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. 2019 Mar 18;12(5):748-755.
doi: 10.1093/ckj/sfz012. eCollection 2019 Oct.

Impact of errors of creatinine and cystatin C equations in the selection of living kidney donors

Ana González-Rinne  1 , Sergio Luis-Lima  2 , Beatriz Escamilla  1 , Natalia Negrín-Mena  2 , Ana Ramírez  3 , Adelaida Morales  4 , Nicanor Vega  5 , Patricia García  6 , Elisa Cabello  7 , Domingo Marrero-Miranda  1 , Ana Aldea-Perona  2   8 , Alejandra Alvarez  1 , María Del Carmen Abad  1 , Lourdes Pérez-Tamajón  1 , Federico González-Rinne  2 , Alejandra González-Delgado  9 , Laura Díaz Martín  2 , Alejandro Jiménez-Sosa  2 , Armando Torres  1   10   11 , Esteban Porrini  10   11
Affiliations

Impact of errors of creatinine and cystatin C equations in the selection of living kidney donors

Ana González-Rinne et al. Clin Kidney J. .

Erratum in

  • Erratum: Impact of errors of creatinine and cystatin C equations in the selection of living kidney donors.
    González-Rinne A, Luis-Lima S, Escamilla B, Negrín-Mena N, Ramírez A, Morales A, Vega N, García P, Cabello E, Marrero-Miranda D, Aldea-Perona A, Alvarez A, Abad MDC, Pérez-Tamajón L, González-Rinne F, González-Delgado A, Díaz Martín L, Jiménez-Sosa A, Torres A, Porrini E. González-Rinne A, et al. Clin Kidney J. 2019 Apr 30;13(5):910. doi: 10.1093/ckj/sfz052. eCollection 2020 Oct. Clin Kidney J. 2019. PMID: 33123368 Free PMC article.

Abstract

Background: Reliable determination of glomerular filtration rate (GFR) is crucial in the evaluation of living kidney donors. Although some guidelines recommend the use of measured GFR (mGFR), many centres still rely on estimated GFR (eGFR) obtained through equations or 24-h creatinine clearance. However, eGFR is neither accurate nor precise in reflecting real renal function. We analysed the impact of eGFR errors on evaluation and decision making regarding potential donors.

Methods: We evaluated 103 consecutive living donors who underwent mGFR via iohexol plasma clearance and eGFR by 51 creatinine- and/or cystatin C-based equations. The cut-off for living donation in our centre is GFR > 80 mL/min for donors >35 years of age or 90 mL/min for those <35 years of age. We analysed the misclassification of donors based on the cut-off for donation-based eGFR.

Results: Ninety-three subjects (90.3%) had mGFR values above (donors) and 10 [9.7% (95% confidence interval 5.4-17)] below (non-donors) the cut-off. In non-donors, most of the equations gave eGFR values above the cut-off, so donation would have been allowed based on eGFR. All non-donors were female with reduced weight, height and body surface. In donors, up to 32 cases showed eGFR below the cut-off, while mGFR was actually higher. Therefore an important number of donors would not have donated based on eGFR alone.

Conclusion: The misclassification of donors around the cut-off for donation is very common with eGFR, making eGFR unreliable for the evaluation of living kidney donors. Whenever possible, mGFR should be implemented in this setting.

Keywords: estimated GFR; living kidney donation; measured GFR.

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Figures

FIGURE 1
FIGURE 1
Decision tree for the evaluation of living kidney donors. Iohexol, iohexol plasma clearance; y, years.
FIGURE 2
FIGURE 2
eGFR as calculated by different equations in non-donors with mGFR of 70 mL/min (range 70–73) or donors with mGFR of 90 mL/min (range 90–93). The arrows represent the estimated value calculated by the same equation in different patients with a similar GFR. Black arrows indicate over- or underestimation of real GFR, leading to incorrect acceptance or exclusion for donation in subjects with an mGFR of (A) ∼70 or (B) 90 mL/min. Equations: CKD-EPI with creatinine, CKD-EPI with cystatin C, MDRD, FAS with creatinine + cystatin C, Rule with cystatin, Lund–Malmö revised and Stevens with cystatin.
FIGURE 3
FIGURE 3
Number and percentage of donors in whom the calculated eGFR by creatinine- and/or cystatin C–based equations was below while the mGFR was actually above the cut-off for acceptance for donation. The numbers are included in each bar.
See this image and copyright information in PMC

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