GFR Estimation in Adolescents and Young Adults

Selistre, Luciano; Souza, V. de; Cochat, Pierre; Antonello, Ivan Carlos Ferreira; Hadj‐Aïssa, Aoumeur; Ranchin, Bruno; Dolomanova, Olga; Varennes, Annie; Françoise, Beyerle; Bacchetta, Justine; Dubourg, Laurence

doi:10.1681/asn.2011070705

Cited by 86 publications

(60 citation statements)

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“…Individual prediction error of GFR ranged from 0% to more than 100% from all models with uncertainty in individual prediction. In this analysis, a prediction error of ≤30% for individual GFR was considered acceptable (35,36). The results of the study for the individual models are summarized below.…”

Section: Resultsmentioning

confidence: 99%

“…Further assessment of the suitability of the methods was done by grouping the number of subjects for each age group according to %error; from ≤10 to ≤30% (35,36).…”

Section: Discussionmentioning

confidence: 99%

“…Biochemical markers such as creatinine or cystatin C concentrations may need to be incorporated along with age or weight in an empirical model to improve the prediction of GFR in an individual subject. Many such methods (36,37) are currently in use with individual prediction error ≤30% in more than 80% subjects. 2.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of Human Glomerular Filtration Rate from Preterm Neonates to Adults: Evaluation of Predictive Performance of Several Empirical Models

Mahmood

Staschen

2016

AAPS J

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Abstract. The objective of this study was to evaluate the predictive performance of several allometric empirical models (body weight dependent, age dependent, fixed exponent 0.75, a data-dependent single exponent, and maturation models) to predict glomerular filtration rate (GFR) in preterm and term neonates, infants, children, and adults without any renal disease. In this analysis, the models were developed from GFR data obtained from inulin clearance (preterm neonates to adults; n = 93) and the predictive performance of these models were evaluated in 335 subjects (preterm neonates to adults). The primary end point was the prediction of GFR from the empirical allometric models and the comparison of the predicted GFR with measured GFR. A prediction error within ±30% was considered acceptable. Overall, the predictive performance of the four models (BDE, ADE, and two maturation models) for the prediction of mean GFR was good across all age groups but the prediction of GFR in individual healthy subjects especially in neonates and infants was erratic and may be clinically unacceptable.

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Section: Resultsmentioning

confidence: 99%

“…Further assessment of the suitability of the methods was done by grouping the number of subjects for each age group according to %error; from ≤10 to ≤30% (35,36).…”

Section: Discussionmentioning

confidence: 99%

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Prediction of Human Glomerular Filtration Rate from Preterm Neonates to Adults: Evaluation of Predictive Performance of Several Empirical Models

Mahmood

Staschen

2016

AAPS J

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“…Validating these equations in children with normal kidney function is considered necessary. 20,24,25 The 2009 shortened equation of Schwartz has been evaluated in children with high GFR values, 1,4,12,[26][27][28] but only isolated papers estimated the accuracy of the tri-marker equation. 29 Chehade et al…”

Section: Introductionmentioning

confidence: 99%

Modification of the Schwartz equations for children increases their accuracy at eGFR > 60 mL/min/1.73 m²

et al. 2016

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the correlation coefficient, relative error (RE) and root mean square relative error (RMSRE) was employed and revealed improvement of RE from 25.9 to 6.8 and 3.9% (depending on the correction method) for eGFRScr; from 19 to 8.1 and 3.9% for eGFRScrBS and: from 11.6% to 2.0 and 2.3% for eGFRS3M (respectively). The RMSRE values changed from 30 to 21.3 and 19.8% for eGFRScr, from 25.1 to 21.6 and 19.8% for eGFRScrBS and from 19.1 to 15.8 and 15.3 % for eGFRS3M. Conclusions: Modifications of Schwartz equations at GFR > 60 ml/min/1.73m 2 significantly improves the accuracy of calculating eGFR. The 3-markers equation is more accurate and should be employed frequently. ARTICLE HISTORY

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“…There is actually a risk that equations (notably creatinine-based equations) underestimate measured GFR. 8,9 Accuracy of the various equations, especially the cystatin C and combined equations, should also be studied in children with abnormal muscular mass (such as spina bifida) because even the updated Schwartz equation would probably overestimate measured GFR in these children. Two other limitations of this study should be mentioned.…”

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confidence: 99%

Estimating GFR in children

Delanaye

Ebert

2012

Nat Rev Nephrol

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In a new study, Schwartz and colleagues have investigated the best way to estimate glomerular filtration rate (GFR) in children. Having already improved GFR estimation with the use of creatinine-based equations, the investigators now propose a more precise method for cystatin C measurement. The precision of a GFR equation will strongly depend on the analytical precision of the biological variables included.In children with chronic kidney disease, measuring glomerular filtration rate (GFR) is the best indicator of global kidney function. 1 Because measuring GFR remains relatively cumbersome and costly, however, estimating GFR using renal biomarkers remains relevant for daily practice. In 1976, Schwartz et al. proposed an equation where the parameter height/serum creatinine was multiplied by a constant (k) to estimate creatinine clearance. 2 This original Schwartz equation has been popular for several decades, but was based on the colourimetric Jaffe creatinine measurement method. Measuring serum creatinine levels by a precise and reproducible method is especially important in children because their mean serum concentrations are lower than those in adults and are thus more prone to interferences, for example from proteins present in the serum. Therefore, it is now recommended that serum creatinine levels should be measured by enzymatic methods in children. 3 "By optimizing the measurements of cystatin C, they improve the estimation of GFR in children..."Changing from the Jaffe method to enzymatic methods had a large impact on the k value in the original Schwartz equation. 3,4 In 2009, Schwartz et al. recalculated the k value of the estimating equation to be used with the enzymatic method and plasma iohexol clearance measurement as a reference method to assess GFR. 4 The fact that most of the enzymatic methods available in 2012 are isotope dilution mass spectrometry (IDMS)-traceable means that an identical equation can be used in all laboratories, which is very important from a practical point of view 5 However, a limitation of the 2009 study was that the equation was not validated in an independent validation cohort. In the same publication, the researchers studied the performance of the new renal biomarker cystatin C. In contrast to prior studies, Schwartz and colleagues demonstrated that cystatin C was less predictive of measured GFR than was height/serum creatinine, which resulted in a less powerful cystatin C exponent in the final equation compared with height/serum creatinine. This final equation included other variables such as blood urea nitrogen (BUN), height and sex. 4 One major issue was the turbidimetric method used to measure cystatin C, which has later been demonstrated as relatively imprecise.In 2012, Schwartz and colleagues studied children included in the Chronic Kidney Disease in Children (CKiD) study in order to determine the best way to estimate GFR. 6 Only individuals aged between 1 year and 16 years with an initial estimated GFR of 30-60 ml/min/1.73 m 2 (by the original Schwartz equati...

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GFR Estimation in Adolescents and Young Adults

Cited by 86 publications

References 20 publications

Prediction of Human Glomerular Filtration Rate from Preterm Neonates to Adults: Evaluation of Predictive Performance of Several Empirical Models

Prediction of Human Glomerular Filtration Rate from Preterm Neonates to Adults: Evaluation of Predictive Performance of Several Empirical Models

Modification of the Schwartz equations for children increases their accuracy at eGFR > 60 mL/min/1.73 m²

Estimating GFR in children

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GFR Estimation in Adolescents and Young Adults

Cited by 86 publications

References 20 publications

Prediction of Human Glomerular Filtration Rate from Preterm Neonates to Adults: Evaluation of Predictive Performance of Several Empirical Models

Prediction of Human Glomerular Filtration Rate from Preterm Neonates to Adults: Evaluation of Predictive Performance of Several Empirical Models

Modification of the Schwartz equations for children increases their accuracy at eGFR > 60 mL/min/1.73 m2

Estimating GFR in children

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Modification of the Schwartz equations for children increases their accuracy at eGFR > 60 mL/min/1.73 m²