Understanding estimated glomerular filtration rate: implications for identifying chronic kidney disease

Rule, Andrew D.

doi:10.1097/mnh.0b013e328057de8b

Cited by 54 publications

(38 citation statements)

References 59 publications

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“…However, this technique has some limitations such as being affected by muscle mass, age, and gender, and is most sensitive when renal injury is advanced and the patient glomerular filtration rate (GFR) is relatively poor (19). In comparison, when GFR is near normal, renal function can be measured with greater accuracy and sensitivity in diabetic patients using cystatin-C (20).…”

Section: Diabetic Nephropathy Standard Biomarkers Used For the Diagnomentioning

confidence: 99%

Successes Achieved and Challenges Ahead in Translating Biomarkers into Clinical Applications

Tesch

Amur

Schousboe

et al. 2010

AAPS J

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Abstract. Biomarkers are important tools for identifying and stratifying diseases, predicting their progression and determining the effectiveness, safety, and doses of therapeutic interventions. This is important for common chronic diseases such as diabetic nephropathy, osteoporosis, and rheumatoid arthritis which affect large numbers of patients worldwide. This article summarizes the current knowledge of established and novel biomarkers for each of these diseases as presented at the 2008 AAPS/ACCP joint symposium "Success Achieved and Challenges Ahead in Translating Biomarkers into Clinical Applications," in Atlanta, Georgia. The advantages and disadvantages of various proteomic, metabolomic, genomic, and imaging biomarkers are discussed in relation to disease diagnosis and stratification, prognosis, drug development, and potential clinical applications. The use of biomarkers as a means to determine therapeutic interventions is also considered. In addition, we show that biomarkers may be useful for adapting therapies for individual needs by allowing the selection of patients who are most likely to respond or react adversely to a particular treatment. They may also be used to determine whether the development of a novel therapy is worth pursuing by informing crucial go/no go decisions around safety and efficacy. Indeed, regulatory bodies now suggest that effective integration of biomarkers into clinical drug development programs is likely to promote the development of novel therapeutics and more personalized medicine.

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Section: Diabetic Nephropathy Standard Biomarkers Used For the Diagnomentioning

confidence: 99%

Successes Achieved and Challenges Ahead in Translating Biomarkers into Clinical Applications

Tesch

Amur

Schousboe

et al. 2010

AAPS J

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“…The precision of the estimating equations was expressed as root mean square error, and accuracy was expressed as % estimating equation within 10% and 30% of iGFR. Residual plots were determined (15,16). Nonlinear regression analysis was used to characterize the relationship between serum creatinine levels and iGFR.…”

Section: Statistical Analysesmentioning

confidence: 99%

Imprecision of Creatinine-Based GFR Estimates in Uninephric Kidney Donors

Tan

Busque³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: To ensure long-term safety of living kidney donors, it is now recommended that they be followed for at least 2 years after donation and that serum creatinine levels be monitored. Such levels are often subjected by clinical laboratories to estimating equations and are reported as estimated GFR (eGFR). The accuracy of such equations in uninephric living donors has yet to be validated. This is especially important in older living donors, who often have senescence-related depression of GFR.Design, setting, participants, & measurements: We compared urinary creatinine clearance, four-variable Modification of Diet in Renal Disease estimating equation (eGFR), and the recently reported CKD-EPI GFR estimating equation with true GFR measured by the urinary iothalamate clearance (iGFR) in 64 subjects after kidney donation.Results: Creatinine clearance overestimated iGFR. Both creatinine-based estimating equations were poorly correlated with and underestimated iGFR. More than half of kidney donors had eGFR <60 ml/min per 1.73 m 2 after donation, a level that categorized them as having stage 3 chronic kidney disease by our current laboratory reporting, whereas only 25% had iGFR <60 ml/min per 1.73 m 2 . This misclassification disproportionately affected older donors age >55 years, of whom 80% had eGFR <60 ml/min per 1.73 m 2 . Neither significant albuminuria nor hypertension was observed. Conclusions: The current practice of reporting eGFR after donation commonly leads to a misclassification of chronic kidney disease, particularly in older donors. To ensure long-term well-being of living kidney donors, more precise estimates of GFR are required, particularly among older potential donors.

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“…Their competence to evaluate an early impairment of GFR is debatable (63). Furthermore, the standardization of SCr measurements becomes mandatory to avoid differences in the results of prediction formulas due to interlaboratory variability in the measurement of SCr (40,59,64,67). Finally, SCr-based prediction formulas should be validated in the different ethnic groups and in patients with different body composition, such as obese and malnourished patients (12,15,20,34,58,61).…”

mentioning

confidence: 99%

Serum and urinary markers of early impairment of GFR in chronic kidney disease patients: diagnostic accuracy of urinary β-trace protein

Donadio

2010

American Journal of Physiology-Renal Physiology

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Understanding estimated glomerular filtration rate: implications for identifying chronic kidney disease

Cited by 54 publications

References 59 publications

Successes Achieved and Challenges Ahead in Translating Biomarkers into Clinical Applications

Successes Achieved and Challenges Ahead in Translating Biomarkers into Clinical Applications

Imprecision of Creatinine-Based GFR Estimates in Uninephric Kidney Donors

Serum and urinary markers of early impairment of GFR in chronic kidney disease patients: diagnostic accuracy of urinary β-trace protein

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