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2015 ; 165
(3
): 437-45
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Applicability of estimating glomerular filtration rate equations in pediatric
patients: comparison with a measured glomerular filtration rate by iohexol
clearance
#MMPMID25445208
Deng F
; Finer G
; Haymond S
; Brooks E
; Langman CB
Transl Res
2015[Mar]; 165
(3
): 437-45
PMID25445208
show ga
Estimating glomerular filtration rate (eGFR) has become popular in clinical
medicine as an alternative to measured GFR (mGFR), but there are few studies
comparing them in clinical practice. We determined mGFR by iohexol clearance in
81 consecutive children in routine practice and calculated eGFR from 14 standard
equations using serum creatinine, cystatin C, and urea nitrogen that were
collected at the time of the mGFR procedure. Nonparametric Wilcoxon test,
Spearman correlation, Bland-Altman analysis, bias (median difference), and
accuracy (P15, P30) were used to compare mGFR with eGFR. For the entire study
group, the mGFR was 77.9 ± 38.8 mL/min/1.73 m(2). Eight of the 14 estimating
equations demonstrated values without a significant difference from the mGFR
value and demonstrated a lower bias in Bland-Altman analysis. Three of these 8
equations based on a combination of creatinine and cystatin C (Schwartz et al.
New equations to estimate GFR in children with CKD. J Am Soc Nephrol
2009;20:629-37; Schwartz et al. Improved equations estimating GFR in children
with chronic kidney disease using an immunonephelometric determination of
cystatin C. Kidney Int 2012;82:445-53; Chehade et al. New combined serum
creatinine and cystatin C quadratic formula for GFR assessment in children. Clin
J Am Soc Nephrol 2014;9:54-63) had the highest accuracy with approximately 60% of
P15 and 80% of P30. In 10 patients with a single kidney, 7 with kidney
transplant, and 11 additional children with short stature, values of the 3
equations had low bias and no significant difference when compared with mGFR. In
conclusion, the 3 equations that used cystatin C, creatinine, and growth
parameters performed in a superior manner over univariate equations based on
either creatinine or cystatin C and also had good applicability in specific
pediatric patients with single kidneys, those with a kidney transplant, and short
stature. Thus, we suggest that eGFR calculations in pediatric clinical practice
use only a multivariate equation.