Estimated GFR: time for a critical appraisal

Porrini, Esteban; Ruggenenti, Piero; Luis-Lima, Sergio; Carrara, Fabiola; Jiménez, Alejandro; Vries, Aiko P. J. de; Torres, Armando; Gaspari, Flavio; Remuzzi, Giuseppe

doi:10.1038/s41581-018-0080-9

Cited by 236 publications

(222 citation statements)

References 127 publications

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“…Description of the profile of the ratio between percentages of Foxp3 + CD127 − CD25 high CD4 + Tregs/ CD45RO + RA − CD8 + memory T cells (see also Supplemental Online Figure 3A Nevertheless, this approach strengthens our kidney graft function data, because direct measurement of true GFR with this technique avoids bias related to inaccurate GFR estimation using formulas. 23 Moreover, urinary protein excretion remained within the normal range, both before and after weaning the patient off therapy, clinically ruling out chronic allograft rejection or relapse of his pretransplant glomerulopathy ( Figure 1C). Importantly, surveillance graft biopsy specimens were collected at the end of the current monitoring period under free-immunosuppressive therapy.…”

Section: Significance Statementmentioning

confidence: 88%

“…We cannot rule out, however, the possibility that the rising trend of measured GFR could be attributable, at least in part, to the progressive removal of the intrarenal vasoconstrictive effect of CsA during tapering of this calcineurin inhibitor . Nevertheless, this approach strengthens our kidney graft function data, because direct measurement of true GFR with this technique avoids bias related to inaccurate GFR estimation using formulas …”

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confidence: 89%

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Kidney transplant tolerance associated with remote autologous mesenchymal stromal cell administration

Casiraghi

Perico

Gotti

et al. 2019

Stem Cells Translational Medicine

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Here we report the case of successful immune tolerance induction in a living‐donor kidney transplant recipient remotely treated with autologous bone marrow‐derived mesenchymal stromal cells (MSC). This case report, which to the best of our knowledge is the first in the world in this setting, provides evidence that the modulation of the host immune system with MSC can enable the safe withdrawal of maintenance immunosuppressive drugs while preserving optimal long‐term kidney allograft function.

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Section: Significance Statementmentioning

confidence: 88%

mentioning

confidence: 89%

Kidney transplant tolerance associated with remote autologous mesenchymal stromal cell administration

Casiraghi

Perico

Gotti

et al. 2019

Stem Cells Translational Medicine

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“…Therefore, the accuracy was unacceptable in eGFR formula and it is inappropriate to apply eGFR formulae to all oncology patients, which had been. Previous studies also have criticized the performance of eGFR in estimating real renal function [22]. Oncologists should identify populations where eGFR formulae based on serum creatinine is not likely to provide an accurate estimate and thus alternative measurements of the GFR should be considered.…”

Section: Discussionmentioning

confidence: 99%

A novel nomogram to predict the reliability of estimated glomerular filtration rate formula in oncology patients

Cheng

Huang

Han

et al. 2020

Preprint

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Background: Formulae of estimated glomerular filtration rate (eGFR) based on serum creatinine (Scr) are routinely used in oncology patients, however, they are inaccurate in some populations. Our aim was to assess the agreement of eGFR formulae and thereby build a nomogram to predict the reliability of estimates. Methods: Measured GFR (mGFR) using isotope from 445 oncology patients were compared with eGFR from six formulae (Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), modified MDRD formulae for Chinese (C-MDRD), Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration, Wright and full age spectrum (FAS)). Bias, precision and accuracy of eGFR formulae were examined. We also evaluated statistics of agreement: the total deviation index (TDI), the concordance correlation coefficient (CCC) and the coverage probability (CP). Multivariate logistic regression was applied to identify characteristics associated with inaccurate eGFR and construct a predictive nomogram. Results: All eGFR formulae tended to overestimate the eGFR. The percentage of patients with eGFR within 30% the mGFR ranged from 38.0% to 62.8%. Cockcroft-Gault and MDRD showed low bias and high precision. The MDRD formula exhibited lowest TDI, meaning that 90% of estimations ranged from -36 to 36% of mGFR. Multivariate logistic regression showed that inaccuracy of MDRD was found in elderly patients or in patients with eGFR greater than 120 ml/min. A nomogram was constructed to help oncologists to predict the risk of inaccuracy of eGFR. The calibration curve showed good agreement. Conclusions: Our results suggest that the error of eGFR by any formulae was common and wide in Chinese oncology patients. Our nomogram may assist oncologists in decision-making when mGFR is needed.

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“…The estimation of renal function, which is apparently easy using the creatinine assay, raises some difficulties in clinical practice [37]. One of the practical reason is that several methods have been proposed across years, with the creatinine clearance using the Gault-Cockroft formula, the eGFR estimated using the MDRD (''Modification of Diet in Renal Disease") formula and more recently the CKD-EPI (''Chronic Kidney Diabetes Epidemiology Collaboration") equation, all methods that may result in slightly different results [37]. Currently, the nephrologists recommend the use of the CKD-EPI equation, which appears to be more accurate with less potential biases, but this method is not very popular among endocrinologists yet.…”

Section: Need For Detection Of Renal Diseasementioning

confidence: 99%

Series: Implications of the recent CVOTs in type 2 diabetes

Scheen

2020

Diabetes Research and Clinical Practice

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Estimated GFR: time for a critical appraisal

Cited by 236 publications

References 127 publications

Kidney transplant tolerance associated with remote autologous mesenchymal stromal cell administration

Kidney transplant tolerance associated with remote autologous mesenchymal stromal cell administration

A novel nomogram to predict the reliability of estimated glomerular filtration rate formula in oncology patients

Series: Implications of the recent CVOTs in type 2 diabetes

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