The Cockcroft-Gault formula should not be used in children

Filler, Guido; Foster, Jennifer A.; Acker, Amy; Lepage, Nathalie; Akbari, Ayub; Ehrich, J. H. H.

doi:10.1111/j.1523-1755.2005.00336.x

Cited by 75 publications

(72 citation statements)

References 12 publications

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“…Adult eGFR calculations based on serum creatinine, such as the Modification of Diet in Renal Disease study equation and the CockcroftGault equation, require additional information such as age, weight, gender, and ethnicity. In children, these formulas cannot be used (37). Before the findings of this study can be generalized, the increased eGFR errors that occur at lower FF will need to be confirmed in adult populations using adult eGFR equations that are based on serum creatinine.…”

Section: Discussionmentioning

confidence: 99%

Hyperfiltration Affects Accuracy of Creatinine eGFR Measurement

Huang

Sharma²,

Yasin³

et al. 2011

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Surrogate markers such as creatinine, cystatin C (CysC), and beta trace protein (BTP) have been used to estimate GFR (eGFR). The accuracy of eGFR may be altered with hyperfiltration and differences in filtration fraction (FF). It is hypothesized that the accuracy of creatinine for eGFR may be affected by hyperfiltration and different effective renal plasma flow (ERPF). Design, setting, participants, & measurements A total of 127 pediatric patients with various renal diseases underwent simultaneous measurements of GFR using 51Cr-EDTA renal scan and ERPF (131I-hippurate clearance) to calculate the FF (FF = GFR/ERPF). The eGFRs were calculated using the commonly used Schwartz (creatinine), Filler (CysC), and Benlamri (BTP) formulas. Agreement of the eGFRs with the measured isotope GFRs was assessed by Bland–Altman plots. Correlation analysis was performed using nonparametric tests to compare FF with eGFR − GFR. Results The 127 children at a median age (with 25th percentile, 75th percentile) of 11.9 (8.5, 14.9) years had a mean 51Cr EDTA-GFR of 100.6 ± 32.1 ml/min per 1.73 m2 and a median 131I-hippurate clearance (ERPF) of 588 (398,739) ml/min per 1.73 m2. Mean FF was 17.7 ± 4.5% with no correlation between the FF and the error (eGFR − GFR) for CysC and BTP eGFR, whereas there was a significant negative correlation between the error for Schwartz eGFR and FF. Conclusions There is a significant negative correlation between the error for the Schwartz eGFR and the FF. CysC and BTP are not affected by differences in FF.

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Section: Discussionmentioning

confidence: 99%

Hyperfiltration Affects Accuracy of Creatinine eGFR Measurement

Huang

Sharma²,

Yasin³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Third, it is acknowledged that, although all recruited subjects had normal serum creatinine measurements before surgery, an estimation of GFR to document normal kidney function was not made. However, estimation of GFR in children using serum creatinine or creatinine-based equations is fraught with imprecision (39). Fourth, in addition to NGAL, simultaneous examination of other urinary biomarkers as potential predictors of AKI may be informative (25).…”

Section: Discussionmentioning

confidence: 99%

Urine NGAL Predicts Severity of Acute Kidney Injury After Cardiac Surgery

Bennett

Dent²,

Ma³

et al. 2008

Clinical Journal of the American Society of Nephrology

698

553

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Background and objectives: The authors have previously shown that urine neutrophil gelatinase-associated lipocalin (NGAL), measured by a research ELISA, is an early predictive biomarker of acute kidney injury (AKI) after cardiopulmonary bypass (CPB). In this study, whether an NGAL immunoassay developed for a standardized clinical platform (ARCHITECT analyzer, Abbott Diagnostics Division, Abbott Laboratories, Abbott Park, IL) can predict AKI after CPB was tested.Design, setting, participants, & measurements: In a pilot study with 136 urine samples (NGAL range, 0.3 to 815 ng/ml) and 6 calibration standards (NGAL range, 0 to 1000 ng/ml), NGAL measurements by research ELISA and by the ARCHITECT assay were highly correlated (r ‫؍‬ 0.99). In a subsequent study, 196 children undergoing CPB were prospectively enrolled and serial urine NGAL measurements obtained by ARCHITECT assay. The primary outcome was AKI, defined as a >50% increase in serum creatinine.Results: AKI developed in 99 patients (51%), but the diagnosis using serum creatinine was delayed by 2 to 3 d after CPB. In contrast, mean urine NGAL levels increased 15-fold within 2 h and by 25-fold at 4 and 6 h after CPB. For the 2-h urine NGAL measurement, the area under the curve was 0.95, sensitivity was 0.82, and the specificity was 0.90 for prediction of AKI using a cutoff value of 100 ng/ml. The 2-h urine NGAL levels correlated with severity and duration of AKI, length of stay, dialysis requirement, and death.Conclusions: Accurate measurements of urine NGAL are obtained using the ARCHITECT platform. Urine NGAL is an early predictive biomarker of AKI severity after CPB.

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“…The Cockroft-Gault formula was used to compute GFR in subjects 12 years of age and older [21,22]. This equation incorporates age, sex, height, weight, and serum creatinine levels into its estimation of GFR.…”

Section: Phenotype Definitionmentioning

confidence: 99%

Estimated glomerular filtration rate in sickle cell anemia is associated with polymorphisms of bone morphogenetic protein receptor 1B

Nolan

Cohen

et al. 2006

American J Hematol

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Renal disease is common in sickle cell anemia. In this exploratory work, we used data from a longitudinal study of the natural history of sickle cell disease to examine the hypothesis that polymorphisms (SNPs) in selected candidate genes are associated with glomerular filtration rate (GFR). DNA samples and clinical and laboratory data were available for 1,140 patients with sickle cell anemia. GFR was estimated using the Cockcroft-Gault and Schwartz formulas for adults and children, respectively. We examined *175 haplotype tagging (ht) SNPs in about 70 genes of the TGFb/BMP pathway for their association with GFR using linear regression. Four SNPs in BMPR1B, a bone morphogenetic protein (BMP) receptor gene, yielded statistically significant associations (P values ranging from 0.015 to 0.046). Three haplotypes in this gene were also associated with GFR. The TGF-b/BMP pathway has been associated with the development of diabetic nephropathy, which has some features in common with sickle cell nephropathy. Our results suggest that, as with other subphenotypes of sickle cell disease, renal function may be genetically modulated. Am. J. Hematol. 82:179-184, 2007. V V C 2006 Wiley-Liss, Inc.

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The Cockcroft-Gault formula should not be used in children

Abstract: Cockcroft-Gault formula showed the worst agreement with GFR, regardless of using published or recalculated constants. The cystatin C-based approach resulted in the least error, and should be used for estimation of GFR.

Cited by 75 publications

References 12 publications

Hyperfiltration Affects Accuracy of Creatinine eGFR Measurement

Hyperfiltration Affects Accuracy of Creatinine eGFR Measurement

Urine NGAL Predicts Severity of Acute Kidney Injury After Cardiac Surgery

Estimated glomerular filtration rate in sickle cell anemia is associated with polymorphisms of bone morphogenetic protein receptor 1B

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