TY - JOUR
T1 - Estimated versus measured glomerular filtration rate inchildren before hematopoietic cell transplantation
AU - Laskin, Benjamin L.
AU - Nehus, Edward
AU - Goebel, Jens
AU - Furth, Susan
AU - Davies, Stella M.
AU - Jodele, Sonata
N1 - Funding Information:
Financial disclosure: B.L.L. is supported by an American Society for Blood and Marrow Transplantation /Genentech New Investigator Award and a McCabe Family Pilot Award from the University of Pennsylvania . The REDCap database is supported by a Cincinnati Children's Hospital Center for Clinical and Translational Science and Training grant ( UL1-RR026314-01 National Center for Research Resources / National Institutes of Health ) and by National Institutes of Health grant 8UL1 TR000077 . S.F. is supported by The National Institute of Diabetes and Digestive and Kidney Diseases grants K24DK078737 and U01DK066174 . None of these funding sources had any input in the study design, analysis, manuscript preparation, or decision to submit for publication.
Publisher Copyright:
© 2014 American Society for Blood and Marrow Transplantation.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - An accurate assessment of kidney function before hematopoietic cell transplantation (HCT) can help to properly dose conditioning chemotherapy and follow patients for the development of chronic kidney disease. We cross-sectionally examined 94 children and young adults before HCT to compare formal nuclear glomerular filtration rate (GFR) testing with estimated GFR using creatinine and cystatin C-based equations, including the original Schwartz formula and the more recent formulas developed in the Chronic Kidney Disease in Children (CKiD) cohort. The median age of the cohort was 5.9years (range, .26 to 30.5years). The mean cohort nuclear GFR was 107.4±24.7mL/min/1.73m2, with 18 of 94 subjects (19.1%) having abnormal kidney function (GFR<90mL/min/1.73m2) before HCT. The creatinine-based original Schwartz and bedside CKiD formulas showed significant bias, overestimating the nuclear GFR by 57.4 (95% confidence interval [CI], 49.0 to 65.8) and 14.1 (95% CI, 7.1 to 21.1) mL/min/1.73m2, respectively. Cystatin C formulas had less mean bias and improved accuracy but also had decreased sensitivity to detect abnormal kidney function before HCT. The Full CKiD equation showed the best performance, with a mean bias of-3.6mL/min/1.73m2 (95% CI,-8.4 to 1.2) that was not significantly different from the measured value and 87.7% of estimates within ±30% of the nuclear GFR. Although the more recent bedside CKiD formula performed better than the original Schwartz formula, both formulas had poor sensitivity for detecting a low GFR. An abnormal pretransplant nuclear GFR was not associated with post-HCT acute kidney injury, the need for dialysis, or death in the first 100days. In conclusion, we observed cystatin C-based equations outperformed creatinine-based equations in estimating GFR in children before HCT. However, all formulas had decreased sensitivity to detect impaired GFR. Formal measurement of kidney function should be considered in children and young adults who need an accurate assessment of kidney function before HCT.
AB - An accurate assessment of kidney function before hematopoietic cell transplantation (HCT) can help to properly dose conditioning chemotherapy and follow patients for the development of chronic kidney disease. We cross-sectionally examined 94 children and young adults before HCT to compare formal nuclear glomerular filtration rate (GFR) testing with estimated GFR using creatinine and cystatin C-based equations, including the original Schwartz formula and the more recent formulas developed in the Chronic Kidney Disease in Children (CKiD) cohort. The median age of the cohort was 5.9years (range, .26 to 30.5years). The mean cohort nuclear GFR was 107.4±24.7mL/min/1.73m2, with 18 of 94 subjects (19.1%) having abnormal kidney function (GFR<90mL/min/1.73m2) before HCT. The creatinine-based original Schwartz and bedside CKiD formulas showed significant bias, overestimating the nuclear GFR by 57.4 (95% confidence interval [CI], 49.0 to 65.8) and 14.1 (95% CI, 7.1 to 21.1) mL/min/1.73m2, respectively. Cystatin C formulas had less mean bias and improved accuracy but also had decreased sensitivity to detect abnormal kidney function before HCT. The Full CKiD equation showed the best performance, with a mean bias of-3.6mL/min/1.73m2 (95% CI,-8.4 to 1.2) that was not significantly different from the measured value and 87.7% of estimates within ±30% of the nuclear GFR. Although the more recent bedside CKiD formula performed better than the original Schwartz formula, both formulas had poor sensitivity for detecting a low GFR. An abnormal pretransplant nuclear GFR was not associated with post-HCT acute kidney injury, the need for dialysis, or death in the first 100days. In conclusion, we observed cystatin C-based equations outperformed creatinine-based equations in estimating GFR in children before HCT. However, all formulas had decreased sensitivity to detect impaired GFR. Formal measurement of kidney function should be considered in children and young adults who need an accurate assessment of kidney function before HCT.
KW - Cystatin C
KW - Kidney function
KW - Pediatrics
KW - Transplant
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U2 - 10.1016/j.bbmt.2014.07.008
DO - 10.1016/j.bbmt.2014.07.008
M3 - Article
C2 - 25038395
AN - SCOPUS:84912525035
SN - 1083-8791
VL - 20
SP - 2056
EP - 2061
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 12
ER -