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Estimating glomerular filtration rate in children: evaluation of creatinine- and cystatin C-based equations

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Abstract

Background

Glomerular filtration rate (GFR) estimated by creatinine- and/or cystatin C-based equations (eGFR) is widely used in daily practice. The purpose of our study was to compare new and old eGFR equations with measured GFR (mGFR) by iohexol clearance in a cohort of children with chronic kidney disease (CKD).

Methods

We examined 96 children (median age 9.2 years (range 0.25–17.5)) with CKD stages 1–5. A 7-point iohexol clearance (GFR7p) was defined as the reference method (median mGFR 66 mL/min/1.73 m2, range 6–153). Ten different eGFR equations, with or without body height, were evaluated: Schwartzbedside, SchwartzCKiD, SchwartzcysC, CAPA, LMREV, (LMREV + CAPA) / 2, FAScrea, FAScysC, FAScombi, FASheight. The accuracy was evaluated with percentage within 10 and 30% of GFR7p (P10 and P30).

Results

In the group with mGFR below 60 mL/min/1.73 m2, the SchwartzcysC equation had the lowest median bias (interquartile range; IQR) 3.27 (4.80) mL/min/1.73 m2 and the highest accuracy with P10 of 44% and P30 of 85%. In the group with mGFR above 60 mL/min/1.73 m2, the SchwartzCKiD presented with the lowest bias 3.41 (13.1) mL/min/1.73 m2 and P10 of 62% and P30 of 98%. Overall, the SchwartzcysC had the lowest bias − 1.49 (13.5) mL/min/1.73 m2 and both SchwartzcysC and SchwartzCKiD showed P30 of 90%. P10 was 44 and 48%, respectively.

Conclusions

The SchwartzcysC and the combined SchwartzCKiD present with lower bias and higher accuracy as compared to the other equations. The SchwartzcysC equation is a good height-independent alternative to the SchwartzCKiD equation in children and can be reported directly by the laboratory information system.

Clinical Trial Registration

ClinicalTrials.gov, Identifier NCT01092260, https://clinicaltrials.gov/ct2/show/NCT01092260?term=tondel&rank=2

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Acknowledgements

We wish to express our gratitude to the pediatric study nurses Mai Britt Lynum (Oslo University Hospital), Hildur Grindheim, and Renathe Håpoldøy (Haukeland University Hospital) for their technical assistance with the sample collection and to the laboratory engineer Kjersti Carstensen for the iohexol analyses (Haukeland University Hospital). The study was supported by grants from the Health Trust of Western Norway, The Norwegian Society of Nephrology, Haukeland University Hospital, and Oslo University Hospital.

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Authors and Affiliations

  1. Department of Medical Biochemistry, Oslo University Hospital, PB 4950 Nydalen, 0424, Oslo, Norway

    Cathrin L Salvador & Lars Mørkrid

  2. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Cathrin L Salvador & Lars Mørkrid

  3. Department of Pediatrics, Haukeland University Hospital, Bergen, Norway

    Camilla Tøndel & Damien Brackman

  4. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Camilla Tøndel

  5. Department of Newborn screening, Oslo University Hospital, Oslo, Norway

    Alexander D Rowe

  6. Department of Pediatrics, Oslo University Hospital, Oslo, Norway

    Anna Bjerre

  7. Laboratory for Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway

    Atle Brun

  8. Department of Clinical Science, University of Bergen, Bergen, Norway

    Atle Brun

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  1. Cathrin L Salvador
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  2. Camilla Tøndel
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  3. Alexander D Rowe
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  4. Anna Bjerre
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  5. Atle Brun
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  7. Lars Mørkrid
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Correspondence to Cathrin L Salvador.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Regional Ethics Committee of Western Norway and an informed consent form was obtained by all patients and/or their designees. The study was performed in accordance with the Declaration of Helsinki.

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Salvador, C.L., Tøndel, C., Rowe, A.D. et al. Estimating glomerular filtration rate in children: evaluation of creatinine- and cystatin C-based equations. Pediatr Nephrol 34, 301–311 (2019). https://doi.org/10.1007/s00467-018-4067-3

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  • DOI: https://doi.org/10.1007/s00467-018-4067-3

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