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. 2024 Aug 10;9(11):3236-3249.
doi: 10.1016/j.ekir.2024.08.012. eCollection 2024 Nov.

Dried Blood Spot Sampling for Monitoring Children With Immune-Mediated Glomerulopathies and After Kidney Transplantation

Lena Brunkhorst  1 , Michael Terhardt  2 , Björn Bulitta  2 , Miriam Gutting  3 , Nils Janzen  2   4   5 , Dieter Haffner  1 , Nele Kanzelmeyer  1
Affiliations

Dried Blood Spot Sampling for Monitoring Children With Immune-Mediated Glomerulopathies and After Kidney Transplantation

Lena Brunkhorst et al. Kidney Int Rep. .

Erratum in

Abstract

Introduction: Monitoring kidney function and immunosuppressant levels in children post-kidney transplantation or those with glomerulopathies is challenging due to frequent venipunctures and clinic visits. Capillary dried blood spot sampling (DBS) offers a potential alternative.

Methods: In this prospective single-center study, 89 children (38% female and 62% male) requiring therapeutic drug monitoring (TDM) and kidney function assessment were enrolled. Of the patients, 79% were kidney transplant recipients, and 21% had immune-mediated glomerulopathies. The mean age was 13.4 (range, 5.7-18.0) years. DBS and standard venous serum samples were collected simultaneously for tacrolimus (TAC), cyclosporine A (CsA), everolimus (EVR), and creatinine levels. Furthermore, patient feedback on pain perception and feasibility was collected via questionnaire.

Results: No significant differences in parameter values between DBS and standard methods were observed (creatinine, -1.7 ± 14.5 μmol/l; EVR, 0.1 ± 1.2 μg/l; TAC, 0.3 ± 1.1 μg/l; CsA, 2.8 ± 9.8 μg/l). DBS demonstrated sufficient accuracy compared with standard methods. Patients favored DBS and telehealth consultations, especially due to less travel and school absences. Patients preferred finger pricking over ear pricking.

Conclusion: Capillary DBS proves reliable for TDM and kidney function assessment in pediatric kidney disease. It reduces patient and family burden compared with venous blood collection and enables telehealth consultations.

Keywords: children; dried blood spot; kidney transplantation.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Comparison of DBS analyses with expected target concentrations. DBS, dried blood spot sampling; LLOQ, lower limits of quantification; MPA, mycophenolic acid.
Figure 2
Figure 2
Comparison of creatinine concentrations. DBS, dried blood spot sampling; LA, limits of agreement (−30.69 to 26.85 μmol/l).
Figure 3
Figure 3
Plot of difference creatinine. DBS, dried blood spot sampling; LA, limits of agreement (−34.01 to 31.57%).
Figure 4
Figure 4
Linear regression analysis creatinine. DBS, dried blood spot sampling.
Figure 5
Figure 5
Comparison of TAC concentrations. DBS, dried blood spot sampling; LA, limits of agreement (−1.78 to 2.37 μg/l); TAC, tacrolimus.
Figure 6
Figure 6
Plot of differences TAC. DBS, dried blood spot sampling; TAC, tacrolimus.
Figure 7
Figure 7
Linear regression analysis TAC. DBS, dried blood spot sampling; TAC, tacrolimus.
Figure 8
Figure 8
Comparison of EVR concentrations. DBS, dried blood spot sampling; EVR, everolimus; LA, limits of agreement (−2.38 to 2.41 μg/l).
Figure 9
Figure 9
Plot of differences EVR. DBS, dried blood spot sampling; EVR, everolimus.
Figure 10
Figure 10
Linear regression analysis EVR. DBS, dried blood spot sampling; EVR, everolimus.
Figure 11
Figure 11
Comparison of CsA concentrations. DBS, dried blood spot sampling; CsA, cyclosporine A; LA, limits of agreement (−16.52 to 22.02 μg/l).
Figure 12
Figure 12
Plot of differences CsA. CsA, cyclosporine A; DBS, dried blood spot sampling.
Figure 13
Figure 13
Linear regression analysis CsA. CsA, cyclosporine A; DBS, dried blood spot sampling.
Figure 14
Figure 14
Reasons for DBS. DBS, dried blood spot sampling.
Figure 15
Figure 15
Patients' pain levels.
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