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Freedman SB, Schnadower D, Estes M, Casper TC, Goldstein SL, Grisaru S, Pavia AT, Wilfond BS, Metheney M, Kimball K, Tarr PI. Hyperhydration to Improve Kidney Outcomes in Children with Shiga Toxin-Producing E. coli Infection: a multinational embedded cluster crossover randomized trial (the HIKO STEC trial). Trials 2023; 24:359. [PMID: 37245030 DOI: 10.1186/s13063-023-07379-w] [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: 03/17/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Shiga toxin-producing E. coli (STEC) infections affect children and adults worldwide, and treatment remain solely supportive. Up to 15-20% of children infected by high-risk STEC (i.e., E. coli that produce Shiga toxin 2) develop hemolytic anemia, thrombocytopenia, and kidney failure (i.e., hemolytic uremic syndrome (HUS)), over half of whom require acute dialysis and 3% die. Although no therapy is widely accepted as being able to prevent the development of HUS and its complications, several observational studies suggest that intravascular volume expansion (hyperhydration) may prevent end organ damage. A randomized trial is needed to confirm or refute this hypothesis. METHODS We will conduct a pragmatic, embedded, cluster-randomized, crossover trial in 26 pediatric institutions to determine if hyperhydration, compared to conservative fluid management, improves outcomes in 1040 children with high-risk STEC infections. The primary outcome is major adverse kidney events within 30 days (MAKE30), a composite measure that includes death, initiation of new renal replacement therapy, or persistent kidney dysfunction. Secondary outcomes include life-threatening, extrarenal complications, and development of HUS. Pathway eligible children will be treated per institutional allocation to each pathway. In the hyperhydration pathway, all eligible children are hospitalized and administered 200% maintenance balanced crystalloid fluids up to targets of 10% weight gain and 20% reduction in hematocrit. Sites in the conservative fluid management pathway manage children as in- or outpatients, based on clinician preference, with the pathway focused on close laboratory monitoring, and maintenance of euvolemia. Based on historical data, we estimate that 10% of children in our conservative fluid management pathway will experience the primary outcome. With 26 clusters enrolling a mean of 40 patients each with an intraclass correlation coefficient of 0.11, we will have 90% power to detect a 5% absolute risk reduction. DISCUSSION HUS is a devastating illness with no treatment options. This pragmatic study will determine if hyperhydration can reduce morbidity associated with HUS in children with high-risk STEC infection. TRIAL REGISTRATION ClinicalTrials.gov NCT05219110 . Registered on February 1, 2022.
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Affiliation(s)
- Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Childrens Hospital, Alberta Childrens Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children, s Hospital Medical Center and Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Myka Estes
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - T Charles Casper
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children, s Hospital Medical Center and Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Silviu Grisaru
- Section of Nephrology, Department of Pediatrics, Alberta Children, s Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Benjamin S Wilfond
- Divisions of Bioethics and Palliative Care and Pulmonary and Sleep Medicine, Department of Pediatrics and Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA
| | - Melissa Metheney
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Kadyn Kimball
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Koch VH. Obesity Facts and Their Influence on Renal Function Across the Life Span. Front Med (Lausanne) 2021; 8:704409. [PMID: 34869407 PMCID: PMC8632716 DOI: 10.3389/fmed.2021.704409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Obesity is a chronic disease, with a rapidly increasing prevalence worldwide. Body mass index (BMI) provides the most useful population-level measure of overweight and obesity. For adults, overweight is defined as a BMI (Kg/m2) ≥ 25, and obesity as a BMI ≥ 30, for non-Asians and ≥ 27.5 for Asians. Abdominal obesity can be defined as a waist circumference equal to or higher than 102 cm for men and ≥88 cm for women. The definition of children and adolescents BMI changes with age and sex. Obesity may be exogenous or endogenous obesity, the latter is multifactorial and predominantly manifested during childhood. Presently, overweight and obesity are linked to more deaths worldwide than underweight. The total kidney glomerular filtration rate (GFR) is determined by the sum of nephrons and the GFR within each nephron or single nephron GFR. In clinical practice, GFR is more frequently calculated by GFR estimating equations based upon the plasma levels of creatinine, cystatin C, or both. The measured value of plasma creatinine is strongly influenced by non-GFR factors, by its tubular and gastrointestinal secretion, and by the problems associated with the lack of standardization of creatinine's laboratory assay discrediting it as an ideal GFR biomarker. Unlike creatinine, cystatin C plasma levels are mainly determined by GFR. Obesity may affect the kidney, via development of systemic arterial hypertension and/or diabetes mellitus, or directly, by ectopic accumulation of adipose tissue in the kidney. As obesity is a clinical condition associated with altered body composition, creatinine may not be the ideal biomarker for GFR measurement in obese individuals.
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Affiliation(s)
- Vera H Koch
- Pediatric Nephrology Unit, Department of Pediatrics, Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Different approaches to long-term treatment of aHUS due to MCP mutations: a multicenter analysis. Pediatr Nephrol 2021; 36:463-471. [PMID: 32715379 PMCID: PMC7815604 DOI: 10.1007/s00467-020-04714-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/29/2020] [Accepted: 07/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Atypical hemolytic uremic syndrome (aHUS) is a rare, life-threatening microangiopathy, frequently causing kidney failure. Inhibition of the terminal complement complex with eculizumab is the only licensed treatment but mostly requires long-term administration and risks severe side effects. The underlying genetic cause of aHUS is thought to influence the severity of initial and recurring episodes, with milder courses in patients with mutations in membrane cofactor protein (MCP). METHODS Twenty pediatric cases of aHUS due to isolated heterozygous MCP mutations were reported from 12 German pediatric nephrology centers to describe initial presentation, timing of relapses, treatment, and kidney outcome. RESULTS The median age of onset was 4.6 years, with a female to male ratio of 1:3. Without eculizumab maintenance therapy, 50% (9/18) of the patients experienced a first relapse after a median period of 3.8 years. Kaplan-Meier analysis showed a relapse-free survival of 93% at 1 year. Four patients received eculizumab long-term treatment, while 3 patients received short courses. We could not show a benefit from complement blockade therapy on long term kidney function, independent of short-term or long-term treatment. To prevent 1 relapse with eculizumab, the theoretical number-needed-to-treat (NNT) was 15 for the first year and 3 for the first 5 years after initial presentation. CONCLUSION Our study shows that heterozygous MCP mutations cause aHUS with a risk of first relapse of about 10% per year, resulting in large NNTs for prevention of relapses with eculizumab. More studies are needed to define an optimal treatment schedule for patients with MCP mutations to minimize the risks of the disease and treatment.
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Cheang I, Liao S, Yao W, Lu X, Gao R, Zhou Y, Zhang H, Li X. Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality stratification in acute heart failure: A STROBE-compliant prospective observational study. Medicine (Baltimore) 2020; 99:e22996. [PMID: 33126378 PMCID: PMC7598854 DOI: 10.1097/md.0000000000022996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
An increasing number of studies outline renal function as an important risk marker for mortality in acute heart failure (AHF). However, routine estimation of glomerular filtration rate (eGFR) based on serum creatinine is imprecise.This study aims to compare the prognostic impact of CKD-EPI creatinine based equation (eGFRcr), cystatin C based equation (eGFRcyst), and creatinine-cystatin C equation (eGFRcrcyst) for the mortality stratification in AHF.A total of 354 Patients with AHF were prospectively included between January 2012 and June 2016. Creatinine and cystatin C were measured using the same blood sample tube on admission. We quantified eGFR by the eGFRcr, eGFRcyst, and eGFRcrcyst equations. The continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) were calculated to compare the discriminative prognostic value of different CKD-EPI formula.After a median follow-up of 35 months, 161 patients (45.5%) died. Reduced eGFRcyst and eGFRcrcyst remained significant association with death after adjustment. eGFRcyst showed the best area under the curve value (0.706) for the prediction of all-cause mortality. Considering mortality reclassification, both eGFRcyst (IDI = 7.3%, P < .001; cNRI = 19.6%, P = .012) and eGFRcrcyst (IDI = 4.3%, P < .001; cNRI = 8.7%, P = .138) showed its tendency in improving risk prediction compared to eGFRcr. Compared to eGFRcrcyst showed, eGFRcyst further improved mortality stratification (IDI = 3%, P = .049; cNRI = 11.1%, P = .036).In patients with AHF, our study demonstrates the eGFR calculated by CKD-EPI cystatin C-based equation improved the risk stratification of mortality over both creatinine-based and creatinine/cystatin C-based equations.
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Evaluation of administrative case definitions for chronic kidney disease in children. Pediatr Res 2020; 87:569-575. [PMID: 31578037 DOI: 10.1038/s41390-019-0595-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/13/2019] [Accepted: 09/05/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Administrative data is increasingly used for chronic disease surveillance; however, its validity to define cases of chronic kidney disease (CKD) in children is unknown. We sought to evaluate the performance of case definitions for CKD in children. METHODS We utilized population-based administrative data from the Manitoba Center for Health Policy to evaluate the validity of algorithms based on a combination of hospital claims, outpatient physician visits, and pharmaceutical use over 1-3 years in children <18 years of age. Algorithms were compared with a laboratory-based definition (estimated glomerular filtration rate < 90 ml/min/1.73 m2 and/or presence of proteinuria). RESULTS All algorithms evaluated had very low sensitivity (0.20-0.39) and moderate positive predictive value (0.52-0.68). Algorithms had excellent specificity (0.98-0.99) and negative predictive value (0.96-0.97). Receiver operating characteristic (ROC) curves indicate fair accuracy (0.60-0.68). Sensitivity improved with increasing years of data. One or more physician claims and one or more prescriptions over 3 years had the highest sensitivity and ROC. CONCLUSIONS The sensitivity of administrative data algorithms for CKD is unacceptably low for a screening test. Specificity is excellent; therefore, children without CKD are correctly identified. Alternate data sources are required for population-based surveillance of this important chronic disease.
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Savadogo H, Coulibaly G, Bandaogo V, Kaboré A, Dao L, Kaboret S, Ouédraogo-Yugbaré SO, Kouéta F, Yé D. [Hemoglobinuria in children hospitalized in Ouagadougou: short term inpatient care and prognosis]. Pan Afr Med J 2019; 34:165. [PMID: 32153705 PMCID: PMC7046116 DOI: 10.11604/pamj.2019.34.165.14729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 08/01/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction L’objectif de ce travail était d’analyser les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs de l’hémoglobinurie chez l’enfant au CHU Pédiatrique Charles-De-Gaulle de Ouagadougou. Méthodes Il s’est agi d’une étude transversale à visée descriptive sur la période allant du 01 juillet au 31 décembre 2014. Ont été inclus dans l’étude, tous les enfants âgés de zéro à 15 ans hospitalisés dans le Service de Pédiatrie Médicale du CHU Pédiatrique Charles-de-Gaulle, chez qui une hémoglobinurie macroscopique a été diagnostiquée pendant la période de l’étude. Résultats Trente-huit patients ont été inclus dans l’étude. La fréquence hospitalière de l’hémoglobinurie était de 1,9%. L’âge moyen des patients était de 80,8 ± 44,1 mois (extrêmes = 21 et 168). Il s’agissait de 23 garçons (60,5%) et 15 filles (39,5%). Les principaux signes cliniques étaient: la fièvre (86,8%), les urines foncées « coca cola » (86,8%), la pâleur (63,2%), l’hépatomégalie (50%). Le débit de filtration glomérulaire DFG était inférieur à 80 mL/min/1,73m2 chez 23 patients (69,7%); 21 patients avaient un déficit en G6PD. Les principales étiologies présumées de l’hémoglobinurie étaient: le paludisme grave, les infections bactériennes et virales, le déficit en G6PD, la fièvre bilieuse hémoglobinurique. Les traitements administrés étaient: les dérivées de l’artémisinine, les antibiotiques et les antipyrétiques. Le recours à la dialyse a été nécessaire chez un patient. Conclusion L’hémoglobinurie est un symptôme qui pose surtout un problème de diagnostic étiologique dans notre contexte. Sa gravité réside dans le fait qu’elle peut provoquer une IRA sévère.
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Affiliation(s)
- Hamidou Savadogo
- Service de Pédiatrie Médicale, Centre Hospitalier Universitaire Pédiatrique Charles-de-Gaulle, Ouagadougou, Burkina Faso
| | - Gérard Coulibaly
- Service de Néphrologie et Hémodialyse, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Viviane Bandaogo
- Service de Pédiatrie Médicale, Centre Hospitalier Universitaire Pédiatrique Charles-de-Gaulle, Ouagadougou, Burkina Faso
| | - Aïssata Kaboré
- Service de Pédiatrie Médicale, Centre Hospitalier Universitaire Pédiatrique Charles-de-Gaulle, Ouagadougou, Burkina Faso
| | - Lassina Dao
- Service de Pédiatrie Médicale, Centre Hospitalier Universitaire Pédiatrique Charles-de-Gaulle, Ouagadougou, Burkina Faso
| | - Sonia Kaboret
- Service de Pédiatrie Médicale, Centre Hospitalier Universitaire Pédiatrique Charles-de-Gaulle, Ouagadougou, Burkina Faso
| | | | - Fla Kouéta
- Service de Pédiatrie Médicale, Centre Hospitalier Universitaire Pédiatrique Charles-de-Gaulle, Ouagadougou, Burkina Faso
| | - Diarra Yé
- Service de Pédiatrie Médicale, Centre Hospitalier Universitaire Pédiatrique Charles-de-Gaulle, Ouagadougou, Burkina Faso
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Dart AB, McGavock J, Sharma A, Chateau D, Schwartz GJ, Blydt-Hansen T. Estimating glomerular filtration rate in youth with obesity and type 2 diabetes: the iCARE study equation. Pediatr Nephrol 2019; 34:1565-1574. [PMID: 31049718 DOI: 10.1007/s00467-019-04250-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/14/2019] [Accepted: 03/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The validity of pediatric estimated glomerular filtration rate equations (eGFRs) in early stages of CKD including hyperfiltration is unknown. The purpose of this study was to develop an eGFR equation for adolescents with obesity and type 2 diabetes (T2D). METHODS eGFRs were developed from iohexol-derived GFRs (iGFRs) in 26 overweight/obese (BMI > 85th percentile) youth and 100 with T2D from the iCARE (Improving renal Complications in Adolescents with T2D through REsearch) cohort. Twenty percent of the cohort was withheld as a validation dataset. Linear regression analyses were used to develop the best formula based on body size, sex, creatinine, urea, ± cystatin C. Comparable validity of commonly used eGFR equations was assessed. RESULTS Mean age 15.4 + 2.4 years, BMI Z-score 2.5 + 1.2, 61% female, and mean iGFR 129.0 + 27.7 ml/min/ 1.73 m2. The best adjusted eGFR formula (ml/min/1.73 m2) was 50.7 × BSA0.816 × (height (cm)/creatinine)0.405 × 0.8994 if sex = female | 1 otherwise. It resulted in 53.8% of eGFRs within 10% of measured iGFR and 96.2% within 30%. Bland-Altman 95% limits of agreement in the external dataset were - 37.6 to 45.5 ml/min/1.73m2 (bias = 3.96), and the correlation was 0.62. This equation performed better than all previously published creatinine-based eGFRs. cystatin C did not significantly improve results; however, some other cystatin C formulas also performed well. CONCLUSIONS The iCARE equation provides a more accurate creatinine-based eGFR in obese youth with and without T2D. Further studies are warranted to evaluate within-subject variability and applicability to lower GFRs and other populations.
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Affiliation(s)
- A B Dart
- Department of Pediatrics and Child Health, Section of Nephrology, Children's Hospital Research Institute of Manitoba, Diabetes Research Envisioned and Accomplished in Manitoba Research Team, University of Manitoba, FE009 - 840 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada.
| | - J McGavock
- Department of Pediatrics and Child Health, University of Manitoba, FE009 - 840 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - A Sharma
- Department of Pediatrics and Child Health, University of Manitoba, FE009 - 840 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - D Chateau
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - G J Schwartz
- University of Rochester Medical Center, Rochester, NY, USA
| | - T Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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Jeong TD, Kim J, Lee W, Chun S, Hong KS, Min WK. Evaluation of the 1B Equation to Estimate Glomerular Filtration Rate in Pediatric Patients with Cancer. Ann Lab Med 2018; 38:261-265. [PMID: 29401562 PMCID: PMC5820072 DOI: 10.3343/alm.2018.38.3.261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/04/2017] [Accepted: 01/08/2018] [Indexed: 01/27/2023] Open
Abstract
The 1B equation is recommended for calculating the glomerular filtration rate (GFR) in children. Since few reports have evaluated the performance of the 1B equation, we investigated the performance of estimated GFR (eGFR) equations with the blood urea nitrogen (BUN) variable for pediatric cancer patients. In total, 203 children with cancer who underwent measured GFR (mGFR) assessment were enrolled. The median (range) mGFR and eGFR calculated using the updated Schwartz equation were 118 (43–241) and 135 (34–257) mL/min/1.73 m2, respectively. The bias, precision (root mean square error [RMSE]), and accuracy (P30, mGFR±30%) of three eGFR equations including updated Schwartz, 1B, and full age spectrum (FAS) were compared. The median bias (mL/min/1.73 m2) was: updated Schwartz, 8.5; 1B, −9.0; and FAS, 4.2. The biases for all three eGFR equations were significantly different from zero. The P30 was: updated Schwartz, 63.5%; 1B, 66.0%; and FAS, 66.0%. The RMSE was the lowest for the 1B equation (40.4), followed by FAS (42.3), and updated Schwartz (45.5). The median eGFR/mGFR ratio for the eGFR equations decreased with age and reduced kidney functions (i.e., increased creatinine and BUN concentrations). The bias may be further reduced by using the average from two equations, such as the updated Schwartz and 1B, or FAS equation, rather than using the updated Schwartz or 1B equation alone. The use of the 1B equation may underestimate the GFR. Using creatinine and BUN variables in the eGFR equation may yield a more accurate estimate of the GFR in pediatric cancer patients.
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Affiliation(s)
- Tae Dong Jeong
- Department of Laboratory Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jaeryuk Kim
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Woochang Lee
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Sail Chun
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Ki Sook Hong
- Department of Laboratory Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Won Ki Min
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
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Methods of Estimating Kidney Function for Drug Dosing in Special Populations. Clin Pharmacokinet 2018; 57:943-976. [DOI: 10.1007/s40262-018-0628-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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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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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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