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. 2014 Jun;63(6):1007-18.
doi: 10.1053/j.ajkd.2014.01.436. Epub 2014 Apr 2.

Performance of creatinine-based GFR estimating equations in solid-organ transplant recipients

Kamran Shaffi  1 , Katrin Uhlig  2 , Ronald D Perrone  2 , Robin Ruthazer  3 , Andrew Rule  4 , John C Lieske  4 , Gerjan Navis  5 , Emilio D Poggio  6 , Lesley A Inker  2 , Andrew S Levey  7
Affiliations

Performance of creatinine-based GFR estimating equations in solid-organ transplant recipients

Kamran Shaffi et al. Am J Kidney Dis. 2014 Jun.

Abstract

Background: Accurate assessment of kidney function is important for the management of solid-organ transplant recipients. In other clinical populations, glomerular filtration rate (GFR) most commonly is estimated using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine or the 4-variable MDRD (Modification of Diet in Renal Disease) Study equation. The accuracy of these equations compared with other GFR estimating equations in transplant recipients has not been carefully studied.

Study design: Diagnostic test study.

Setting & participants: Solid-organ transplant recipients longer than 6 months posttransplantation from 5 clinical populations (N=3,622, including recipients of kidney [53%], liver [35%], and other or multiple organs [12%]).

Index test: Estimated GFR (eGFR) using creatinine-based GFR estimating equations identified from a systematic review of the literature. Performance of the CKD-EPI creatinine and the MDRD Study equations was compared with alternative equations.

Reference test: Measured GFR (mGFR) from urinary clearance of iothalamate or plasma clearance of iohexol.

Measurements: Error (difference between mGFR and eGFR) expressed as P30 (proportion of absolute percent error <30%) and mean absolute error.

Results: We identified 26 GFR estimating equations. Mean mGFR was 55.1±22.7 (SD) mL/min/1.73 m(2). P30 and mean absolute error for the CKD-EPI and the MDRD Study equations were 78.9% (99.6% CI, 76.9%-80.8%) for both and 10.6 (99.6% CI, 10.1-11.1) versus 11.0 (99.6% CI, 10.5-11.5) mL/min/1.73 m(2), respectively; these equations were more accurate than any of the alternative equations (P <0.001 for all pairwise comparisons for both measures). They performed better than or as well as the alternative equations in most subgroups defined by demographic and clinical characteristics, including type of transplanted organ.

Limitations: Study population included few nonwhites and people with solid-organ transplants other than liver and kidneys.

Conclusions: The CKD-EPI creatinine and the MDRD Study equations perform better than the alternative creatinine-based estimating equations in solid-organ transplant recipients. They can be used for clinical management.

Keywords: Glomerular filtration rate (GFR) estimation; creatinine-based estimated glomerular filtration rate (eGFR) equation; kidney transplantation; renal function; solid-organ transplant recipient.

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Figures

Fig 1
Fig 1
Search strategy to identify eGFR equations *KDOQI; Kidney Disease Outcomes Quality Initiative
Fig 2
Fig 2
The performance of the CKD-EPI or the MDRD Study equation vs. the alternative equations Difference in P30 (upper panels) and the mean absolute error (lower panels) of the CKD-EPI or the MDRD Study equation and the alternative equations along with their 99.6 % CIs are shown. For the metric of P30, a difference of >0 indicates that CKD-EPI or the MDRD Study equation is superior to the alternative equations. For mean absolute error, a difference of <0 indicates that the CKD-EPI or the MDRD Study equation has a lower mean absolute error than the alternative equations. P values for all pair wise comparisons with the CKD-EPI or the MDRD Study equation are < 0.004. *Equations that had transplant recipients in the development cohort
Fig 3
Fig 3
The difference between the P30 (99.6% CI) of the CKD-EPI or the MDRD Study equation and each of the alternative equations in subgroups by organ [Kidney, Liver, Lung, Heart, Pancreas, and Multiple organs(Heart/Kidney, Heart/Liver, Kidney/Liver, Kidney/Lung, Kidney/Pancreas, Lung/Liver or Lung/Herat)] A significant global p value (≤0.004) indicates that the difference in the performance of the CKD-EPI (upper panels) or the MDRD Study equation (lower panels) and the alternative equations is different across studies. A difference of >0 indicates that the P30 of the alternative equation is less than the CKD-EPI or the MDRD Study equation. If the lower margin of the 99.6% CI is above 0, then the alternative equation is inferior; if the margin includes 0, then the alternative equation is similar. For the difference in P30, only the values that are >−20% and < 60% are shown for ease of representation. Interaction P values represent 4 categories; P≤0.004, P>0.004–0.01, P>0.01–0.05, and P>0.05 *Equations that had transplant recipients in the development cohort
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References

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