Assessing glomerular filtration rate in healthy adult potential kidney donors in Bangladesh: A comparison of various prediction equations with measured glomerular filtration rate by diethylentriamine pentaacetic acid renogram

Abstract

To ensure that potential kidney donors in Bangladesh have no renal impairment, it is extremely important to have accurate methods for evaluating the glomerular filtration rate (GFR). We evaluated the performance of serum creatinine based GFR in healthy adult potential kidney donors in Bangladesh to compare GFR determined by DTPA with that determined by various prediction equations. In this study GFR in 61 healthy adult potential kidney donors were measured with 99 m Tc-diethylenetriamine penta-acetic acid (DTPA) renogram. We also estimated GFR using a four variable equation modification of diet in renal disease (MDRD), Cockcroft-Gault creatinine clearance (CG CrCl), Cockcroft-Gault glomerular filtration rate (CG-GFR). The mean age of study population was 34.31±9.46 years and out of them 65.6% was male. In this study mean mGFR was 85.4±14.8. Correlation of estimated GFR calculated by CG-CrCl, CG-GFR and MDRD were done with measured GFR DTPA using quartile. Kappa values were also estimated which was found to be 0.104 for (p=0.151), 0.336 for (p=0.001) and 0.125 for (p=0.091) respectively. This indicates there is no association between estimated GFR calculated by CG-CrCl, CG-GFR, MDRD with measured GFR DTPA. These results show poor performance of these equations in evaluation of renal function among healthy population and also raise question regarding validity of these equations for assessment of renal function in chronic kidney disease in our population.

Comparison of Glomerular Filtration Rate Estimated by Three Methods in a Pakistani Community Cohort

“…Validation studies have also been performed on these equations in various parts of the world [3], [7]- [11]. In South Asian region that comprises around one-fourth of the world population, at least one study each from India [14] and Bangladesh [15] was published comparing GFR estimated by Cockroft-Gault and modified MDRD study equations with GFR measured with 99mTc-diethylenetriamine penta-acetic acid (DTPA) renogram. One study from Pakistan [13] had tested these two equations against 24-hour urinary creatinine clearance, but not the measured GFR.…”

“…However, the said study was restricted to adults aged 40 years or older, the mean GFR had a wide standard deviation/dispersion. The studies from India [14] and Bangladesh [15] measuring GFR with 99mTc-diethylenetriamine penta-acetic acid (DTPA) renogram had found it to be 95.5±11.6 and 85.4±14.8 ml/min per 1.73 m 2 , respectively. All of these studies still suggest that the normal GFR seems to be lower in the South Asian population compared to the western standards.…”

“…Validation studies have also been performed on these equations mostly in western parts of the world [3], [7]- [11]. In South Asia that makes around 23.5% of the whole world population according to latest World Bank data available online, a few studies [12]- [15] had compared Cockroft-Gault and MDRD equations but CKD-EPI equation that is relatively newer has never been validated or compared with other equations in this region.…”