053 × weight) 2/3 . The current equation used to estimate BSA in dogs is traditionally expressed as BSA (m 2 ) = (10.1 × W 2/3 )/10 000, where W is the body weight in grams (conversion to kg‐based formula yields 0.101 × body mass (kg) 2/3 ), and was developed in 1911 based on data from only 6 puppies …”

Section: Introductionmentioning

confidence: 99%

Use of computed tomography and radiation therapy planning software to develop a novel formula for body surface area calculation in dogs

Girens

Bukoski

Maitz

et al. 2019

Veterinary Internal Medicne

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Background Body surface area (BSA) can reflect metabolic rate that might normalize dosing of chemotherapeutics across widely variable weights within a species. The current BSA formula for dogs lacks height, length, and body condition. Hypothesis Computed tomography (CT) imaging will allow inclusion of morphometric variables in allometric modeling of BSA in dogs resulting in an improved formula for BSA estimation. Animals Forty‐eight dogs from 4 institutions with whole‐body CT images. Methods Retrospective and prospective case series. Body surface area was contoured using whole‐body CT scans and radiation therapy planning software. Body length and height were determined from CT images and also in 9 dogs by physical measurement. Nonlinear regression was used to model the BSA data sets using allometric equations. Goodness‐of‐fit criteria included average relative deviation, mean standard error, Akaike information criterion, and r2 (derived from the r‐value generated by regression models). Results Contoured BSA differed from the current formula by −9% to +19%. Nonlinear regression on untransformed data yielded BSA = 0.0134 × body weight [kg]∧0.4746 × length (cm)∧0.6393 as the best‐fit model. Heteroscedasticity (increasing morphometric variability with increasing BSA) was an important finding. Conclusions and Clinical Importance Computed tomography‐derived BSA was used to incorporate body length into a novel BSA formula. This formula can be applied prospectively to determine whether it correlates with adverse events attributed to chemotherapy.

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Is Body Surface Area the Appropriate Index for Glomerular Filtration Rate?

Cited by 7 publications

References 51 publications

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to ^99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to ^99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

Transdermal optical renal function monitoring in humans: development, verification, and validation of a prototype device

Use of computed tomography and radiation therapy planning software to develop a novel formula for body surface area calculation in dogs

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Is Body Surface Area the Appropriate Index for Glomerular Filtration Rate?

Cited by 7 publications

References 51 publications

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to 99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to 99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

Transdermal optical renal function monitoring in humans: development, verification, and validation of a prototype device

Use of computed tomography and radiation therapy planning software to develop a novel formula for body surface area calculation in dogs

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Product

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Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to ^99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to ^99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis