What is the best method for measuring renal function in adults and children with cystic fibrosis?

Soulsby, Natalie; Greville, Hugh; Coulthard, Kingsley; Doecke, Chris

doi:10.1016/j.jcf.2009.12.002

Cited by 19 publications

(16 citation statements)

References 18 publications

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“…However, our GFR data, consistent with those from a recently published smaller pediatric CF study [35], when considered in context of published normal values in children and the published adult CF literature, demonstrate the presence of glomerular hyperfiltration in this CF population. Future studies should be directed toward confirmation of this finding via controlled studies and subsequently elucidating the underlying mechanisms of this hyperfiltration and its relationship to long-term outcomes of renal dysfunction in this at-risk population.…”

Section: Discussionsupporting

confidence: 91%

“…These results are remarkably similar to those recently reported by an Australian group, who found a mean mGFR of 142 ml/min/1.73 m 2 ±27.2 in 27 children with a mean age 11.4 years±4.7. This study also used 99m TcDTPA GFR methodology, with blood samples at 2, 3, and 4 h; however, had excluded any patient who received aminoglycoside antibiotics within the previous 8 weeks [35].…”

Section: Discussionmentioning

confidence: 99%

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Renal function in pediatric cystic fibrosis patients in the first decade of life

et al. 2010

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With increasing life expectancy and the need for lung transplantation in the cystic fibrosis (CF) population, there are increasing reports of chronic kidney disease (CKD). However, values for baseline or longitudinal glomerular filtration rate (GFR) as measured by exogenous clearance markers are lacking in this population. Retrospective cross-sectional study in 2 to 18-year-olds cared for at a single CF center who had a GFR measured by plasma disappearance of Technetium-99 m diethylenetriaminepentaacetic acid (mGFR). The primary outcome was evidence of renal dysfunction as defined by CKD stage II or below (mGFR <90 ml/min/1.73 m(2), persistent abnormalities in urinary sediment, abnormal renal imaging). Of 63 patients evaluated, four had apparent renal dysfunction, one demonstrated decreased mGFR, and three others had persistent microscopic hematuria. The mean mGFR was substantially higher (140 ± 24 ml/min/1.73 m(2)) than expected or previously reported for healthy children. We did not demonstrate the presence of significant renal impairment after limited aminoglycoside exposure in the first decade following diagnosis with CF. However, we did document the presence of glomerular hyperfiltration in a significant proportion of our CF patients.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Renal function in pediatric cystic fibrosis patients in the first decade of life

et al. 2010

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“…Without a gold standard available for comparison, it is difficult to know which prediction equation performs better. Unfortunately, there is no consensus on the best creatinine-based estimating equation for glomerular filtration rate in patients with CF, although one study found CockcroftGault to be superior to aMDRD (32). Choice of estimating equation is unlikely to influence the diagnosis of more advanced disease (as demonstrated in our study) but may play an important role in identifying borderline cases of renal dysfunction.…”

Section: Discussionmentioning

confidence: 67%

Risk Factors for Chronic Kidney Disease in Adults with Cystic Fibrosis

Quon

Mayer-Hamblett

Aitken

et al. 2011

Am J Respir Crit Care Med

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Rationale: Adults with cystic fibrosis (CF) possess multiple potential risk factors for chronic kidney disease, including CF-related diabetes (CFRD) and lifetime nephrotoxic drug exposure. Objectives: To determine whether cumulative intravenous (IV) aminoglycoside exposure and CFRD increase the risk of chronic kidney disease in adults with CF. Methods: This was a cohort study using adults (> 18 yr) in the CF Foundation registry from [2001][2002][2003][2004][2005][2006][2007][2008]. Chronic kidney disease (stage 3 or greater) was defined by an estimated glomerular filtration rate of less than 60 ml/min/1.73 m 2 . Time-dependent multivariable Cox proportional hazards models were used to determine whether cumulative number of acute pulmonary exacerbations (surrogate for IV aminoglycoside exposure) and CFRD requiring insulin increase the risk of chronic kidney disease, adjusting for confounders. Measurements and Main Results: The study cohort included 11,912 adults with a median follow-up of 4 years. During the study period, 204 subjects had chronic kidney disease, with an annual disease prevalence of 2.3%. Disease prevalence doubled with every 10-year increase in age. CFRD requiring insulin therapy substantially increased the risk of chronic kidney disease (1-4 yr of CFRD requiring insulin vs. no CFRD, hazard ratio [HR] ¼ 2.40, 95% confidence interval [CI] 1.74-3.32; > 5 yr, HR ¼ 4.56, 95% CI 2.84-7.31). Pulmonary exacerbations did not significantly increase the risk of chronic kidney disease (one to five exacerbations vs. none, HR ¼ 0.79, 95% CI 0.56-1.11; six to nine exacerbations, HR ¼ 0.92, 95% CI 0.58-1.46; > 10 exacerbations, HR ¼ 1.16, 95% CI 0.75-1.81). Conclusions: CF-related diabetes is a significant risk factor for chronic kidney disease in adults with CF, but additional studies examining IV aminoglycoside exposure directly are required.

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“…Five studies evaluated the performance of cystatin C-estimating equations in special populations including diabetes, cystic fibrosis, Fabry disease, HIV and patients with liver transplants [29][30][31][32][33].…”

Section: Performance Of Estimating Equations In Special Populationsmentioning

confidence: 99%

“…Three studies [30][31][32] compared the performance of creatinine and cystatin C-based equations in patients with decreased muscle mass. Soulsby et al [30] evaluated 47 adult and pediatric patients with cystic fibrosis from two hospitals in Australia.…”

Section: Decreased Muscle Massmentioning

confidence: 99%