Predicting Glomerular Filtration Rate in Kidney Transplantation: Are the K/DOQI Guidelines Applicable?

Mariat, Christophe; Alamartine, Éric; Afiani, Aïda; Thibaudin, Lise; Laurent, B.; Berthoux, P; Filippis, Jean-Pierre De; Thibaudin, Damien; Mayor, Brice; Elessawy, Abdel Basset; Berthoux, F

doi:10.1111/j.1600-6143.2005.01070.x

Cited by 52 publications

(31 citation statements)

References 20 publications

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“…The applicability of the MDRD study equation in RTRs has been studied widely with conflicting results, although on balance it was shown to be the most accurate with the least bias when compared with other formulae used to estimate GFR (9)(10)(11)(12) as CKD stage 1T-2T according to the level of GFR alone, which is in contrast to the KDOQI guidelines for native CKD, where markers of kidney damage (i.e. proteinuria, scarring) are also required.…”

Section: Ckd Classificationmentioning

confidence: 99%

Chronic Renal Failure in Kidney Transplant Recipients. Do They Receive Optimum Care?: Data from the UK Renal Registry

Ansell

Udayaraj

Steenkamp

et al. 2007

American Journal of Transplantation

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We report the prevalence of chronic kidney disease (CKD) and related complications in a national cohort of RTR (n = 9542), and compare this with dialysis patients. The majority of RTR were classified as having CKD stage 2T (21.6%) or 3T (57.5%) with 15.7% classified as CKD stage 4T and 3.1% as stage 5T. Only 2.1% of RTR were in CKD stage 1T. The proportion of patients with stage 4T and 5T CKD who lost their graft in the following year was 8% and 49%, respectively. The prevalence of anemia (hemoglobin <11 g/dL) increased from 4.4% in stage 1T to 51.5% in stage 5T and compared with 30% in dialysis patients (p < 0.0001). Hypertension, hyperphosphatemia, elevated Ca × PO 4 , raised iPTH and hypoalbuminemia rose with increasing CKD stage. For many variables, the achievement of standards was lower in stage 5T RTR than in dialysis patients. There were center differences in median estimated glomerular filtration rate and percentage of patients with hemoglobin <11 g/dL (p < 0.0001). In conclusion, many patients in stage 4T-5T have CKDrelated complications that fall below targets established for nontransplant CKD patients. They are at increased risk of graft loss. More attention needs to be paid to managing these complications and preparing these patients for a return to dialysis and/or retransplantation.

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Section: Ckd Classificationmentioning

confidence: 99%

Chronic Renal Failure in Kidney Transplant Recipients. Do They Receive Optimum Care?: Data from the UK Renal Registry

Ansell

Udayaraj

Steenkamp

et al. 2007

American Journal of Transplantation

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“…PubMed research (last accessed July 2010) recovered only 12 studies with mGFRs Ͼ100 reporting this performance of the CG and MDRD formulas, and their results are presented in Table 2 (6,44,72,90,92,95,99,(103)(104)(105)(106)(107). Comparing CG versus MDRD formula in studies with data for both formulas (6431 subjects) showed similar overall proper classification of the subjects, 64% versus 63%, range 55% to 72% versus 53% to 71%, respectively (6,72,92,95,99,(103)(104)(105)(106)(107). The best performance of CG and MDRD equations was in mGFR group 30 to 59 ml/min per 1.73 m 2 , whereas the worst one was in mGFR groups Ͻ15 and Ͼ90 ml/min per 1.73 m 2 , respectively.…”

Section: Effect Of Egfr On K/doqi-ckd Diagnosing and Stagingmentioning

confidence: 99%

The Clinician and Estimation of Glomerular Filtration Rate by Creatinine-based Formulas

Botev

Mallié²,

Wetzels³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryThe GFR has a paramount diagnostic and staging role in the Kidney Disease Outcome Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease (K/DOQI-CKD). The most widely used serum creatininebased formulas in adults for estimated GFR (eGFR) are the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease Study (MDRD). Recently, a new Chronic Kidney Disease Epidemiology Collaboration equation has been developed. Review of the literature revealed that CG and MDRD formulas correctly assigned overall only 64% and 62%, respectively, of the subjects to their actual K/DOQI-CKD classification's GFR groups as determined by measured GFR (mGFR). This suggests that approximately 10 million (38%) subjects may have been misclassified on the basis of estimated CKD prevalence of 26.3 million adults in the United States. The purpose of this review is to help the clinician understand the limitations of using eGFR in daily practice. We also elaborate upon issues such as the differences among markers of mGFR, the validity of adjusting GFR for body surface area in certain populations, the limited data on boundaries for normal mGFR according to age, gender, and race, the need for calibration of a wide spectrum of serum creatinine measurements, the lack of actual eGFR value above 60 ml/min per 1.73 m 2 and reference for normal mGFR in the clinical laboratories' reports, and the performance evaluation of the eGFR formulas. Several pitfalls have to be overcome before we can reliably determine health and disease in daily nephrology practice to preserve the first rule of practicing medicine: primum non nocere.Clin J Am Soc Nephrol 6: 937-950, 2011.

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“…In RTR the performance of urine-creatinine clearance and of many different prediction formulas has been found similar [14,25]. The comparison with isotopic measurement of GFR was often disappointing [26,27]. In particular, prediction errors of fformulas are much higher in patients with better renal function [28].…”

Section: Discussionmentioning

confidence: 99%

Predicted and Measured Creatinine Clearance for the Estimation of Renal Graft Function: New Tools from Body Composition Analysis

Donadio

2014

Intern Med

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Aim of this study was to evaluate, in Renal Transplant Recipients (RTR), a new method to predict Creatinine Clearance (Ccr) from Plasma Creatinine (Pcr) and from the value of Body Cell Mass (BCM).The values of BCM were obtained, from body impedance analysis (BIA) using an impedance plethysmograph, in 87 RTR with different graft function. The ratios of 24-hour Urinary Creatinine Excretion (Ucr) over BCM were calculated in 30 RTR. In the remaining 57 RTR, Ccr was predicted from Pcr and individual values of BCM (BCM Ccr), using the mean ratio Ucr/BCM found in the first group of patients. In the same patients, Ccr was predicted according to Cockcroft and Gault (CG Ccr). The mean of triplicate measurement of 24-hour Ccr (24 h Ccr), obtained by the standard formula Ucr x Vol/min/Pcr, was used as the reference value of renal graft function.BCM Ccr had a better agreement with 24 h Ccr than CG Ccr, particularly in patients with graft failure.Thanks to its simplicity, accuracy and reproducibility, BCM Ccr is more suitable than 24-hour Ccr to estimate graft function. In the meantime, the body composition data gives useful information for the evalutation of nutritional status and of the equilibrium of body fluid compartments.

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Predicting Glomerular Filtration Rate in Kidney Transplantation: Are the K/DOQI Guidelines Applicable?

Cited by 52 publications

References 20 publications

Chronic Renal Failure in Kidney Transplant Recipients. Do They Receive Optimum Care?: Data from the UK Renal Registry

Chronic Renal Failure in Kidney Transplant Recipients. Do They Receive Optimum Care?: Data from the UK Renal Registry

The Clinician and Estimation of Glomerular Filtration Rate by Creatinine-based Formulas

Predicted and Measured Creatinine Clearance for the Estimation of Renal Graft Function: New Tools from Body Composition Analysis

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