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. 2023 Sep;38(9):3043-3053.
doi: 10.1007/s00467-023-05926-w. Epub 2023 Mar 20.

Low agreement between various eGFR formulae in pediatric and young adult ADPKD patients

Pieter Schellekens  1   2   3 , Marcelien Verjans  4 , Peter Janssens  1   5 , Angélique Dachy  1   6 , Stéphanie De Rechter  1   4 , Luc Breysem  7 , Karel Allegaert  8   9   10 , Bert Bammens  2   3 , Rudi Vennekens  11 , Pieter Vermeersch  12 , Hans Pottel  13 , Djalila Mekahli  14   15
Affiliations

Low agreement between various eGFR formulae in pediatric and young adult ADPKD patients

Pieter Schellekens et al. Pediatr Nephrol. 2023 Sep.

Abstract

Background: Young autosomal dominant polycystic kidney disease (ADPKD) patients are becoming the new target population for the development of new treatment options. Determination of a reliable equation for estimated glomerular filtration rate (eGFR) from early stages is needed with the promising potential interventional therapies.

Methods: Prospective and longitudinal study on a cohort of 68 genotyped ADPKD patients (age range 0-23 years) with long-term follow-up. Commonly used equations for eGFR were compared for their relative performance.

Results: The revised Schwartz formula (CKiD) showed a highly significant decline in eGFR with aging (- 3.31 mL/min/1.73 m2/year, P < 0.0001). The recently updated equation by the Schwartz group (CKiDU25) showed a smaller (- 0.90 mL/min/1.73 m2/year) but significant (P = 0.001) decline in eGFR with aging and also showed a significant sex difference (P < 0.0001), not observed by the other equations. In contrast, the full age spectrum (FAS) equations (FAS-SCr, FAS-CysC, and the combined) showed no age and sex dependency. The prevalence of hyperfiltration is highly dependent on the formula used, and the highest prevalence was observed with the CKiD Equation (35%).

Conclusions: The most widely used methods to calculate eGFR in ADPKD children (CKiD and CKiDU25 equations) were associated with unexpected age or sex differences. The FAS equations were age- and sex-independent in our cohort. Hence, the switch from the CKiD to CKD-EPI equation at the transition from pediatric to adult care causes implausible jumps in eGFR, which could be misinterpreted. Having reliable methods to calculate eGFR is indispensable for clinical follow-up and clinical trials. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: ADPKD; Creatinine; Cystatin c; Estimated glomerular filtration rate; Hyperfiltration; Measured glomerular filtration rate.

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