Combination of pediatric and adult formulas yield valid glomerular filtration rate estimates in young adults with a history of pediatric chronic kidney disease

Derek K. Ng, George J. Schwartz, Michael F. Schneider, Susan L. Furth, Bradley A. Warady

Research output: Contribution to journalArticlepeer-review

Abstract

As patients with chronic kidney disease (CKD) transition from pediatric nephrology care to adult care, their kidney function is clinically assessed by estimated glomerular filtration rate (eGFR) using both pediatric and adult equations, which may not be congruent. Here we evaluated commonly used eGFR equations and directly measured iohexol GFR (iGFR) among participants between ages 18 and 26 with a diagnosis of pediatric CKD in the Chronic Kidney Disease in Children (CKiD) cohort. The bedside serum creatinine (SCr)-only equation (CKiD SCr ), the SCr-only CKD-EPI (CKD-EPI SCr ), the cystatin C (Cys)-only CKD-EPI (CKD-EPI Cys ) and the combined SCr and Cys CKD-EPI (CKD-EPI SCr-Cys ) were compared with a) 279 measured iGFRs obtained from 187 participants and b) 548 eGFRs from the SCr and Cys-based CKiD equation (CKiD SCr-Cys ) obtained from 219 participants. Among emerging adults with a median iGFR of 49 ml/min/1.73m 2 , the CKiD SCr-Cys equation had low bias (+1.5 ml/min/1.73m 2 ) and high correlation (0.94), while CKiD SCr underestimated iGFR and CKiD SCr-Cys (–5.6 and –7.4 ml/min/1.73m 2 , respectively) and CKD-EPI SCr had an overestimation bias (+8.2 and +6.1 ml/min/1.73m 2 , respectively). However, the CKD-EPI Cys and CKD-EPI SCr-Cys exhibited strong agreement with both iGFR and CKiD SCr-Cys . GFR may also be validly estimated in this population by taking the simple average of CKiD SCr and CKD-EPI SCr (average bias +1.3 compared to iGFR and -0.6 compared to CKiD SCr-Cys ). Clinicians should be aware that individually the pediatric and adult SCr-based estimates of GFR had large discrepancies among emerging adults with pediatric CKD. Thus, when cystatin C is not available, we recommend the average of pediatric and adult SCr-based eGFR as a valid tool for clinical use.

Original languageEnglish (US)
Pages (from-to)170-177
Number of pages8
JournalKidney international
Volume94
Issue number1
DOIs
StatePublished - Jul 2018

Keywords

  • chronic kidney disease
  • clinical nephrology
  • glomerular filtration rate
  • pediatric nephrology
  • young adults

ASJC Scopus subject areas

  • Nephrology

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