Kinetic Estimation of GFR Improves Prediction of Dialysis and Recovery after Kidney Transplantation

Pianta, Timothy J; Endre, Zoltán H.; Pickering, John W.; Buckley, Nicholas A.; Peake, Philip W.

doi:10.1371/journal.pone.0125669

Cited by 47 publications

(65 citation statements)

References 34 publications

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“…The Jelliffe equation for unstable kidney function, which is calculated on the basis of the volume of distribution and creatinine kinetics rather than steady state parameters such as body weight or age, correlated well with CCr in a small study of 12 patients in the ICU 33,34 . The kinetic eGFR, which similarly to the Jelliffe equation, estimates GFR on the basis of the creatinine kinetics has shown promise in renal transplant recipients, but should be validated in other cohorts such as hospitalized patients with native kidneys 35 . Iohexol clearance has been used in critically ill patients but as mentioned above, is laborious and time consuming 36,37 .…”

Section: Management Of Persistent Akimentioning

confidence: 99%

“…Alternative or complementary measures of kidney function, including other filtration markers such as cystatin C and timed urine clearance measurements, could hold promise for improved phenotyping of functional recovery from AKD but require further validation before recommending their routine adoption into clinical practice 35,[63][64][65][66] . Methods to assess glomerular functional reserve (for example, by assessing the effect of a protein load on GFR) or tubular functional reserve (for example, through furosemide stress testing or the administration of intravenous creatinine) have also been developed in the CKD setting but have yet to be applied to patients with AKD 67,68 .…”

Section: Consensus Statement 2hmentioning

confidence: 99%

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Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

et al. 2017

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Section: Management Of Persistent Akimentioning

confidence: 99%

Section: Consensus Statement 2hmentioning

confidence: 99%

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

et al. 2017

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“…Approximately 20-30% of deceased donor kidneys and half the kidneys donated after cardiac death develop delayed graft function (DGF) [1]. DGF is usually defined as a requirement for dialysis within 1 week after transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…[5]). The KeGFR formula is potentially adaptable to other filtration biomarkers including plasma cystatin C [1]. Also intuitive is the suggestion that if the rate of excretion (E) is less than the rate of production (estimated generation, eG) of creatinine, then the ratio (E/eG) would be a near ‘real-time' marker of kidney performance [6] relative to steady state performance, and therefore a predictor of DGF.…”

Section: Introductionmentioning

confidence: 99%

Timely Diagnosis of Acute Kidney Injury Using Kinetic eGFR and the Creatinine Excretion to Production Ratio, E/eG - Creatinine Can Be Useful!

Endre

Pianta²,

Pickering

2016

Nephron

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Post transplant repeated measurements of urine volume and serum creatinine (sCr) are used to assess kidney function. Under non-steady state conditions, repeated measurement of sCr allows calculation of the kinetic estimated GFR (KeGFR). Additional measurement of urinary creatinine allows the calculation of the creatinine excretion to (estimated) production ratio (E/eG). We hypothesized that post-transplant KeGFR and E/eG would predict delayed graft function (DGF), as early as 4 h and outperform a validated clinical model at 12 h. This was a retrospective analysis of prospectively acquired data in a study of 56 recipients of deceased-donor kidney transplant. We assessed predictive performance with the area under the receiver operator characteristic curve (AUC) and the added value to a clinical model with integrated discrimination improvement analysis. At 4 h, the AUC for E/eG was 0.87 (95% CI 0.77-0.96) and for KeGFR 0.69 (95% CI 0.56-0.83). Both E/eG and KeGFR improved the risk prediction of a clinical model for DGF by 32 and 18%, and for non-DGF by 17 and 10%, respectively. While E/eG had better predictive performance of DGF than KeGFR, KeGFR might also facilitate perioperative management including drug dosing after kidney transplantation. Together these measurements may facilitate the possibility of conducting trials of early intervention to ameliorate the adverse effects of ischaemia-reperfusion injury on long-term DGF.

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“…However, 2 recently published articles reported that kinetic GFR improved risk prediction in a clinical model of delayed graft function. 8,9 Other researchers have shown that, in cardiac surgery patients, kinetic GFR modeling enabled the early identification of patients with AKI before significant incremental increases in serum creatinine appeared. 10 Our results showed the superiority of kinetic GFR estimation to MDRD and CG GFR estimation for predicting stages of AKI according to the RIFLE criteria, when creatinine-defined AKI staging is used.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Hekmat

Eshraghi²,

Esmailpour³

et al. 2017

Exp Clin Transplant

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Objectives: Kinetic glomerular filtration rate estimation may have more power and versatility than the Modification of Diet in Renal Disease or CockcroftGault formula for evaluating kidney function when plasma creatinine fluctuates rapidly. After kidney donation, glomerular filtration rate rapidly fluctuates in otherwise healthy patients. We compared 3 formulas for estimating glomerular filtration rate: kinetic, Modification of Diet in Renal Disease, and Cockcroft-Gault, for determining stages of acute kidney injury early after kidney donation. Materials and Methods: In 42 living kidney donors, we measured serum creatinine, cystatin C, neutrophil gelatinase-associated lipocalin, and glomerular filtration rates before uninephrectomy and 3 days afterward. To estimate glomerular filtration rate, we used Cockcroft-Gault, Modification of Diet in Renal Disease, and kinetic equations. We sought the most accurate formula for staging acute kidney injury according to the risk, injury, failure, loss, and end-stage criteria. Results: The kinetic glomerular filtration rate model found more cases of stage 3 acute kidney injury than did the Modification of Diet in Renal Disease or Cockcroft-Gault formula. Receiver operating characteristic curves showed that the kinetic glomerular filtration rate model had more sensitivity and specificity than the Cockroft-Gault formula for discriminating among risk, injury, failure, loss, and end-stage criteria stages of acute kidney injury, based on serum creatinine changes. On day 2 after donation, a more sensitive marker with a shorter half-life (serum neutrophil gelatinase-associated lipocalin) was more significantly correlated with kinetic glomerular filtration rate estimation. Conclusions: The kinetic glomerular filtration rate model was able to discriminate stages of acute kidney injury early after kidney donation according to risk, injury, failure, loss, and end-stage criteria better than the Modification of Diet in Renal Disease or CockcroftGault formulas. The kinetic model detected failurestage acute kidney injury ≥ 1 to 2 days earlier than the MDRD formula, CG formula detected no failure.

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Kinetic Estimation of GFR Improves Prediction of Dialysis and Recovery after Kidney Transplantation

Cited by 47 publications

References 34 publications

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

Timely Diagnosis of Acute Kidney Injury Using Kinetic eGFR and the Creatinine Excretion to Production Ratio, E/eG - Creatinine Can Be Useful!

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