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Comparative Study
. 2011 Mar;6(3):552-60.
doi: 10.2215/CJN.04180510. Epub 2010 Nov 29.

Which creatinine and cystatin C equations can be reliably used in children?

Justine Bacchetta  1 , Pierre Cochat, Nicolas Rognant, Bruno Ranchin, Aoumeur Hadj-Aissa, Laurence Dubourg
Affiliations
Comparative Study

Which creatinine and cystatin C equations can be reliably used in children?

Justine Bacchetta et al. Clin J Am Soc Nephrol. 2011 Mar.

Abstract

Background and objectives: Estimation of GFR in children is challenging; reference methods are cumbersome, and formulas have limitations. The aims of this study were to evaluate (1) the new creatinine-based formula recently proposed by Schwartz using a kinetic colorimetric compensated Jaffe technique; (2) some cystatin C-derived formulas (Hoek, Le Bricon, Larsson, Rule, Filler, and Zappitelli) using a nephelemetric technique; and (3) combined formulas using both cystatin and creatinine (Zappitelli and Bouvet).

Design, setting, participants, & measurements: These formulas were evaluated in a cross-sectional cohort of 252 children with moderate CKD or normal GFR, in comparison with the reference standard (inulin clearance, iGFR). Mean age, body weight, height, creatinine, and cystatin C were 10.7 ± 4.0 years, 35 ± 15 kg, 137 ± 20 cm, 55 ± 30 μmol/L, and 0.91 ± 0.35 mg/L, respectively.

Results: Mean ± SD iGFR was 101 ± 32 ml/min per 1.73 m². When evaluating agreement between these formulas and iGFR (e.g. correlation, Bland Altman plots, bias, and accuracies), there was a good correlation between iGFR and all Le Bricon, Larsson, Rule, and Zappitelli (both) and locally adapted Schwartz and 2009 Schwartz formulas; by contrast, Filler and original 1976 Schwartz formulas overestimated iGFR, whereas Hoek and Bouvet formulas underestimated iGFR.

Conclusion: Different cystatin C-derived formulas (at least Larsson and Le Bricon) for estimating GFR as well as the Zappitelli combined formula are accurate in addition to the new Schwartz bedside formula in a general pediatric population.

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Figures

Figure 1.
Figure 1.
Comparison between plasma creatinine measured with an enzymatic Roche method and with a compensated Jaffe technique (n = 199 adult patients, mean ± SD = 130.2 ± 1.7 μmol/L, R2 = 0.997, P < 0.05). (A) Univariate relationship. (B) Bland and Altman plot (mean ± SD for the difference = 3.9 ± 7.4 μmol/L).
Figure 2.
Figure 2.
Bland Altman plots of the different formulas (eGFR) in comparison with inulin clearance (GFR). (A) 1976 Schwartz formula. (B) 2009 Schwartz formula. (C) Hoek formula. (D) Le Bricon formula. (E) Larsson formula. (F) Rule formula. (G) Filler formula. (H) Zappitelli formula. (I) Combined Zappitelli formula. (J) Bouvet formula. GFR and eGFR values are expressed in ml/min per 1.73 m2 (except for E and J). The solid lines correspond to the mean of GFR-eGFR ± 1.96 SD. The dotted line corresponds to the mean of GFR-eGFR.
Figure 2.
Figure 2.
Bland Altman plots of the different formulas (eGFR) in comparison with inulin clearance (GFR). (A) 1976 Schwartz formula. (B) 2009 Schwartz formula. (C) Hoek formula. (D) Le Bricon formula. (E) Larsson formula. (F) Rule formula. (G) Filler formula. (H) Zappitelli formula. (I) Combined Zappitelli formula. (J) Bouvet formula. GFR and eGFR values are expressed in ml/min per 1.73 m2 (except for E and J). The solid lines correspond to the mean of GFR-eGFR ± 1.96 SD. The dotted line corresponds to the mean of GFR-eGFR.
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References

    1. Stevens LA, Coresh J, Greene T, Levey AS: Assessing kidney function: Measured and estimated glomerular filtration rate. N Engl J Med 354: 2473–2483, 2006 - PubMed
    1. Bökenkamp A, Herget-Rosenthal S, Bokenkamp R: Cystatin C, kidney function and cardiovascular disease. Pediatr Nephrol 21: 1223–1230, 2006 - PubMed
    1. Simonsen O, Grubb A, Thysell H: The blood serum concentration of cystatin C (gamma-trace) as a measure of the glomerular filtration rate. Scand J Clin Lab Invest 45: 97–101, 1985 - PubMed
    1. Maillard N, Mariat C, Bonneau C, Mehdi M, Thibaudin L, Laporte S, Alamartine E, Chamson A, Berthoux F: Cystatin C-based equations in renal transplantation: Moving toward a better glomerular filtration rate prediction? Transplantation 85: 1855–1858, 2008 - PubMed
    1. Dharnidharka VR, Kwon C, Stevens G: Serum cystatin C is superior to serum creatinine as a marker of kidney function: A meta-analysis. Am J Kidney Dis 40: 221–226, 2002 - PubMed

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