The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation best characterizes kidney function in patients being considered for lung transplantation

Abstract

BACKGROUND Methods for direct measurement of glomerular filtration rate (GFR) are expensive and inconsistently applied across transplant centers. The Modified Diet in Renal Disease (MDRD) equation is commonly used for GFR estimation, but is inaccurate for GFRs > 60 ml/min per 1.73 m2. The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) and Wright equations have shown improved predictive capabilities in some patient populations. We compared these equations to determine which one correlates best with direct GFR measurement in lung transplant candidates. METHODS We conducted a retrospective cohort analysis of 274 lung transplant recipients. Pre-operative GFR was measured directly using a radionuclide GFR assay. Results from the MDRD, CKDEPI, Wright, and Cockroft–Gault equations were compared with direct measurement. Findings were validated using logistic regression models and receiver operating characteristic (ROC) analyses in looking at GFR as a predictor of mortality and renal function outcomes post-transplant. RESULTS Assessed against the radionuclide GFR measurement, CKDEPI provided the most consistent results, with low values for bias (0.78), relative standard error (0.03) and mean absolute percentage error (15.02). Greater deviation from radionuclide GFR was observed for all other equations. Pearson’s correlation between radionuclide and calculated GFR was significant for all equations. Regression and ROC analyses revealed equivalent utility of the radionuclide assay and GFR equations for predicting post-transplant acute kidney injury and chronic kidney disease (p < 0.05). CONCLUSIONS In patients being evaluated for lung transplantation, CKDEPI correlates closely with direct radionuclide GFR measurement and equivalently predicts post-operative renal outcomes. Transplant centers could consider replacing or supplementing direct GFR measurement with less expensive, more convenient estimation by using the CKDEPI equation.

Characteristics and outcomes among patients with need for early dialysis after lung transplantation surgery

“…Among the recipient characteristics, pre‐transplant glomerular filtration rate (GFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) equation . The CKD‐EPI equation has been well studied and found to be valid and reliable for estimation of GFR (eGFR) among lung transplant candidates . Serum creatinine at the time of transplant listing was used for the estimation of GFR.…”

“…9 The CKD-EPI equation has been well studied and found to be valid and reliable for estimation of GFR (eGFR) among lung transplant candidates. 10,11 Serum creatinine at the time of transplant listing was used for the estimation of GFR. CKD-EPI equation was analyzed as follows 9 is serum creatinine (mg/dL), κ is 0.7 for females and 0.9 for males, α is −0.329 for females and −0.411 for males, "min" reflects the minimum of Scr/κ or 1, and "max" indicates the maximum of Scr/κ or 1.…”

Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation

“…(15,16) Renal function: Increased risk has been demonstrated in lung transplant candidates with GFR <60 mL/min/1.73m 2 by chronic kidney disease epidemiology equation (CKD-EPI) at the time of listing, especially in patients > 45 years of age. (17)(18)(19)(20)(21) Renal function is especially important following lung transplant as the perioperative period is often complicated by hypotension and hypoperfusion of kidneys, and nephrotoxic calcineurin inhibitors remain the mainstay of maintenance immunosuppression.…”