Lean Body Mass Is Better Than Body Surface Area in Correcting GFR

Si, Hongwei; Lei, Zhi-Li; Li, Sijin; Liu, Jianzhong; Jianhua, Geng; Shengzu, Chen

doi:10.1097/rlu.0b013e318263905b

Cited by 5 publications

(5 citation statements)

References 27 publications

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“…There are many studies looking at the problems related to BSA based GFR estimation formula, suggesting other parameters such as lean body mass [3] but if the goal of estimating GFR is drug dosing or an individual assessment of kidney function, the absolute values without further correction might be more accurate and easy to calculate.…”

Section: Discussionmentioning

confidence: 99%

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The use of absolute values improves performance of estimation formulae: a retrospective cross sectional study

2013

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BackgroundEstimation of Glomerular Filtration Rate (GFR) by equations such as Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) or Modification of Diet in Renal Disease (MDRD) is usually expressed as a Body Surface Area (BSA) indexed value (ml/min per 1.73 m2). This can have severe clinical consequences in patients with extreme body sizes, resulting in an underestimation in the case of obesity or an overestimation of GFR in the case of underweight patients. The aim of this study was to compare the performance of both estimation formula expressed in ml/min, instead of ml/min per 1.73 m2, with a reference method.MethodsRetrospective single centre cross sectional study of 185 patients. GFR was measured with 51Cr-EDTA and estimated with CKD-EPI and MDRD. Bias, precision and accuracy of absolute estimated GFR was calculated.ResultsBias of CKD-EPI and MDRD formulae expressed as an absolute value was 0.49 and 0.27 ml/min respectively, which is lower than previously reported. Precision was 12.95 and 16.33 and accuracy expressed as P30 was over 92.43% for CKD-EPI. There were no significant differences in GFR between the reference method and the estimation formulae.ConclusionsThe performance of CKD-EPI and MDRD formulae can be significantly improved in the individual patient if the absolute values are used by removing the BSA normalization factor. Absolute estimated GFR by CKD-EPI is comparable to measured GFR, improving the performance of this formula in the assessment of individual kidney function, thus providing clinicians with an alternative to reference methods.

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Section: Discussionmentioning

confidence: 99%

“…It is important for clinicians to be aware of the implications of using BSA indexed GFR values in populations with extreme BSA values, as suggested by an increasing amount of scientific papers investigating relationship between GFR and BSA over the last ten years [3-5]. …”

Section: Introductionmentioning

confidence: 99%

The use of absolute values improves performance of estimation formulae: a retrospective cross sectional study

2013

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“…Since the number of nephrons is set at birth and does not change with weight gain, an increase in GFR to meet metabolic needs in the obese requires an increase in single-nephron GFR which, according to the concept of kidney symmorphosis, may represent a pathologic rather than physiologic adaptive mechanism [2]. The underestimation of GFR by BSA indexing might conceal these changes [11,12]. Some authors report that the use of absolute values improves the performance of GFR estimations in adults [13], while others propose that alternative size descriptors should be used for indexing [14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Normalization of glomerular filtration rate in obese children

et al. 2016

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“…[14] In this study, the Passing & Bablok regression could make the estimates closer to the measured values and make the regression line pass through the origin point with a slope of 1. [15] …”

Section: Methodsmentioning

confidence: 99%

A step-by-step regressed pediatric kidney depth formula validated by a reasonable index

Chen

et al. 2017

Medicine

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In predicting pediatric kidney depth, we are especially interested in that the errors of most estimates are within a narrow range. Therefore, this study was intended to use the proportion of estimates within a range of −5 to 5 mm (P5 mm) to evaluate the formulas and tried to regress a kidney depth formula for children. The enrolled children aged from 1 to 19 years were randomly sampled into group A and group B (75% and 25% of all recruits, respectively). Using data of the group A, the test formula was regressed by nonlinear regression and subsequently Passing & Bablok regression, and validated in group B. The Raynaud, Gordon, Tonnesen, Taylor, and the test formulas were evaluated in the 2 groups. Accuracy was evaluated by bias, absolute bias, and P5 mm; and precision was evaluated by correlation coefficient. In addition, root-mean square error was used as a mixed index for both accuracy and precision. Body weight, height, and age did not have significant differences between the 2 groups. In the nonlinear regression, coefficients of the formula (kidney depth = a × weight/height + b × age) from group A were in narrower 95% confidence intervals. After the Passing & Bablok regression, biases of left and right kidney estimates were significantly decreased. In the evaluation of formulas, the test formula was obviously better than other formulas mentioned above, and P5 mm for left and right kidneys was about 60%. Among children younger than 10 years, P5 mm was even more than 70% for left and right kidney depths. To predict pediatric kidney depth, accuracy and precision of a step-by-step regressed formula were better than the 4 “standard” formulas.

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Lean Body Mass Is Better Than Body Surface Area in Correcting GFR

Abstract: The commonsense of BSA correction should be seriously reevaluated. Lean body mass can better improve the correlation coefficient between paired GFRs than BSA can and it can be suitable in the correction.

Cited by 5 publications

References 27 publications

The use of absolute values improves performance of estimation formulae: a retrospective cross sectional study

The use of absolute values improves performance of estimation formulae: a retrospective cross sectional study

Normalization of glomerular filtration rate in obese children

A step-by-step regressed pediatric kidney depth formula validated by a reasonable index

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