HDCN Abstract:  ASN Annual Meeting -- San Francisco  

White CA, Huang D, Akbari A, et al.

Glomerular Filtration Rate Estimation Equations Based on Serum Creatinine Are Inaccurate in Renal Transplantation: A Systematic Review.

ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:683A 2007

Creatinine-based glomerular filtration rate (GFR) estimation equations are commonly used to estimate kidney function in renal transplant recipients (RTRs). The accuracy of these equations in RTRs remains unclear. We performed a systematic review of studies evaluating the performance of creatinine-based GFR prediction equations in adult RTRs.

We searched the databases MEDLINE and EMBASE from 1966 and 1980 respectively to October 2006, reviewed five specialty journals (January 2000-July 2006) and hand-searched the abstracts from the American Society of Nephrology Annual meeting (2000-2005) and the American Transplant Congress (2000-2006). The search yielded 25 studies (5105 GFR measures in 3593 patients). The analysis of most studies was similar with the reporting of bias (mean difference between measured GFR and estimated GFR using the prediction equation) and accuracy (percent of GFR estimates within 10%, 20%, or 30% of measured GFR). For the abbreviated MDRD equation (n=9), the results were quite variable. The biases ranged from a low of -11.4 to a high of + 9.2 ml/min/1.73m2. The reported accuracy was low with a pooled weighted mean 30% accuracy (proportion of estimates falling within 30% of the measured GFR) of only 76%. Only three studies calibrated the serum creatinine to the Cleveland Clinic.

The results for the Cockcroft-Gault equation (n=20) were similar with biases that ranged from -3.1 to +16 ml/min/1.73m2 and with a pooled weighted mean 30% accuracy of 73%. For the Nankivell equation (n=9) the biases ranged from -1.4 to 36.3 ml/min/1.73m2. The pooled weighted mean 30% accuracy was 57%. Differences in patient populations, reference standard GFR measurement techniques and creatinine assay calibration likely account for the discrepancies between studies.

The wide range of bias with both over and underestimation of measured GFR indicates that the creatinine-based estimates are not sufficiently accurate for use in the renal transplant population and that novel and more accurate markers of GFR are urgently needed.

© Copyright 2007-2008, American Society of Nephrology. Reproduced with permission.
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