MDRD Versus CKD-EPI Equation to Estimate Glomerular Filtration Rate in Kidney Transplant Recipients

Masson, Ingrid; Flamant, Martin; Maillard, Nicolas; Rule, Andrew D.; Vrtovsnik, François; Peraldi, Marie Noëlle; Thibaudin, Lise; Cavalier, Étienne; Vidal‐Petiot, Emmanuelle; Bonneau, Christine; Moranne, Olivier; Alamartine, Éric; Mariat, Christophe

doi:10.1097/tp.0b013e318288caa6

Cited by 92 publications

(82 citation statements)

References 26 publications

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“…Measurement of GFR by inulin clearance remains the gold standard for assessing renal function [21], but this process is cumbersome and expensive. In multiple studies comparing methods of estimating GFR in renal transplant recipients, the four-variable MDRD equation has been demonstrated to be the most accurate in a White population [22,23,24,25]. …”

Section: Discussionmentioning

confidence: 99%

Estimated Glomerular Filtration Rate Decline as a Predictor of Dialysis in Kidney Transplant Recipients

2014

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Background: It is now common for individuals to require dialysis following the failure of a kidney transplant. Management of complications and preparation for dialysis are suboptimal in this group. To aid planning, it is desirable to estimate the time to dialysis requirement. The rate of decline in the estimated glomerular filtration rate (eGFR) may be used to this end. Methods: This study compared the rate of eGFR decline prior to dialysis commencement between individuals with failing transplants and transplant-naïve patients. The rate of eGFR decline was also compared between transplant recipients with and without graft failure. eGFR was calculated using the four-variable MDRD equation with rate of decline calculated by least squares linear regression. Results: The annual rate of eGFR decline in incident dialysis patients with graft failure exceeded that of the transplant-naïve incident dialysis patients. In the transplant cohort, the mean annual rate of eGFR decline prior to graft failure was 7.3 ml/min/1.73 m² compared to 4.8 ml/min/1.73 m² in the transplant-naïve group (p < 0.001) and 0.35 ml/min/1.73 m² in recipients without graft failure (p < 0.001). Factors associated with eGFR decline were recipient age, decade of transplantation, HLA mismatch and histological evidence of chronic immunological injury. Conclusions: Individuals with graft failure have a rapid decline in eGFR prior to dialysis commencement. To improve outcomes, dialysis planning and management of chronic kidney disease complications should be initiated earlier than in the transplant-naïve population.

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Section: Discussionmentioning

confidence: 99%

Estimated Glomerular Filtration Rate Decline as a Predictor of Dialysis in Kidney Transplant Recipients

2014

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“…As such, estimating GFR equations using creatinine (Cr) have become the mainstay for assessment of GFR in transplant recipients. A comparison of Cr-based GFR estimating equations in solid organ transplants showed similar performance between the Modification of Diet in Renal Disease (MDRD) (1) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Cr equations (2) in two studies (3,4), but superior performance of the MDRD equation in others (5)(6)(7). Several generally applicable non-GFR determinants of serum Cr have been recognized, such as muscle mass (8).…”

Section: Introductionmentioning

confidence: 95%

Creatinine–Based and Cystatin C–Based GFR Estimating Equations and Their Non-GFR Determinants in Kidney Transplant Recipients

Keddis

Amer

Voskoboev

et al. 2016

CJASN

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Background and objectives eGFR equations have been evaluated in kidney transplant recipients with variable performance. We assessed the performance of the Modification of Diet in Renal Disease equation and the Chronic Kidney Disease Epidemiology Collaboration equations on the basis of creatinine, cystatin C, and both (eGFR creatinine-cystatin C) compared with measured GFR by iothalamate clearance and evaluated their non-GFR determinants and associations across 15 cardiovascular risk factors.Design, setting, participants, & measurements A cross-sectional cohort of 1139 kidney transplant recipients .1 year after transplant was analyzed. eGFR bias, precision, and accuracy (percentage of estimates within 30% of measured GFR) were assessed. Interaction of each cardiovascular risk factor with eGFR relative to measured GFR was determined.Results Median measured GFR was 55.0 ml/min per 1.73 m 2 . eGFR creatinine overestimated measured GFR by 3.1% (percentage of estimates within 30% of measured GFR of 80.4%), and eGFR Modification of Diet in Renal Disease underestimated measured GFR by 2.2% (percentage of estimates within 30% of measured GFR of 80.4%). eGFR cystatin C underestimated measured GFR by 213.7% (percentage of estimates within 30% of measured GFR of 77.1%), and eGFR creatinine-cystatin C underestimated measured GFR by 28.1% (percentage of estimates within 30% of measured GFR of 86.5%). Lower measured GFR associated with older age, women, obesity, longer time after transplant, lower HDL, lower hemoglobin, lower albumin, higher triglycerides, higher proteinuria, and an elevated cardiac troponin T level but did not associate with diabetes, smoking, cardiovascular events, pretransplant dialysis, or hemoglobin A1c. These risk factor associations differed for five risk factors with eGFR creatinine, six risk factors for eGFR Modification of Diet in Renal Disease, ten risk factors for eGFR cystatin C, and four risk factors for eGFR creatinine-cystatin C.Conclusions Thus, eGFR creatinine and eGFR creatinine-cystatin C are preferred over eGFR cystatin C in kidney transplant recipients because they are less biased, more accurate, and more consistently reflect the same risk factor associations seen with measured GFR.

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“…Conflicting results have been reported in renal transplant patients regarding the accuracy of prediction of 24-hour Ccr using the method of Cockcroft and Gault [22][23][24]. In RTR the performance of urine-creatinine clearance and of many different prediction formulas has been found similar [14,25]. The comparison with isotopic measurement of GFR was often disappointing [26,27].…”

Section: Discussionmentioning

confidence: 99%

Predicted and Measured Creatinine Clearance for the Estimation of Renal Graft Function: New Tools from Body Composition Analysis

Donadio

2014

Intern Med

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Aim of this study was to evaluate, in Renal Transplant Recipients (RTR), a new method to predict Creatinine Clearance (Ccr) from Plasma Creatinine (Pcr) and from the value of Body Cell Mass (BCM).The values of BCM were obtained, from body impedance analysis (BIA) using an impedance plethysmograph, in 87 RTR with different graft function. The ratios of 24-hour Urinary Creatinine Excretion (Ucr) over BCM were calculated in 30 RTR. In the remaining 57 RTR, Ccr was predicted from Pcr and individual values of BCM (BCM Ccr), using the mean ratio Ucr/BCM found in the first group of patients. In the same patients, Ccr was predicted according to Cockcroft and Gault (CG Ccr). The mean of triplicate measurement of 24-hour Ccr (24 h Ccr), obtained by the standard formula Ucr x Vol/min/Pcr, was used as the reference value of renal graft function.BCM Ccr had a better agreement with 24 h Ccr than CG Ccr, particularly in patients with graft failure.Thanks to its simplicity, accuracy and reproducibility, BCM Ccr is more suitable than 24-hour Ccr to estimate graft function. In the meantime, the body composition data gives useful information for the evalutation of nutritional status and of the equilibrium of body fluid compartments.

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MDRD Versus CKD-EPI Equation to Estimate Glomerular Filtration Rate in Kidney Transplant Recipients

Abstract: The CKD-EPI creatinine equation does not offer a better GFR prediction in renal transplant patients compared with the MDRD Study equation, even in the earlier CKD stages.

Cited by 92 publications

References 26 publications

Estimated Glomerular Filtration Rate Decline as a Predictor of Dialysis in Kidney Transplant Recipients

Estimated Glomerular Filtration Rate Decline as a Predictor of Dialysis in Kidney Transplant Recipients

Creatinine–Based and Cystatin C–Based GFR Estimating Equations and Their Non-GFR Determinants in Kidney Transplant Recipients

Predicted and Measured Creatinine Clearance for the Estimation of Renal Graft Function: New Tools from Body Composition Analysis

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