The Cockcroft-Gault formula should not be used in children

Filler, Guido; Foster, Jennifer A.; Acker, Amy; Lepage, Nathalie; Akbari, Ayub; Ehrich, J. H. H.

doi:10.1111/j.1523-1755.2005.00336.x

Cited by 75 publications

(72 citation statements)

References 12 publications

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“…Adult eGFR calculations based on serum creatinine, such as the Modification of Diet in Renal Disease study equation and the CockcroftGault equation, require additional information such as age, weight, gender, and ethnicity. In children, these formulas cannot be used (37). Before the findings of this study can be generalized, the increased eGFR errors that occur at lower FF will need to be confirmed in adult populations using adult eGFR equations that are based on serum creatinine.…”

Section: Discussionmentioning

confidence: 99%

Hyperfiltration Affects Accuracy of Creatinine eGFR Measurement

Huang

Sharma²,

Yasin³

et al. 2011

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Surrogate markers such as creatinine, cystatin C (CysC), and beta trace protein (BTP) have been used to estimate GFR (eGFR). The accuracy of eGFR may be altered with hyperfiltration and differences in filtration fraction (FF). It is hypothesized that the accuracy of creatinine for eGFR may be affected by hyperfiltration and different effective renal plasma flow (ERPF). Design, setting, participants, & measurements A total of 127 pediatric patients with various renal diseases underwent simultaneous measurements of GFR using 51Cr-EDTA renal scan and ERPF (131I-hippurate clearance) to calculate the FF (FF = GFR/ERPF). The eGFRs were calculated using the commonly used Schwartz (creatinine), Filler (CysC), and Benlamri (BTP) formulas. Agreement of the eGFRs with the measured isotope GFRs was assessed by Bland–Altman plots. Correlation analysis was performed using nonparametric tests to compare FF with eGFR − GFR. Results The 127 children at a median age (with 25th percentile, 75th percentile) of 11.9 (8.5, 14.9) years had a mean 51Cr EDTA-GFR of 100.6 ± 32.1 ml/min per 1.73 m2 and a median 131I-hippurate clearance (ERPF) of 588 (398,739) ml/min per 1.73 m2. Mean FF was 17.7 ± 4.5% with no correlation between the FF and the error (eGFR − GFR) for CysC and BTP eGFR, whereas there was a significant negative correlation between the error for Schwartz eGFR and FF. Conclusions There is a significant negative correlation between the error for the Schwartz eGFR and the FF. CysC and BTP are not affected by differences in FF.

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Section: Discussionmentioning

confidence: 99%

Hyperfiltration Affects Accuracy of Creatinine eGFR Measurement

Huang

Sharma²,

Yasin³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Third, it is acknowledged that, although all recruited subjects had normal serum creatinine measurements before surgery, an estimation of GFR to document normal kidney function was not made. However, estimation of GFR in children using serum creatinine or creatinine-based equations is fraught with imprecision (39). Fourth, in addition to NGAL, simultaneous examination of other urinary biomarkers as potential predictors of AKI may be informative (25).…”

Section: Discussionmentioning

confidence: 99%

Urine NGAL Predicts Severity of Acute Kidney Injury After Cardiac Surgery

Bennett

Dent²,

Ma³

et al. 2008

Clinical Journal of the American Society of Nephrology

681

539

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Background and objectives: The authors have previously shown that urine neutrophil gelatinase-associated lipocalin (NGAL), measured by a research ELISA, is an early predictive biomarker of acute kidney injury (AKI) after cardiopulmonary bypass (CPB). In this study, whether an NGAL immunoassay developed for a standardized clinical platform (ARCHITECT analyzer, Abbott Diagnostics Division, Abbott Laboratories, Abbott Park, IL) can predict AKI after CPB was tested.Design, setting, participants, & measurements: In a pilot study with 136 urine samples (NGAL range, 0.3 to 815 ng/ml) and 6 calibration standards (NGAL range, 0 to 1000 ng/ml), NGAL measurements by research ELISA and by the ARCHITECT assay were highly correlated (r ‫؍‬ 0.99). In a subsequent study, 196 children undergoing CPB were prospectively enrolled and serial urine NGAL measurements obtained by ARCHITECT assay. The primary outcome was AKI, defined as a >50% increase in serum creatinine.Results: AKI developed in 99 patients (51%), but the diagnosis using serum creatinine was delayed by 2 to 3 d after CPB. In contrast, mean urine NGAL levels increased 15-fold within 2 h and by 25-fold at 4 and 6 h after CPB. For the 2-h urine NGAL measurement, the area under the curve was 0.95, sensitivity was 0.82, and the specificity was 0.90 for prediction of AKI using a cutoff value of 100 ng/ml. The 2-h urine NGAL levels correlated with severity and duration of AKI, length of stay, dialysis requirement, and death.Conclusions: Accurate measurements of urine NGAL are obtained using the ARCHITECT platform. Urine NGAL is an early predictive biomarker of AKI severity after CPB.

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“…At present, these equations appear to offer very limited advantage compared to the MDRD equation, which is based on serum creatinine, age, sex and race, at least for the general population (110-115, 127, 128). These equations also appear to offer limited precision (52,110,113,116,124,129,130). As we shall see below, they could be more useful in certain subpopulations in which creatinine-based equations are particularly inaccurate, as in paediatrics (116,117,124), transplantation (113,115,(131)(132)(133) or oncology (134).…”

Section: Gfr Measurement Algorithms Incorporating Cyscmentioning

confidence: 99%

Cystatin C: current position and future prospects

Séronie-Vivien

Delanaye

Piéroni³

et al. 2008

Clinical Chemistry and Laboratory Medicine

160

140

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Cystatin C is a low-molecular-weight protein which has been proposed as a marker of renal function that could replace creatinine. Indeed, the concentration of cystatin C is mainly determined by glomerular filtration and is particularly of interest in clinical settings where the relationship between creatinine production and muscle mass impairs the clinical performance of creatinine. Since the last decade, numerous studies have evaluated its potential use in measuring renal function in various populations. More recently, other potential developments for its clinical use have emerged. This review summarises current knowledge about the physiology of cystatin C and about its use as a renal marker, either alone or in equations developed to estimate the glomerular filtration rate. This paper also reviews recent data about the other applications of cystatin C, particularly in cardiology, oncology and clinical pharmacology. Clin Chem Lab Med 2008;46:1664-86.

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The Cockcroft-Gault formula should not be used in children

Abstract: Cockcroft-Gault formula showed the worst agreement with GFR, regardless of using published or recalculated constants. The cystatin C-based approach resulted in the least error, and should be used for estimation of GFR.

Cited by 75 publications

References 12 publications

Hyperfiltration Affects Accuracy of Creatinine eGFR Measurement

Hyperfiltration Affects Accuracy of Creatinine eGFR Measurement

Urine NGAL Predicts Severity of Acute Kidney Injury After Cardiac Surgery

Cystatin C: current position and future prospects

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