The origin of the 1·73‐m<sup>2</sup> body surface area normalization: problems and implications

Heaf, James

doi:10.1111/j.1475-097x.2006.00718.x

Cited by 55 publications

(44 citation statements)

References 15 publications

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“…Indeed, equations used to estimate BSA have not been validated in obese individuals and are not stratified by sex (26). Measuring BSA in obese subjects still remains a challenging and unsolved problem, and choosing the best body size descriptor to scale kidney function is difficult (24). Although the Dubois and Dubois formula has already been criticized, we found that BSA and mGFR with another BSA equation (the formula by Livingston and Lee [15]) are not significantly different (Supplemental Table 1) from the results derived from the Dubois and Dubois formula.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of GFR Estimation in Obese Patients

Lemoine

Guebre-Egziabher

Sens

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Adequate estimation of renal function in obese patients is essential for the classification of patients in CKD category as well as the dose adjustment of drugs. However, the body size descriptor for GFR indexation is still debatable, and formulas are not validated in patients with extreme variations of weight.Design, setting, participants, & measurements This study included 209 stages 1-5 CKD obese patients referred to the Department of Renal Function Study at the University Hospital in Lyon between 2010 and 2013 because of suspected renal dysfunction. GFR was estimated with the Chronic Kidney Disease and Epidemiology equation (CKD-EPI) and measured with a gold standard method (inulin or iohexol) not indexed (mGFR) or indexed to body surface area determined by the Dubois and Dubois formula with either real (mGFRr) or ideal (mGFRi) body weight. Mean bias (eGFR2mGFR), precision, and accuracy of mGFR were compared with the results obtained for nonobese participants (body mass index between 18.5 and 24.9) who had a GFR measurement during the same period of time.Results Mean mGFRr (51.6624.2 ml/min per 1.73 m 2 ) was significantly lower than mGFR, mGFRi, and eGFR CKD-EPI . eGFR CKD-EPI had less bias with mGFR (0.29; 21.7 to 2.3) and mGFRi (21.62; 23.1 to 0.45) compared with mGFRr (8.7; 7 to 10). This result was confirmed with better accuracy for the whole cohort (78% for mGFR, 84% for mGFRi, and 72% for mGFRr) and participants with CKD stages 3-5. Moreover, the Bland Altman plot showed better agreement between mGFR and eGFR CKD-EPI . The bias between eGFR CKD-EPI and mGFRr was greater in obese than nonobese participants (8.7 versus 0.58, P,0.001).Conclusions This study shows that, in obese CKD patients, the performance of eGFR CKD-EPI is good for GFR#60 ml/min per 1.73 m 2 . Indexation of mGFR with body surface area using ideal body weight gives less bias than mGFR scaled with body surface area using real body weight.

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Section: Discussionmentioning

confidence: 99%

Accuracy of GFR Estimation in Obese Patients

Lemoine

Guebre-Egziabher

Sens

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Patients had received tyrosine kinase inhibitors (sunitinib, n ϭ 90; sorafenib, n ϭ 15; axitinib, n ϭ 8) or bevacizumab (n ϭ 3) as first-line treatment for metastatic RCC. Detailed patient information is given in Table 1 [11,12]. VFA and SFA were measured retrospectively on available computed tomography scans performed before treatment initiation, at the level of the umbilicus with the patient in the supine position, as described previously [13].…”

Section: Patients Materials and Methodsmentioning

confidence: 99%

Does Obesity Influence the Prognosis of Metastatic Renal Cell Carcinoma in Patients Treated with Vascular Endothelial Growth Factor–Targeted Therapy?

Steffens¹,

Grünwald²,

Ringe

et al. 2011

The Oncologist

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Background. Obesity increases the risk for renal cell carcinoma (RCC). However, it has only recently been identified as an independent positive prognostic factor for localized RCC.Objective. To determine whether obesity influences longterm prognosis in metastatic RCC patients receiving vascular endothelial growth factor-targeted therapy.Design, Setting, and Participants. In 116 patients with metastatic RCC who received antiangiogenic agents (sunitinib, sorafenib, axitinib, bevacizumab) in 2005-2010, we evaluated whether body mass index (BMI), a body surface area (BSA) above the European average, the visceral fat area (VFA), or s.c. fat area (SFA) were of predictive relevance.Measurements. BMI was categorized based on current World Health Organization definitions. BSA was stratified

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“…The mean BSA of the entire cohort in the present study was 1.91 m 2 , which is similar to the current mean BSA of 25-year-old males and females in the United States of 1.92 m 2 [42]. In contrast, the current reference BSA is 1.73 m 2 , against which individually measured GFR values were normalized in the development of all the GFR equations considered in the current study [16,17,30].…”

Section: Gentamicin Volume Of Distribution Per Tbw (L Kgmentioning

confidence: 52%

The performance of contemporary cystatin C‐based GFR equations in predicting gentamicin clearance

Chin

Chew-Harris

Florkowski

et al. 2015

Brit J Clinical Pharma

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AIMSWe aimed to compare the performances of contemporary cystatin C (Cys)-based GFR equations, and the creatinine only Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for predicting gentamicin clearance. METHODSThe bias and imprecision of the CKD-EPI, CKD-EPI_Cys and creatinine-cystatin C CKD-EPI (CKD-EPI_CrCys) equations for predicting gentamicin clearances, were assessed in 260 patients treated with gentamicin during 2012-2013. The creatinine-cystatin C Berlin Initiative Study equation (BIS_CrCys) was examined in the ≥70 year subgroup. The reference gentamicin clearance was calculated using post-dose plasma concentrations. RESULTSThe CKD-EPI_CrCys equation had the highest percentage of estimates within 30% of the reference gentamicin clearance (70%, P = 0.003) and lowest root mean square error (95% CI) of 29 (25, 23) ml min −1 of the three equations for the entire cohort. There was no significant improvement in the performances of the equations with the exclusion of 41 patients with abnormal thyroid function tests or steroid co-prescription at the time of the index gentamicin dose. Of the remaining 219 patients, adjustment for individual BSA improved the performances of all GFR equations (P ≤ 0.003) in those with body mass indices (BMI) <18.5 or ≥30 kg m CONCLUSIONSThe CKD-EPI_CrCys equation provided the best estimate of gentamicin clearance. If used for guiding gentamicin dosing, the results from GFR equations should be adjusted for individual BSA at the extremes of body size.

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The origin of the 1·73‐m² body surface area normalization: problems and implications

Cited by 55 publications

References 15 publications

Accuracy of GFR Estimation in Obese Patients

Accuracy of GFR Estimation in Obese Patients

Does Obesity Influence the Prognosis of Metastatic Renal Cell Carcinoma in Patients Treated with Vascular Endothelial Growth Factor–Targeted Therapy?

The performance of contemporary cystatin C‐based GFR equations in predicting gentamicin clearance

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The origin of the 1·73‐m2 body surface area normalization: problems and implications

Cited by 55 publications

References 15 publications

Accuracy of GFR Estimation in Obese Patients

Accuracy of GFR Estimation in Obese Patients

Does Obesity Influence the Prognosis of Metastatic Renal Cell Carcinoma in Patients Treated with Vascular Endothelial Growth Factor–Targeted Therapy?

The performance of contemporary cystatin C‐based GFR equations in predicting gentamicin clearance

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The origin of the 1·73‐m² body surface area normalization: problems and implications