Comparison of creatinine-based equations for estimating glomerular filtration rate in deceased donor renal transplant recipients.

Autor: Selistre LDS; Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France.; Universidade de Caxias do Sul-Programa de Pós-Graduação em Ciências da Saúde, Caxias do Sul, Brazil.; Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil., Lemoine S; Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France.; Université Lyon 1, Lyon, France.; CarMeN: Cardiovasculaire, Métabolisme, Diabétologie & Nutrition-INSERM U1060/Lyon 1, Lyon, France., Dantec A; Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France., Buron F; Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France., de Souza VC; Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France.; Universidade de Caxias do Sul-Programa de Pós-Graduação em Ciências da Saúde, Caxias do Sul, Brazil.; Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil., Bertoldo M; Universidade de Caxias do Sul-Programa de Pós-Graduação em Ciências da Saúde, Caxias do Sul, Brazil., Poli-de-Figueiredo CE; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil., Rimmelé T; CarMeN: Cardiovasculaire, Métabolisme, Diabétologie & Nutrition-INSERM U1060/Lyon 1, Lyon, France.; Service d'anesthésie-réanimation, hôpital Edouard-Herriot, Lyon, France., Thaunat O; Université Lyon 1, Lyon, France.; Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France.; Unité INSERM U1111, Lyon, France., Badet L; Université Lyon 1, Lyon, France.; Service d'Urologie et Transplantation, Hôpital Edouard Herriot, Lyon, France., Morelon E; Université Lyon 1, Lyon, France.; Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France.; Unité INSERM U1111, Lyon, France., Sicard A; Université Lyon 1, Lyon, France.; Unité INSERM U1111, Lyon, France., Dubourg L; Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France.; Université Lyon 1, Lyon, France.; Laboratoire de Biologie Tissulaire et d'ingénierie Thérapeutique (LBTI), UMR 5305 CNRS, Université Claude Bernard Lyon 1, Lyon, France.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Apr 28; Vol. 15 (4), pp. e0231873. Date of Electronic Publication: 2020 Apr 28 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0231873
Abstrakt: Background: Estimating glomerular filtration rate (GFR) is important for clinical management in kidney transplantation recipients (KTR). However, very few studies have evaluated the performance of the new GFR estimating equations (Lund-Malmö Revised-LMR, and Full Age Spectrum-FAS) in KTR.
Methods: GFR was estimated (eGFR) using CKD-EPI, MDRD, LMR, and FAS equations and compared to GFR measurement (mGFR) by reference methods (inuline urinary and iohexol plasma clearance) in 395 deceased-donor KTR without corticosteroids. The equations performance was assessed using bias (mean difference of eGFR and mGFR), precision (standard deviation of the difference), accuracy (concordance correlation coefficient-CCC), and agreements (total deviation index-TDI). The area under receiver operating characteristic curves (ROC) and the likelihood ratio for a positive result were calculated.
Results: In the total population, the performance of the CKD-EPI, MDRD and FAS equations was significantly lower than the LMR equation regarding the mean [95%CI] difference in bias (-2.0 [-4.0; -1.5] versus 9.0 [7.5; 10.0], 5.0 [3.5; 6.0] and 10.0 [8.5; 11.0] mL/min/1.73m2, P<0.005) and TDI (17.10 [16.41; 17.88], 25.91 [24.66; 27.16], 21.23 [19.48; 23.13] and 25.84 [24.16; 27.57], respectively). Concerning the CCC, all equation had poor agreement (<0.800) without statically difference between them. However, all equations had excellent area under the ROC curve (>0.900), and LMR equation had the best ability to correctly predict KTR with mGFR<45 mL/min/1.73 m2 (positive likelihood ratio: 8.87 [5.79; 13.52]).
Conclusion: Among a referral group of subjects KTR, LMR equation had the best mean bias and TDI, but with no significant superiority in other agreement tools. Caveat is required in the use and interpretation of PCr-based equations in this specific population.
Competing Interests: No. The authors have declared that no competing interests exist.
Databáze: MEDLINE
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