TY - JOUR
T1 - Combination of pediatric and adult formulas yield valid glomerular filtration rate estimates in young adults with a history of pediatric chronic kidney disease
AU - Ng, Derek K.
AU - Schwartz, George J.
AU - Schneider, Michael F.
AU - Furth, Susan L.
AU - Warady, Bradley A.
N1 - Funding Information:
Data in this manuscript were collected by the Chronic Kidney Disease in Children prospective cohort study (CKiD) with clinical coordinating centers (principal investigators) at Children's Mercy Hospital and the University of Missouri–Kansas City (Bradley Warady, MD) and Children's Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD) at the Johns Hopkins Bloomberg School of Public Health. The CKiD Study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01-DK-082194, U01-DK-66116). The CKiD website is located at http://www.statepi.jhsph.edu/ckid . The authors acknowledge Drs. Alvaro Muñoz and Josef Coresh for critical input in the preparation of this manuscript.
Publisher Copyright:
© 2018 International Society of Nephrology
PY - 2018/7
Y1 - 2018/7
N2 - 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.
AB - 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.
KW - chronic kidney disease
KW - clinical nephrology
KW - glomerular filtration rate
KW - pediatric nephrology
KW - young adults
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U2 - 10.1016/j.kint.2018.01.034
DO - 10.1016/j.kint.2018.01.034
M3 - Article
C2 - 29735307
AN - SCOPUS:85046828033
SN - 0085-2538
VL - 94
SP - 170
EP - 177
JO - Kidney international
JF - Kidney international
IS - 1
ER -