A Comparison of Iothalamate-GFR and Serum Creatinine-Based Outcomes

Lewis, Julia B.; Greene, Tom; Appel, Lawrence J.; Contreras, Gabriel; Douglas, Janice G.; Lash, Jim; Toto, Robert D.; Lente, Fredrick Van; Wang, Xuelei; Wright, Jackson T.

doi:10.1097/01.asn.0000146688.74084.a3

Cited by 67 publications

(44 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The rate of GFR loss varies from patient to patient, even among patients with the same renal disease, but for a given patient, the rate is generally believed to be constant (5). Recently, however, it was suggested that the decline slope may accelerate late in the course of chronic kidney disease (CKD) (6). Despite improved therapies in recent years with angiotensin antagonist therapy and aggressive BP control, many patients continue to lose renal function and ultimately reach ESRD.…”

mentioning

confidence: 99%

Pirfenidone Slows Renal Function Decline in Patients with Focal Segmental Glomerulosclerosis

Cho¹,

Smith²,

Branton³

et al. 2007

Clinical Journal of the American Society of Nephrology

191

View full text Add to dashboard Cite

Background and Objectives: Pirfenidone is an orally available antifibrotic agent that has shown benefit in animal models of pulmonary and renal fibrosis and in clinical trials of pulmonary fibrosis, multiple sclerosis, and hepatic cirrhosis. Our objective was to determine whether pirfenidone slows the loss of renal function in focal segmental glomerulosclerosis.Design, Setting, Participants, & Measurements: An open-label trial was performed to evaluate the safety and efficacy of pirfenidone in patients with idiopathic and postadaptive focal segmental glomerulosclerosis. The monthly change in estimated GFR, expressed as ml/min per 1.73 m 2 , was compared between the baseline period and the treatment period. During both periods, patients received angiotensin antagonist therapy if tolerated. Twenty-one patients were enrolled, and 18 patients completed a median of 13 mo of pirfenidone treatment.Results: The monthly change in GFR improved from a median of ؊0.61 ml/min per 1.73 m 2 (interquartile range ؊1.31 to ؊0.41) during the baseline period to ؊0.45 ml/min per 1.73 m 2 (interquartile range ؊0.78 to ؊0.16) with pirfenidone therapy. This change represents a median of 25% improvement in the rate of decline (P < 0.01). Pirfenidone had no effect on BP or proteinuria. Adverse events attributed to therapy included dyspepsia, sedation, and photosensitive dermatitis.Conclusions: It is concluded that pirfenidone is an attractive candidate for placebo-controlled trials in patients with progressive chronic kidney disease.

show abstract

mentioning

confidence: 99%

Pirfenidone Slows Renal Function Decline in Patients with Focal Segmental Glomerulosclerosis

Cho¹,

Smith²,

Branton³

et al. 2007

Clinical Journal of the American Society of Nephrology

191

View full text Add to dashboard Cite

show abstract

“…eGFR levels were derived from the re-expressed MDRD Study formula, namely, 175 ϫ (serum creatinine value) Ϫ1.154 ϫ age Ϫ0.203 ϫ 0.742 (if female) ϫ 1.21 (if black) (10). An additional equation was used for black participants, the specific equation developed at the baseline evaluation for AASK, relating clearance of I 125 -iothalamate to serum creatinine, gender, and age: eGFR ϭ 329 ϫ creatinine Ϫ 1.096 ϫ age Ϫ 0.294 ϫ 0.736 (if female) (11). Because body mass index was higher for black individuals, we also used eGFR estimates, unadjusted for body surface area (BSA), by multiplying each patient's eGFR by BSA and dividing by 1.73 m 2 .…”

mentioning

confidence: 99%

Screening for Chronic Kidney Disease Complications in US Adults

Ibrahim

Wang

Ishani

et al. 2008

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives: An ideal and effective screening tool should perform equally across ethnic groups. The objective of this study was to determine whether the widely advocated creatinine-based estimated GFR (eGFR) threshold of 60 ml/min per 1.73 m 2 identifies the typical metabolic abnormalities related to chronic kidney disease equally well in minority and nonminority adults.Design, setting, participants, & measurements: This objective was addressed using data for 8918 minority and nonminority adult participants in the National Health and Nutrition Examination Survey 2003 through 2006, which used stratified, multistage, probability sampling methods to assemble a nationwide probability sample of the noninstitutionalized population of the United States. Metabolic abnormalities including BP, potassium, hemoglobin, bicarbonate, uric acid, calcium, phosphorus, and parathyroid hormone were defined by fifth or 95th percentile values.Results: Among participants with eGFR <60 ml/min per 1.73 m 2 , black individuals were more likely than white individuals to have low hemoglobin (adjusted odds ratio [aOR] 3.76; 95% confidence interval [CI] 1.94 to 7.28), elevated uric acid (aOR 2.15; 95% CI 1.26 to 3.68), and elevated parathyroid hormone (aOR 3.93; 95% CI 2.33 to 6.66).Conclusions: Metabolic consequences of reduced eGFR are more common in black individuals and seem to be present at levels well above 60 ml/min per 1.73 m 2 ; thus, black individuals should be screened for the metabolic complications of chronic kidney at higher GFR levels.

show abstract

“…For example, patients with muscle mass that is higher than average for their age, sex, and race will have an average eGFR Cr that is lower than true GFR, and patients with muscle mass that is lower than average for their age, sex, and race will have an average eGFR Cr that is higher than true GFR. Error is best determined by the test-retest reliability, which does not appear to differ much between eGFR and mGFR (10,47). To the extent that eGFR error is similar in magnitude to mGFR error, differences in method precision do not explain stronger associations with eGFR compared with mGFR.…”

Section: Imprecision With Mgfr Is a Problem That Can Be Adequately Admentioning

confidence: 99%

GFR Estimating Equations

Rule

Glassock

2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryThe application of serum creatinine and cystatin C in patients with CKD has been limited to using estimated glomerular filtration rate (eGFR). Criteria for choosing the best GFR estimating equation are 1) accuracy in estimating measured GFR, 2) optimal discrimination of clinical outcomes, and 3) association with CKD risk factors and outcomes similar to that of measured GFR. Notably, these criteria are often not in agreement; and while the last criterion is the most important, it has been widely overlooked. The primary problem with eGFR is that the non-GFR determinants of serum creatinine and cystatin C, as well as their surrogates (age, sex, and race), associate with CKD risk factors and outcomes. This leads to a distorted understanding of CKD, though eGFR based on serum creatinine appears to be less biased than eGFR based on cystatin C. Because of this problem, the use of eGFR should be limited to settings where knowing actual GFR is relevant and eGFR is more informative about GFR than serum creatinine or cystatin C alone. Such settings include staging CKD severity by GFR and dosing medications cleared by glomerular filtration. Alternatively, the diagnosis of CKD, the longitudinal progression of CKD, and prognostic models for CKD are settings where serum creatinine and cystatin C can be better applied and interpreted without eGFR.

show abstract

A Comparison of Iothalamate-GFR and Serum Creatinine-Based Outcomes

Cited by 67 publications

References 22 publications

Pirfenidone Slows Renal Function Decline in Patients with Focal Segmental Glomerulosclerosis

Pirfenidone Slows Renal Function Decline in Patients with Focal Segmental Glomerulosclerosis

Screening for Chronic Kidney Disease Complications in US Adults

GFR Estimating Equations

Contact Info

Product

Resources

About