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Yan R, Zhang C, Wang C, Sun Z, Peng X. Evaluation of glomerular filtration rate estimation equations based on serum creatinine in healthy Chinese children and adolescents: a nationwide cross-sectional study. BMJ Paediatr Open 2023; 7:e002132. [PMID: 37827805 PMCID: PMC10582894 DOI: 10.1136/bmjpo-2023-002132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Several equations for glomerular filtration rate (GFR) estimation based on serum creatinine (SCr) have been proposed for children, but most were developed among patients with kidney disease. The association between SCr and GFR may be distorted by kidney dysfunction and thus not applicable to healthy children. This study aimed to evaluate the applicability of existing SCr-based GFR estimation equations in healthy Chinese children. METHODS GFR estimation equations that developed in healthy children were mainly analysed, including the Flanders Metadata (FM), simple height-independent (Simple), full age spectrum (FAS) and FAS-height equations. The FM equation assumed that GFR is proportional to the ratio of height to SCr. The Simple, FAS and FAS-height equations assumed that the ratio of GFR to population mean is equal to the reciprocal ratio of SCr to population mean (denoted by Q). Estimated GFR were calculated using data of SCr, age, sex and height collected from 12 208 healthy Chinese children aged 3 months to <20 years. The performance of GFR estimation equations was evaluated by the sex and age distribution of the estimated GFR and the deviation from the measured GFR reported by other literatures. RESULTS The FM and Simple equations performed well in their applicable age of 1 month to 14 years, but presented undesirable sex difference after adolescence. The FAS and FAS-height equations showed reasonable development trend of estimated GFR throughout childhood, and the FAS equation had higher consistency than the FAS-height equation compared with measured GFR in healthy children. The GFR estimated by the FAS equation increased with age before 2 years, and reached the adult level thereafter without important sex difference. CONCLUSIONS The FAS equation is applicable to healthy Chinese children.
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Affiliation(s)
- Ruohua Yan
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
| | - Chao Zhang
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
| | - Chen Wang
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
| | - Zimo Sun
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
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Khondker A, Groff M, Nunes S, Sun C, Jawa N, Lee J, Cockovski V, Hejri-Rad Y, Chanchlani R, Fleming A, Garg A, Jeyakumar N, Kitchlu A, Lebel A, McArthur E, Mertens L, Nathan P, Parekh R, Patel S, Pole J, Ramphal R, Schechter T, Silva M, Silver S, Sung L, Wald R, Gibson P, Pearl R, Wheaton L, Wong P, Kim K, Zappitelli M. KIdney aNd blooD prESsure ouTcomes in Childhood Cancer Survivors: Description of Clinical Research Protocol of the KINDEST-CCS Study. Can J Kidney Health Dis 2022; 9:20543581221130156. [PMID: 36325265 PMCID: PMC9618744 DOI: 10.1177/20543581221130156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Approximately 30% of childhood cancer survivors (CCSs) will develop chronic kidney disease (CKD) or hypertension 15 to 20 years after treatment ends. The incidence of CKD and hypertension in the 5-year window after cancer therapy is unknown. Moreover, extent of monitoring of CCS with CKD and associated complications in current practice is underexplored. To inform the development of new and existing care guidelines for CCS, the epidemiology and monitoring of CKD and hypertension in the early period following cancer therapy warrants further investigation. Objective To describe the design and methods of the KIdney aNd blooD prESsure ouTcomes in Childhood Cancer Survivors study, which aims to evaluate the burden of late kidney and blood pressure outcomes in the first ~10 years after cancer therapy, the extent of appropriate screening and complications monitoring for CKD and hypertension, and whether patient, disease/treatment, or system factors are associated with these outcomes. Design Two distinct, but related studies; a prospective cohort study and a retrospective cohort study. Setting Five Ontario pediatric oncology centers. Patients The prospective study will involve 500 CCS at high risk for these late effects due to cancer therapy, and the retrospective study involves 5,000 CCS ≤ 18 years old treated for cancer between January 2008 and December 2020. Measurements Chronic kidney disease is defined as Estimated glomerular filtration rate <90 mL/min/1.73 m2 or albumin-to-creatinine ratio ≥ 3mg/mmol. Hypertension is defined by 2017 American Academy of Pediatrics guidelines. Methods Prospective study: we aim to investigate CKD and hypertension prevalence and the extent to which they persist at 3- and 5-year follow-up in CCS after cancer therapy. We will collect detailed biologic and clinical data, calculate CKD and hypertension prevalence, and progression at 3- and 5-years post-therapy. Retrospective study: we aim to investigate CKD and hypertension monitoring using administrative and health record data. We will also investigate the validity of CKD and hypertension administrative definitions in this population and the incidence of CKD and hypertension in the first ~10 years post-cancer therapy. We will investigate whether patient-, disease/treatment-, or system-specific factors modify these associations in both studies. Limitations Results from the prospective study may not be generalizable to non-high-risk CCS. The retrospective study is susceptible to surveillance bias. Conclusions Our team and knowledge translation plan is engaging patient partners, researchers, knowledge users, and policy group representatives. Our work will address international priorities to improve CCS health, provide the evidence of new disease burden and practice gaps to improve CCS guidelines, implement and test revised guidelines, plan trials to reduce CKD and hypertension, and improve long-term CCS health.
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Affiliation(s)
- Adree Khondker
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Michael Groff
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Sophia Nunes
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Carolyn Sun
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Natasha Jawa
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jasmine Lee
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vedran Cockovski
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yasmine Hejri-Rad
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rahul Chanchlani
- Department of Pediatrics, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Adam Fleming
- Department of Pediatric Hematology/Oncology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Amit Garg
- Department of Medicine, London Health Sciences Centre Research Inc., London, ON, Canada
| | | | - Abhijat Kitchlu
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
| | - Asaf Lebel
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Luc Mertens
- Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Nathan
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rulan Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Serina Patel
- Department of Pediatric Hematology/Oncology, Children’s Hospital of Western Ontario, London, Canada
| | - Jason Pole
- Pediatric Oncology Group of Ontario, Toronto, Canada
| | - Raveena Ramphal
- Department of Pediatrics, Children’s Hospital of Eastern Ontario–Ottawa Children’s Treatment Centre, Canada
| | - Tal Schechter
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mariana Silva
- Department of Pediatrics, Kingston Health Sciences Centre, ON, Canada
| | - Samuel Silver
- Division of Nephrology, Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Lillian Sung
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ron Wald
- Unity Health Toronto, ON, Canada
| | - Paul Gibson
- Pediatric Oncology Group of Ontario, Toronto, Canada
| | - Rachel Pearl
- William Osler Health System, Brampton, ON, Canada
| | - Laura Wheaton
- Department of Pediatrics, Kingston Health Sciences Centre, ON, Canada
| | - Peter Wong
- William Osler Health System, Brampton, ON, Canada
| | - Kirby Kim
- Patient Partner, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Zappitelli
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada,Michael Zappitelli, Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Room 11.9722, 11th Floor, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
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Acute kidney injury during cisplatin therapy and associations with kidney outcomes 2 to 6 months post-cisplatin in children: a multi-centre, prospective observational study. Pediatr Nephrol 2022; 38:1667-1685. [PMID: 36260162 DOI: 10.1007/s00467-022-05745-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Few studies describe acute kidney injury (AKI) burden during paediatric cisplatin therapy and post-cisplatin kidney outcomes. We determined risk factors for and rate of (1) AKI during cisplatin therapy, (2) chronic kidney disease (CKD) and hypertension 2-6 months post-cisplatin, and (3) whether AKI is associated with 2-6-month outcomes. METHODS This prospective cohort study enrolled children (aged < 18 years at cancer diagnosis) treated with cisplatin from twelve Canadian hospitals. AKI during cisplatin therapy (primary exposure) was defined based on Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria (≥ stage one). Severe electrolyte abnormalities (secondary exposure) included ≥ grade three hypophosphatemia, hypokalemia, or hypomagnesemia (National Cancer Institute Common Terminology Criteria for Adverse Events v4.0). CKD was albuminuria or decreased kidney function for age (KDIGO guidelines). Hypertension was defined based on the 2017 American Academy of Pediatrics guidelines. RESULTS Of 159 children (median [interquartile range [IQR]] age: 6 [2-12] years), 73/159 (46%) participants developed AKI and 55/159 (35%) experienced severe electrolyte abnormalities during cisplatin therapy. At median [IQR] 90 [76-110] days post-cisplatin, 53/119 (45%) had CKD and 18/128 (14%) developed hypertension. In multivariable analyses, AKI was not associated with 2-6-month CKD or hypertension. Severe electrolyte abnormalities during cisplatin were associated with having 2-6-month CKD or hypertension (adjusted odds ratio (AdjOR) [95% CI]: 2.65 [1.04-6.74]). Having both AKI and severe electrolyte abnormalities was associated with 2-6-month hypertension (AdjOR [95% CI]: 3.64 [1.05-12.62]). CONCLUSIONS Severe electrolyte abnormalities were associated with kidney outcomes. Cisplatin dose optimization to reduce toxicity and clear post-cisplatin kidney follow-up guidelines are needed. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Sun ZM, Zhou N, Peng XX, Wang H, Shen Y. Insufficient application of estimation equations of glomerular filtration rate: a survey of 1009 Chinese pediatricians. World J Pediatr 2022; 18:368-372. [PMID: 35267183 DOI: 10.1007/s12519-021-00509-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Zi-Mo Sun
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Nan Zhou
- Department of Nephrology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xiao-Xia Peng
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
| | - Hui Wang
- Department of Nephrology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Ying Shen
- Department of Nephrology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Defining pediatric community-acquired acute kidney injury: an observational study. Pediatr Res 2020; 87:564-568. [PMID: 31537011 DOI: 10.1038/s41390-019-0577-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/12/2019] [Accepted: 08/08/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pediatric acute kidney injury (AKI) is associated with long-term morbidity and mortality; however, outcomes improve when AKI is detected earlier. Current definitions of AKI use baseline creatinine; community-acquired AKI (CA-AKI) is difficult to define and detect in the pediatric emergency department (ED) when no baseline creatinine is available. Our objective was to compare age- and gender-based creatinine norms to the traditional baseline (lowest creatinine in previous 3 months) to diagnose CA-AKI. METHODS This was a retrospective cross-sectional study conducted in children 1 month-18 years of age seen in the pediatric ED in whom a creatinine was obtained. RESULTS Per the Kidney Disease Improving Global Outcomes AKI definition in encounters with baseline creatinine available, 343/2338 (14.7%) had CA-AKI. When the upper limit of the age- and gender-based creatinine norm was applied as a surrogate baseline creatinine, CA-AKI was diagnosed in 1.5% of encounters (239/15,486). Additionally, CA-AKI was diagnosed in 178 cases using the upper limit of age- and gender-based creatinine norms only, as these cases did not have a baseline creatinine. CONCLUSIONS Age- and gender-based creatinine norms can be applied as a surrogate baseline to detect CA-AKI in all children regardless of whether baseline creatinine is available, potentially detecting it earlier.
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6
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Goldstein SL, Dahale D, Kirkendall ES, Mottes T, Kaplan H, Muething S, Askenazi DJ, Henderson T, Dill L, Somers MJG, Kerr J, Gilarde J, Zaritsky J, Bica V, Brophy PD, Misurac J, Hackbarth R, Steinke J, Mooney J, Ogrin S, Chadha V, Warady B, Ogden R, Hoebing W, Symons J, Yonekawa K, Menon S, Abrams L, Sutherland S, Weng P, Zhang F, Walsh K. A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children. Kidney Int 2019; 97:580-588. [PMID: 31980139 DOI: 10.1016/j.kint.2019.10.015] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/26/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
Nephrotoxic medication (NTMx) exposure is a common cause of acute kidney injury (AKI) in hospitalized children. The Nephrotoxic Injury Negated by Just-in time Action (NINJA) program decreased NTMx associated AKI (NTMx-AKI) by 62% at one center. To further test the program, we incorporated NINJA across nine centers with the goal of reducing NTMx exposure and, consequently, AKI rates across these centers. NINJA screens all non-critically ill hospitalized patients for high NTMx exposure (over three medications on the same day or an intravenous aminoglycoside over three consecutive days), and then recommends obtaining a daily serum creatinine level in exposed patients for the duration of, and two days after, exposure ending. Additionally, substitution of equally efficacious but less nephrotoxic medications for exposed patients starting the day of exposure was recommended when possible. The main outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria (increase of 50% or 0.3 mg/dl over baseline). The primary outcome measure was AKI episodes per 1000 patient-days. Improvement was defined by statistical process control methodology and confirmed by Autoregressive Integrated Moving Average (ARIMA) modeling. Eight consecutive bi-weekly measure rates in the same direction from the established baseline qualified as special cause change for special process control. We observed a significant and sustained 23.8% decrease in NTMx-AKI rates by statistical process control analysis and by ARIMA modeling; similar to those of the pilot single center. Thus, we have successfully applied the NINJA program to multiple pediatric institutions yielding decreased AKI rates.
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Affiliation(s)
- Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | - Devesh Dahale
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Eric S Kirkendall
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Theresa Mottes
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Heather Kaplan
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stephen Muething
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David J Askenazi
- Division of Nephrology, Children's Hospital of Alabama, Birmingham, Alabama, USA
| | - Traci Henderson
- Division of Nephrology, Children's Hospital of Alabama, Birmingham, Alabama, USA
| | - Lynn Dill
- Division of Nephrology, Children's Hospital of Alabama, Birmingham, Alabama, USA
| | | | - Jessica Kerr
- Division of Nephrology, Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer Gilarde
- Division of Nephrology, Children's Hospital, Boston, Massachusetts, USA
| | - Joshua Zaritsky
- Division of Nephrology, A.I. Dupont Children's Hospital, Wilmington, Delaware, USA
| | - Valerie Bica
- Division of Nephrology, A.I. Dupont Children's Hospital, Wilmington, Delaware, USA
| | - Patrick D Brophy
- Division of Nephrology, Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Jason Misurac
- Division of Nephrology, Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Richard Hackbarth
- Division of Nephrology, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Julia Steinke
- Division of Nephrology, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Joann Mooney
- Division of Nephrology, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Sara Ogrin
- Division of Nephrology, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Vimal Chadha
- Division of Nephrology, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - Bradley Warady
- Division of Nephrology, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - Richard Ogden
- Division of Nephrology, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - Wendy Hoebing
- Division of Nephrology, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - Jordan Symons
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Karyn Yonekawa
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Shina Menon
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Lisa Abrams
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Scott Sutherland
- Division of Nephrology, Lucille Packard Stanford Children's Hospital, Palo Alto, California, USA
| | - Patricia Weng
- Division of Nephrology, Mattel Children's Hospital, Los Angeles, California, USA
| | - Fang Zhang
- Division of Biostatistics, Harvard Medical School, Boston, Massachusetts, USA; Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - Kathleen Walsh
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Vlajković M, Stević M, Slavković A, Mitić B, Živković V, Artiko V, Matović M. COMPARISON OF SCHWARTZ EGFR-CR WITH GFR MEASURED BY TC-99M-DTPA CLEARANCE IN HEALTHY CHILDREN AND IN CHILDREN WITH URINARY TRACT INFECTION WITH AND WITHOUT VESICOURETERAL REFLUX. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Llanos-Paez CC, Staatz C, Lawson R, Hennig S. Comparison of methods to estimate glomerular filtration rate in paediatric oncology patients. J Paediatr Child Health 2018; 54:141-147. [PMID: 29083076 DOI: 10.1111/jpc.13752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/02/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022]
Abstract
AIMS Glomerular filtration rate (GFR) is estimated daily in paediatric oncology patients; however, few equations, particularly ones that do not include serum creatinine, have been evaluated in this population. We aimed to compare the predictive performance of different equations available to estimate GFR in paediatric oncology patients. METHODS GFR was measured (mGFR) in paediatric oncology patients based on a chromium 51-labeled ethylene diamine tetraacetic acid excretion test. GFR was estimated (eGFR) in these same patients using equations identified from the literature. mGFR and eGFR values were compared, and the predictive performance of various eGFR equations was assessed in terms of their bias, precision and accuracy. RESULTS In total, 124 mGFR values ranging from 7 to 146 mL/min were available for analysis from 73 children. Twenty-two equations were identified from the literature. The Flanders metadata equation displayed the lowest absolute bias (mean error of 0.9 mL/min) and the greatest precision (root mean square error of 13.1 mL/min). The univariate Schwartz equation predicted the highest percentage (81.5%) of eGFR values within 30% of mGFR values, and the Rhodin fat-free mass equation predicted the highest percentage (37.1%) of eGFR values within 10% of mGFR values. CONCLUSIONS A number of equations were identified that could be used to estimate renal function in paediatric oncology patients; however, none was found to be highly accurate. The Flanders metadata equation and univariate Schwartz performed the best in this study, and we would suggest that these two equations may be used cautiously in paediatric oncology patients for clinical decision making, understanding their limitations.
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Affiliation(s)
| | - Christine Staatz
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Rachael Lawson
- Pharmacy Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Stefanie Hennig
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
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9
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Validation of serum creatinine-based formulae in pediatric renal transplant recipients. Pediatr Res 2017; 82:1000-1006. [PMID: 28846672 DOI: 10.1038/pr.2017.209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/16/2017] [Indexed: 01/06/2023]
Abstract
BackgroundAccurate monitoring of kidney function is important post-renal transplant; however, the routine use of measured glomerular filtration rate (GFR) or addition of newer serum markers is prohibitively expensive for routine clinical use, especially in children. We validated the modified Schwartz formula in pediatric renal transplant recipients across a range of demographic and clinical characteristics.MethodsIn a retrospective cohort study with nested cross-sectional analysis, we compared 505 measurements of estimated GFR using serum creatinine to simultaneous diethylenetriaminepentaacetic acid (DTPA) nuclear GFR (nGFR) measurements from 173 pediatric kidney transplant recipients who were < 18 years of age from 1 January 2001 to 31 December 2012 accounting for repeated measures.ResultsAmong 173 children, 62% were males, 85% with nGFR of ≥60 ml/min/1.73 m2, and the median age at transplant was 13.6 years (interquartile range 8.3-16 years). Overall, the modified Schwartz and Pottel formulae had better bias (0.07 and -0.03 ml/min/1.73 m2, respectively) and accuracy within 30% (both 84.4%) in comparison to Lyon and Zappitelli formulae. The 30% accuracy varied for girls and children <5 and >15 years.ConclusionModified Schwartz is a practical, non-invasive, and a valid bedside tool that provides a valid measurement of GFR in pediatric kidney transplant recipients.
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Pottel H. Measuring and estimating glomerular filtration rate in children. Pediatr Nephrol 2017; 32:249-263. [PMID: 27115887 DOI: 10.1007/s00467-016-3373-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 01/01/2023]
Abstract
Glomerular filtration rate (GFR) is the best index for kidney function in health and disease. Knowledge of the GFR is essential for the detection (diagnosis) and monitoring of renal function during disease progression and for ensuring correct medication doses. Inulin clearance (plasma or urine) is currently considered to be the gold standard for measuring GFR, but in clinical practice the measurement of other exogenous filtration markers from the plasma often replaces that of inulin clearance. Different protocols can be used to determine the area under the plasma disappearance curve, and an understanding of these methods is important. GFR can also be estimated by GFR equations (eGFR), which are most often used in clinical practice because they only require a knowledge of the serum creatinine or cystatin C level and demographic information. eGFR equations are easy to use but they do have their limitations, and it is important to know how these equations were derived and in which circumstances they can be used most accurately. The aim of this review is to explain how GFR can be measured using the renal clearance and the plasma clearance method and which eGFR equations can be applied to children, as well as how and when these equations can be used in clinical practice.
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Affiliation(s)
- Hans Pottel
- Department of Public Health and Primary Care, Campus Kulak Kortrijk, KU Leuven, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium.
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11
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Barman H, Bisai S, Das BK, Nath CK, Duwarah SG. Pottels Equation for Estimation of Glomerular Filtration Rate. Indian Pediatr 2017; 54:59-60. [PMID: 28141570 DOI: 10.1007/s13312-017-1001-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The retrospective study was carried out to examine performance of Pottels height- independent equation compared to Schwartzs height-dependent equation to estimate glomerular filtration rate in 115 children in Indian setting. The Pottels equation performed well compared to updated Schwartz equation (R2=0.94, mean bias 0.25, 95% LOA=20.4, -19.9). The precision was better at lower range of estimated GFR.
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Affiliation(s)
- Himesh Barman
- Department of Pediatrics and #Biochemistry, North-eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
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Goldberg JF, Shah MD, Kantor PF, Rossano JW, Shaddy RE, Chiou K, Hanna J, Hagan JL, Cabrera AG, Jeewa A, Price JF. Prevalence and Severity of Anemia in Children Hospitalized with Acute Heart Failure. CONGENIT HEART DIS 2016; 11:622-629. [PMID: 27060888 DOI: 10.1111/chd.12355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Anemia is common among adult heart failure patients and is associated with adverse outcomes, but data are lacking in children with heart failure. The purpose of this study was to determine the prevalence of anemia in children hospitalized with acute heart failure and to evaluate the association between anemia and adverse outcomes. DESIGN Review of the medical records of 172 hospitalizations for acute heart failure. SETTING Single, tertiary children's hospital. PATIENTS All acute heart failure admissions to our institution from 2007 to 2012. INTERVENTIONS None. OUTCOME MEASURES Composite endpoint of death, mechanical circulatory support deployment, or cardiac transplantation. RESULTS Patients ages ranged in age from 4 months to 23 years, with a median of 7.5 years, IQR 1.2, 15.9. Etiologies of heart failure included: dilated cardiomyopathy (n = 125), restrictive cardiomyopathy (n = 16), transplant coronary artery disease (n = 18), ischemic cardiomyopathy (n = 7), and heart failure after history of congenital heart disease (n = 6). Mean hemoglobin concentration at admission was 11.8 g/dL (±2.0 mg/dL). Mean lowest hemoglobin prior to outcome was 10.8 g/dL (±2.2 g/dL). Anemia (hemoglobin <10 g/dL) was present in 18% of hospitalizations at admission and in 38% before outcome. Anemia was associated with increased risk of death, transplant, or mechanical circulatory support deployment (adjusted odds ratio 1.79, 95% confidence interval = 1.12-2.88, P = .011). For every 1 g/dL increase in the patients' lowest hemoglobin during admission, the odds of death, transplant, or mechanical circulatory support deployment decreased by 18% (adjusted odds ratio = 0.82, 95% confidence interval = 0.74-0.93, P = 0.002). CONCLUSIONS Anemia occurs commonly in children hospitalized for acute heart failure and is associated with increased risk of transplant, mechanical circulatory support, and inhospital mortality.
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Affiliation(s)
| | - Mona D Shah
- Baylor College of Medicine, Houston, Tex, USA
| | | | - Joseph W Rossano
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Penn, USA
| | - Robert E Shaddy
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Penn, USA
| | - Kevin Chiou
- Baylor College of Medicine, Houston, Tex, USA
| | | | | | | | - Aamir Jeewa
- Baylor College of Medicine, Houston, Tex, USA
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Zachwieja K, Korohoda P, Kwinta-Rybicka J, Miklaszewska M, Moczulska A, Bugajska J, Berska J, Drożdż D, Pietrzyk JA. Modification of the Schwartz equations for children increases their accuracy at eGFR > 60 mL/min/1.73 m(2). Ren Fail 2016; 38:787-98. [PMID: 27056090 DOI: 10.3109/0886022x.2016.1163152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM Estimation of eGFR in children with normal kidney function using the Schwartz equations results in underestimating real GFR. MATERIALS AND METHODS We propose modification of three Schwartz equations - two based on creatinine concentration (eGFRScrBS bedside) and (eGFRScr) and one 3-marker based on creatinine, urea and cystatin C concentrations (eGFRS3M). The iohexol test (reference method) was performed 417 times in 353 children >2 years with mean GFR: 98 ± 31.6 ml/min/1.73m(2). The assessment included also the Filler and Zappitelli equations. The modification was performed using methods: (1) based on equation, eGFRcor = a [eGFR - T] + T, where T = 50, if eGFR > T, and a equals for: eGFRScrBS 1.4043, for eGFRScr 2.0048, for eGFRS3M 1.2951, and (2) based on correction of all coefficients of the original equation. RESULTS For comparison of all the results and for children with GFR< 60, 60-90, 90-135 and > 135 ml/min/1.73m(2) the correlation coefficient, relative error (RE) and root mean square relative error (RMSRE) was employed and revealed improvement of RE from 25.9 to 6.8 and 3.9% (depending on the correction method) for eGFRScr; from 19 to 8.1 and 3.9% for eGFRScrBS and: from 11.6% to 2.0 and 2.3% for eGFRS3M (respectively). The RMSRE values changed from 30 to 21.3 and 19.8% for eGFRScr, from 25.1 to 21.6 and 19.8% for eGFRScrBS and from 19.1 to 15.8 and 15.3 % for eGFRS3M. CONCLUSIONS Modifications of Schwartz equations at GFR > 60 ml/min/1.73m(2) significantly improves the accuracy of calculating eGFR. The 3-markers equation is more accurate and should be employed frequently.
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Affiliation(s)
- Katarzyna Zachwieja
- a Department of Pediatric Nephrology , Jagiellonian University Medical College , Kraków , Poland
| | - Przemysław Korohoda
- b Faculty Computer Science, Electronics and Telecommunications , AGH University of Science and Technology , Kraków , Poland
| | - Joanna Kwinta-Rybicka
- c Pediatric Nephrology Department , Children's University Hospital of Kraków , Kraków , Poland
| | - Monika Miklaszewska
- a Department of Pediatric Nephrology , Jagiellonian University Medical College , Kraków , Poland
| | - Anna Moczulska
- a Department of Pediatric Nephrology , Jagiellonian University Medical College , Kraków , Poland
| | - Jolanta Bugajska
- d Clinical Biochemistry Department , Jagiellonian University Medical College , Kraków , Poland
| | - Joanna Berska
- d Clinical Biochemistry Department , Jagiellonian University Medical College , Kraków , Poland
| | - Dorota Drożdż
- a Department of Pediatric Nephrology , Jagiellonian University Medical College , Kraków , Poland
| | - Jacek A Pietrzyk
- a Department of Pediatric Nephrology , Jagiellonian University Medical College , Kraków , Poland
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Pottel H, Hoste L, Dubourg L, Ebert N, Schaeffner E, Eriksen BO, Melsom T, Lamb EJ, Rule AD, Turner ST, Glassock RJ, De Souza V, Selistre L, Mariat C, Martens F, Delanaye P. An estimated glomerular filtration rate equation for the full age spectrum. Nephrol Dial Transplant 2016; 31:798-806. [PMID: 26932693 DOI: 10.1093/ndt/gfv454] [Citation(s) in RCA: 320] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/20/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Glomerular filtration rate (GFR) is accepted as the best indicator of kidney function and is commonly estimated from serum creatinine (SCr)-based equations. Separate equations have been developed for children (Schwartz equation), younger and middle-age adults [Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation] and older adults [Berlin Initiative Study 1 (BIS1) equation], and these equations lack continuity with ageing. We developed and validated an equation for estimating the glomerular filtration rate that can be used across the full age spectrum (FAS). METHODS The new FAS equation is based on normalized serum creatinine (SCr/Q), where Q is the median SCr from healthy populations to account for age and sex. Coefficients for the equation are mathematically obtained by requiring continuity during the paediatric-adult and adult-elderly transition. Research studies containing a total of 6870 healthy and kidney-diseased white individuals, including 735 children, <18 years of age, 4371 adults, between 18 and 70 years of age, and 1764 older adults, ≥70 years of age with measured GFR (inulin, iohexol and iothalamate clearance) and isotope dilution mass spectrometry-equivalent SCr, were used for the validation. Bias, precision and accuracy (P30) were evaluated. RESULTS The FAS equation was less biased [-1.7 (95% CI -3.4, -0.2) versus 6.0 (4.5, 7.5)] and more accurate [87.5% (85.1, 89.9) versus 83.8% (81.1, 86.5)] than the Schwartz equation for children and adolescents; less biased [5.0 (4.5, 5.5) versus 6.3 (5.9, 6.8)] and as accurate [81.6% (80.4, 82.7) versus 81.9% (80.7, 83.0)] as the CKD-EPI equation for young and middle-age adults; and less biased [-1.1 (-1.6, -0.6) versus 5.6 (5.1, 6.2)] and more accurate [86.1% (84.4, 87.7) versus 81.8% (79.7, 84.0)] than CKD-EPI for older adults. CONCLUSIONS The FAS equation has improved validity and continuity across the full age-spectrum and overcomes the problem of implausible eGFR changes in patients which would otherwise occur when switching between more age-specific equations.
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Affiliation(s)
- Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Liesbeth Hoste
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Laurence Dubourg
- Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Natalie Ebert
- Charité University Hospital, Institute of Public Health, Berlin, Germany
| | - Elke Schaeffner
- Charité University Hospital, Institute of Public Health, Berlin, Germany
| | - Bjørn Odvar Eriksen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Toralf Melsom
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Edmund J Lamb
- Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Stephen T Turner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Richard J Glassock
- Emeritus Professor of Medicine, Geffen School of Medicine at UCLA, Laguna Niguel, CA, USA
| | - Vandréa De Souza
- Universidade Federal do Rio Grande do Sul, FAMED - Programa de Pós Graduação em Saúde da Criança e do Adolescente, Porto Alegre, Brazil
| | - Luciano Selistre
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - Frank Martens
- Department of Clinical Chemistry, AZ Groeninge Hospital, Kortrijk, Belgium
| | - Pierre Delanaye
- Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
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15
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Vroling AB, Dorresteijn EM, Cransberg K, de Rijke YB. The impact of estimated glomerular filtration rate equations on chronic kidney disease staging in pediatric renal or heart transplant recipients. Pediatr Nephrol 2016; 31:1145-55. [PMID: 26862053 PMCID: PMC4880629 DOI: 10.1007/s00467-016-3312-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 11/27/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the performance of selected pediatric estimated glomerular filtration rate (eGFR) equations in relation to the clinical management of children after renal or heart transplantation or post-chemotherapy treatment. METHODS This study was a retrospective cross-sectional analysis of 61 children whose glomerular function (GFR) had been determined using a single-dose inulin clearance (iGFR) method. Eight equations for estimating the GFR were evaluated for bias, agreement, accuracy, and clinical stratification. RESULTS The outcome of all eight eGFR equations differed from the value determined using the iGFR method, with the mean bias ranging from -3.4 to 20.7 ml/min/1.73 m(2) and 90 % accuracy ranging from 16 to 26 %. All eGFR equations overestimated renal function in patients with decreased kidney function as determined by the iGFR method and underestimated renal function in patients with normal kidney function. Consequently, based on the eGFR values, patients with low GFR values according to the iGFR method were staged in a less severe chronic kidney disease (CKD) category, and patients with normal GFR values according to the iGFR method were staged in a more severe CKD category. The percentage of correctly classified patients ranged from 32.6 to 41.6 %. CONCLUSIONS In our cohort we found the CKiDIII equation to be the best alternative to calculating the GFR using the inulin clearance method, closely followed by the Hoste and the revised Grubb equations. The performances of all eight eGFR equations assessed were moderate at best and only slightly better than the easy-to-do bedside Schwartz equation.
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Affiliation(s)
- Aram Ben Vroling
- />Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eiske Margaretha Dorresteijn
- Department of Pediatric Nephrology, Erasmus University Medical Center-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Karlien Cransberg
- />Department of Pediatric Nephrology, Erasmus University Medical Center–Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
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Rink N, Zappitelli M. Estimation of glomerular filtration rate with and without height: effect of age and renal function level. Pediatr Nephrol 2015; 30:1327-36. [PMID: 25854613 DOI: 10.1007/s00467-015-3063-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The current glomerular filtration rate (GFR) equation (CKiD) may be less accurate in adolescents and children with higher GFR. METHODS This was a retrospective study (n = 161, 247 (99)mTc DTPA-GFRs). Six equations were evaluated for bias, accuracy, and low GFR diagnosis: (1) CKiD; (2) historic center; (3) Hoste(age); (4) Hoste(height); (5) modified Pottel; (6) Gao. Children with ≥ vs. <90 ml/min/1.73 m(2)) and < vs. ≥16 years were compared. Two adult equations were evaluated in children ≥16 years. RESULTS Most equations underestimated GFR by 1-14 % in the higher GFR group, least so for Hoste(age). In the low GFR group, Hoste(age) and historic center overestimated GFR significantly more than CKiD (p < 0.05). Accuracy (within 30 % GFR) was similar across equations and GFR subgroups (66-86 %). In the ≥16 years group, CKiD underestimated GFR by ∼10 %, vs. ∼3 % for Hoste(height). Accuracy was 5-10 % lower in the older group and most equations were more sensitive than specific for detecting low GFR; this discrepancy was less for the Hoste equations. Adult equations were highly inaccurate. CONCLUSIONS GFR estimation in older children and with higher GFR is suboptimal. The Hoste(height) may be an alternative GFR estimation method; Hoste(age) may allow for height-independent GFR estimation in patients with normal GFR.
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Affiliation(s)
- Nikki Rink
- Department of Pediatrics, McGill University Health Centre, Montreal Children's Hospital, 2300 Tupper, Room E-213, Montreal, QC, Canada, H3H 1P3
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Montañés Bermúdez R, Gràcia Garcia S, Fraga Rodríguez G, Escribano Subias J, Diez de los Ríos Carrasco M, Alonso Melgar A, García Nieto V. Documento de consenso: recomendaciones sobre la utilización de ecuaciones para la estimación del filtrado glomerular en niños. An Pediatr (Barc) 2014; 80:326.e1-326.e13. [DOI: 10.1016/j.anpedi.2013.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 06/19/2013] [Indexed: 01/07/2023] Open
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18
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Blufpand HN, Westland R, van Wijk JAE, Roelandse-Koop EA, Kaspers GJL, Bökenkamp A. Height-independent estimation of glomerular filtration rate in children: an alternative to the Schwartz equation. J Pediatr 2013; 163:1722-7. [PMID: 24094878 DOI: 10.1016/j.jpeds.2013.08.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 07/16/2013] [Accepted: 08/15/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare the diagnostic performance of 2 height-independent equations used to calculate estimated glomerular filtration rate (eGFR), those of Pottel (eGFR-Pottel) and the British Columbia Children's Hospital (BCCH) (eGFR-BCCH), with the commonly used Schwartz equation (eGFR-Schwartz). STUDY DESIGN We externally validated eGFR-Pottel and eGFR-BCCH in a well-characterized pediatric patient population (n = 152) and compared their diagnostic performance with that of eGFR-Schwartz using Bland-Altman analysis. All patients underwent glomerular filtration rate measurement using the gold standard single-injection inulin clearance method (GFR-inulin). RESULTS Median GFR-inulin was 92.0 mL/min/1.73 m² (IQR, 76.1-107.4 mL/min/1.73 m²). Compared with GFR-inulin, the mean bias for eGFR-Schwartz was -10.1 mL/min/1.73 m(2) (95% limits of agreement [LOA], -77.5 to 57.2 mL/min/1.73 m(2)), compared with -12.3 mL/min/1.73 m² (95% LOA, -72.6 to 47.9 mL/min/1.73 m(2)) for eGFR-Pottel and -22.1 mL/min/1.73 m² (95% LOA, -105.0 to 60.8 mL/min/1.73 m(2)) for eGFR-BCCH. eGFR-Pottel showed comparable accuracy to eGFR-Schwartz, with 77% and 76% of estimates within 30% of GFR-inulin, respectively. eGFR-BCCH was less accurate than eGFR-Schwartz (66% of estimates within 30% of GFR-inulin; P < .01). CONCLUSION The performance of eGFR-Pottel is superior to that of eGFR-BCCH and comparable with that of eGFR-Schwartz. eGFR-Pottel is a valid alternative to eGFR-Schwartz in children and could be reported by the laboratory if height data are not available.
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Affiliation(s)
- Hester N Blufpand
- Department of Pediatric Nephrology, VU University Medical Center, Amsterdam, The Netherlands; Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands.
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Pottel H, Hoste L, Martens F. A simple height-independent equation for estimating glomerular filtration rate in children. Pediatr Nephrol 2012; 27:973-9. [PMID: 22252520 DOI: 10.1007/s00467-011-2081-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND The chronic kidney disease (CKD) classification system for children is similar to the CKD classification system for adults, using estimated glomerular filtration rate (eGFR) combined with fixed cut-off values of 60, 30, and 15 ml/min/1.73 m(2) for CKD stages III, IV, and V, respectively. To estimate GFR in children, eGFR-equations are used that require serum creatinine (Scr), but also height information, which is normally not available in clinical laboratory databases. METHODS This retrospective study is based on data from two different databases, one that has previously been used to develop the Flanders Metadata equation for children and one database including 353 children who underwent (51)Cr-EDTA GFR, serum creatinine, height, and weight measurements. RESULTS A height-independent eGFR equation based on the concept of a population-normalized Scr, presented before for adults, is extended to children: eGFR = 107.3/(Scr/Q), with Q the median Scr for healthy children of a particular age. This equation is validated against direct measurements of GFR, and against the updated Schwartz and Flanders Metadata equation. CONCLUSIONS The new simple height-independent equation performs very well and should make (mass) screening of kidney function in children easier.
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Affiliation(s)
- Hans Pottel
- Interdisciplinary Research Center, Katholieke Universiteit Leuven Campus Kortrijk, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium.
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