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. 2013 Jul 19;8(7):e69922.
doi: 10.1371/journal.pone.0069922. Print 2013.

Determining glomerular filtration rate in homozygous sickle cell disease: utility of serum creatinine based estimating equations

Monika R Asnani  1 , O'Neil Lynch, Marvin E Reid
Affiliations

Determining glomerular filtration rate in homozygous sickle cell disease: utility of serum creatinine based estimating equations

Monika R Asnani et al. PLoS One. .

Erratum in

Abstract

Background: Various estimating equations have been developed to estimate glomerular filtration rate (GFR) for use in clinical practice. However, the unique renal physiological and pathological processes that occur in sickle cell disease (SCD) may invalidate these estimates in this patient population. This study aims to compare GFR estimated using common existing GFR predictive equations to actual measured GFR in persons with homozygous SCD. If the existing equations perform poorly, we propose to develop a new estimating equation for use in persons with SCD.

Methods: 98 patients with the homozygous SS disease (55 females: 43 males; mean age 34±2.3 years) had serum measurements of creatinine, as well as had GFR measured using (99m)Tc-DTPA nuclear renal scan. GFR was estimated using the Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault (CG), and the serum creatinine based CKD-EPI equations. The Bland-Altman limit of agreement method was used to determine agreement between measured and estimated GFR values. A SCD-specific estimating equation for GFR (JSCCS-GFR equation) was generated by means of multiple regression via backward elimination.

Results: The mean measured GFR±SD was 94.9±27.4 mls/min/1.73 m(2) BSA, with a range of 6.4-159.0 mls/min/1.73 m(2). The MDRD and CG equations both overestimated GFR, with the agreement worsening with higher GFR values. The serum creatinine based CKD-EPI equation performed relatively well, but with a systematic bias of about 45 mls/min. The new equation developed resulted in a better fit to our sickle cell disease data than the MDRD equation.

Conclusion: Current estimating equations, other than the CKD-EPI equation, do not perform very accurately in persons with homozygous SS disease. A fairly accurate estimating equation, suitable for persons with GFR >60 mls/min/1.73 m(2) has been developed from our dataset and validated within a simulated dataset.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Limits of Agreement Plots: Measured GFR versus (a) MDRD estimate (b) CG estimate and (c) Serum Creatinine based CKD-EPI estimate.
Figure 2
Figure 2. Comparison of the new model JSCCS_GFR (GFR as a function of (a)Serum Creatinine, (b) Height and (c) Gender) from the sickle cell disease data with the MDRD model.
Figure 3
Figure 3. Comparison of the new model JSCCS_GFR (GFR as a function of (a)Serum Creatinine, (b) Height and (c) Gender) from the simulated sickle cell disease data with the MDRD model.
See this image and copyright information in PMC

References

    1. Abdu A, Emokpae MA, Uadia PO, Kuliya-Gwarzo A (2011) Proteinuria among adult sickle cell anemia patients in Nigeria. Ann Afr Med 10: 34–37. - PubMed
    1. Lopez Revuelta K, Ricard Andres MP (2011) Kidney abnormalities in sickle cell disease. Nefrologia 31: 591–601. - PubMed
    1. Powars DR, Chan LS, Hiti A, Ramicone E, Johnson C (2005) Outcome of sickle cell anemia: a 4-decade observational study of 1056 patients. Medicine (Baltimore) 84: 363–376. - PubMed
    1. Serjeant GR, Higgs DR, Hambleton IR (2007) Elderly survivors with homozygous sickle cell disease. N Engl J Med 356: 642–643. - PubMed
    1. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, et al. (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139: 137–147. - PubMed

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