Accuracy of eGFR Equation for Predicting Glomeruloar Filtration Rate in Potential Living Kidney Donor
DOI:
https://doi.org/10.53778/pjkd81243Keywords:
End stage kidney disease, chronic kidney disease, eGFR, CKD-EPI, Risk assessment, 24 hour urine creatinine clearanceAbstract
This Descriptive Cross-Sectional Study, involving 201 patients, conducted at Sindh Institute of Urology and Transplantation (SIUT) Karachi, Pakistan after approval from institute research board. The estimated Glomerular Filtration Rate (eGFR) was calculated using the appropriate equation. Participants were instructed to collect their urine over a 24-hour period in a container devoid of any additives or preservatives. The collected urine specimens were subsequently sent to the institutional laboratory for analysis, with GFR determined based on 24-hour urine creatinine clearance to ensure accuracy. All data collected during the study period were meticulously entered into a predefined proforma, which was then electronically stored and utilized for research purposes.
Results: Mean ± SD of age was 33.30±9.12 years. Out of 201 patients, 124 (61.7%) were male while 77 (38.3%) were female. In distribution of accuracy of eGFR by CKD-EPI equation, accuracy of (Cr-Cys) equation was noted as 60 (29.9%), (Cys) as 47 (23.4%) while accuracy of CKD- EPI (PK) equation was documented as 96 (47.8%).
Conclusion: It is to be concluded that accuracy of CKD-EPI is closer to 24 -h urinary creatinine clearance in the calculation of eGFR. However, none of the eGFR formulas can be used in renal transplant donors because of their low accuracy, and 24-h urine creatinine clearance should be used for evaluation of the GFR in this population.
References
Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1459-544.
Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function—measured and estimated glomerular filtration rate. N Engl J Med. 2006;354(23):2473-83.
Perrone RD, Madias NE, Levey AS. Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem. 1992;38(10):1933-53.
Wei L, Ye X, Pei X, Wu J, Zhao W. Reference intervals for serum cystatin C and factors influencing cystatin C levels other than renal function in the elderly. PloS one. 2014;9(1): e86066.
Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012;367 (1):20-9.
Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position statement from kidney disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67(6):2089-100.
Levey AS, Inker LA. GFR evaluation in living kidney donor candidates. J Am Soc Nephrol. 2017;28(4):1062-71.
Jessani S, Levey AS, Bux R, Inker LA, Islam M, Chaturvedi N, et al. Estimation of GFR in South Asians: a study from the general population in Pakistan. AmJ Kidney Dis. 2014;63 (1):49-58.
Inker LA, Koraishy FM, Goyal N, Lentine KL. Assessment of glomerular filtration rate and end-stage kidney disease risk in living kidney donor candidates: a paradigm for evaluation, selection, and counseling. Adv Chronic Kidney Dis. 2018;25(1):21-30.
Stevens LA, Levey AS. Measured GFR as a confirmatory test for estimated GFR. J Am Soc Nephrol 2009;20(11):2305–13.
KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:38–56
USRDS 2015 Annual Data Report: End-stage Renal Disease (ESRD) in the United States. Ch 7: Transplantation. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2015. Available at: https://www.usrds.org/ 2015/ view/v2_07.aspx. Accessed May 4, 2016.
Matas AJ, Smith JM, Skeans MA. OPTN/SRTR 2013 Annual Data Report: kidney. Am J Transplant. 2015;15(Suppl 2):1-34.
Segev DL, Muzaale AD, Caffo BS, Mehta SH, Singer AL, Taranto SE, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303(10): 959-66.
Fehrman-Ekholm I, Elinder CG, Stenbeck M, Tyden G, Groth CG. Kidney donors live longer. Transplantation.1997;64(7):976-8.
Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, et al. Long-term consequences of kidney donation. N Engl J Med. 2009;360(5):459-69.
Mjøen G, Reisaeter A, Hallan S, Line PD, Hartmann A, Midtvedt K, et al. Overall and cardiovascular mortality in Norwegian kidney donors compared to the background population. Nephrol Dial Transplant. 2012;27(1):443-7.
Mjøen G, Hallan S, Hartmann A, Foss A, Midtvedt K, Øyen O, et al. Long-term risks for kidney donors. Kidney Int.2014;86(1):162-7.
Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, et al. Risk of end-stagerenal disease following live kidney donation. JAMA. 2014;311(6):579- 86.
LaPointe Rudow D, Hays R, Baliga P, Cohen DJ, Cooper M, et al. Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J Transplant. 2015;15(4):914-22.
Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, et al. Summary of Kidney Dis-ease: Improving Global Outcomes (KDIGO) clinical practice guideline on the evaluation and care of living kidney donors. Transplantation. 2017;101(8):1783-92.
Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, et al. KDIGO clinical practice guideline on the evaluation and care of living kidney donors. Transplantation. 2017;101(8S Suppl 1):S1-109.
Matsushita K, van der Velde M, Astor BC Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375(9731):2073-81.
Ku E, Xie D, Shlipak M, Anderson AH, Chen J, Go AS, et al. Change in measured GFR versus eGFR and CKD outcomes. J Am Soc Nephrol. 2016;27(7):2196-204.
Wesson L. Physiology of the Human Kidney. NY: Grune & Stratton;1969.
Winearls CG, Glassock RJ. Classification of chronic kidney disease in the elderly: pitfalls and errors. Nephron Clin Pract.2011;119(Suppl1):c2-4.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1):1-150.
Rule AD, Glassock RJ. GFR estimating equations: getting closer to the truth? Clin J Am Soc Nephrol. 2013;8(8):1414-20.
Levey AS, Stevens LA, Schmid CH, Zhang Y, Castro III AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med.2009;150(9):604-12.
Stevens LA, Schmid CH, Greene T, Li L, Beck GJ, Joffe MM, et al. Factors other than glomerular filtration rate affect serum cystatin C levels. Kidney Int.2009;75(6):652-60.
Knight EL, Verhave JC, Spiegelman D, Hillege HL, De Zeeuw D, Curhan GC, et al. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int. 2004;65(4):1416-21.
Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, et al. Estimating glomerularfiltration rate from serum creatinine and cystatin C.N Engl J Med. 2012;367 (1):20-9.
Fan L, Inker LA, Rossert J, Froissart M, Rossing P, Mauer M, et al. Glomerular filtration rate estimation using cystatin C alone or combined with creatinine as a confirmatory test. Nephrol Dial Transplant. 2014;29(6):1195-203.
Tent H, Rook M, Stevens LA, van Son WJ, van Pelt LJ, Hofker HS, et al. Renal function equations before and after living kidney donation: a within-individual comparison of performance at different levels of renal function. Clin J Am Soc Nephrol. 2010;5(11): 1960-8.
Bhuvanakrishna T, Blake GM, Hilton R, Burnapp L, Sibley-Allen C, Goldsmith D. Comparison of estimated GFR and measured GFR in prospective living kidney donors. Int Urol Nephrol. 2015;47(1):201-8.
Ehrich J, Dubourg L, Hansson S, Pape L, Steinle T, Fruth J, et al. Serum myo-inositol, dimethyl sulfone, and valine in combination with creatinine allow accurate assessment of renal insufficiency—a proof of concept. Diagnostics. 2021;11(2):234.
Kakuta Y, Imamura R, Okumi M, Horio M, Isaka Y, Ichimaru N, et al. Assessment of renal function in living kidney donors before and after nephrectomy: A Japanese prospective, observational cohort study. Int J Urol. 2019;26(4):499-505.
Gaillard F, Courbebaisse M, Kamar N, Rostaing L, Jacquemont L, Hourmant M, et al. Impact of estimation versus direct measurement of predonation glomerular filtration rate on the eligibility of potential living kidney donors. Kidney Int. 2019;95(4):896-904.
Jessani S, Levey AS, Bux R, Inker LA, Islam M, Chaturvedi N, et al. Estimation of GFR in South Asians: a study from the general population in Pakistan. Am J Kidney Dis. 2014;63 (1):49-58.
Tsai SF, Shu KH, Wu MJ, Ho HC, Wen MC, Su CK, et al. A higher glomerular filtration rate predicts low risk of developing chronic kidney disease in living kidney donors. World J Surg. 2013;37(4):923-9.
Björk J, Grubb A, Gudnason V, Indridason OS, Levey AS, Palsson R, et al. Comparison of glomerular filtration rate estimating equations derived from creatinine and cystatin C: validation in the Age, Gene/Environment Susceptibility-Reykjavik elderly cohort. Nephrol Dial Transpl. 2018;33(8):1380-8.
Kilbride HS, Stevens PE, Eaglestone G, Knight S, Carter JL, Delaney MP, et al. Accuracy of the MDRD (Modification of Diet in Renal Disease) study and CKD-EPI (CKD Epidemiology Collaboration) equations for estimation of GFR in the elderly. Am J Kidney Dis. 2013;6 1(1):57-66.
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