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Changjie G, Xusheng Z, Hui D, Jianwen L, Ming L. Application of creatinine-based eGFR equations in Chinese septuagenarians and octogenarians. Int Urol Nephrol 2024; 56:719-730. [PMID: 37542000 DOI: 10.1007/s11255-023-03714-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/16/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE The utilization of creatinine-based estimated glomerular filtration rate (eGFR) equations in the adult population is acknowledged. Nevertheless, the appropriateness of creatinine-based eGFR in septuagenarians and octogenarians is debatable. This study evaluates the creatinine-based equations in Chinese septuagenarians and octogenarians cohorts. PATIENTS AND METHODS This study employed a retrospective design, utilizing a review of the hospital medical records system to identify 347 hospitalized participants within the Division of Geriatrics or the Division of Nephrology. These participants underwent renal dynamic imaging with 99 m Tc-DTPA and serum creatinine testing. Comparison of the equations was performed, including the full age-spectrum equation (FAS-Cr equation), European Kidney Function Consortium equation (EKFC equation), Chronic Kidney Disease Epidemiology Collaboration equation for Asian (Asian CKD-EPI equation), Xiangya equation, and Lund-Malmö revised equation (LMR equation). RESULTS Most equations tended to underestimate GFR. The FAS-Cr equation had the smallest interquartile range (IQR), while the Asian CKD-EPI equation (mGFR ≥ 30) and Xiangya equation (mGFR < 30) had the biggest IQRs. The FAS-Cr equation had the highest overall P30 of 63.98%, while the Asian CKD-EPI equation had the highest P30 of 75.64% in mGFR ≥ 60. The Xiangya equation, on the other hand, reported the lowest P30 of 36.36% in mGFR < 30. We discovered similar patterns in root-mean-square error (RMSE) as P30. GFR category misclassification rates in the entire cohort ranged from 46.11 to 49.86% for all equations. The FAS-Cr equation exhibited an advantage in octogenarians over other equations in the GFR category misclassification with mGFR lower than 60 ml/min/1.73 m2. CONCLUSION None of the creatinine-based equations in this study could perform well regarding precision, accuracy, and CKD stages' classification for the Chinese elderly. Nevertheless, the FAS-Cr equation should be suitable for octogenarians with mGFR lower than 60 ml/min/1.73 m2.
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Affiliation(s)
- Guan Changjie
- Department of Nephrology, Guangzhou First People's Hospital, South China University of Technology, No. 1 Panfu Road, Yuexiu District, Guangzhou, 510180, China
| | - Zhu Xusheng
- Department of Nuclear Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, 510180, China
| | - Dai Hui
- Department of Clinical Laboratory Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, 510180, China
| | - Li Jianwen
- Department of Nephrology, Guangzhou First People's Hospital, South China University of Technology, No. 1 Panfu Road, Yuexiu District, Guangzhou, 510180, China
| | - Liang Ming
- Department of Nephrology, Guangzhou First People's Hospital, South China University of Technology, No. 1 Panfu Road, Yuexiu District, Guangzhou, 510180, China.
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Trans JG, Krogstrup NV, Oltean M, Jespersen B, Nielsen MB, Birn H. A comparison of four established GFR formulas to estimate measured GFR and changes in GFR in adult kidney transplant recipients. Scand J Clin Lab Invest 2022; 82:296-303. [PMID: 35697079 DOI: 10.1080/00365513.2022.2084697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The accurate assessment of glomerular filtration rate (GFR) is important in the follow-up of kidney transplant recipients in order to identify graft dysfunction. A number of formulas have been proposed to calculate GFR from endogenous plasma markers such as creatinine or cystatin C since measuring GFR using exogenous markers is troublesome. This study compares and evaluates the ability of four different GFR formulas to estimate kidney graft function and to detect changes in GFR in kidney transplant recipients. The study included patients from the prospective, multicenter CONTEXT trial in kidney transplant recipients. GFR was measured using plasma clearance of 51Cr-EDTA and estimated using the MDRD, CKD-EPI Creatinine, CKD-EPI Cystatin C and CKD-EPI Cystatin C + Creatinine equations at three (n = 83) and twelve (n = 65) months post-transplantation. For each formula mean bias, precision, and accuracy were evaluated. The MDRD equation had the lowest mean bias (0.2 ml/min/1.73 m2), whereas the CKD-EPI Cystatin C + Creatinine equation had the highest precision (8 ml/min/1.73 m2). Accuracy at three months were similar for all equations (P30 > 80%) except for the CKD-EPI Cystatin C equation, which performed poorer (P30 = 55%). None of the formulas evaluated avoided misclassification of changes in GFR. The most optimal combination of precision and accuracy suggests the use of CKD-EPI Creatinine + Cystatin C equation in kidney transplant recipients.
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Affiliation(s)
| | - Nicoline V Krogstrup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Nephrology, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Mihai Oltean
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Marie Bodilsen Nielsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Henrik Birn
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
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Aghayev A, Memon AA, Greenough PG, Nayak L, Zheng S, Siedlecki AM. Alternative Diagnostic Strategy for the Assessment and Treatment of Pulmonary Embolus: A Case Series. Clin Pract Cases Emerg Med 2020; 4:308-311. [PMID: 32926673 PMCID: PMC7434252 DOI: 10.5811/cpcem.2020.5.46517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/05/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction Ferumoxytol-enhanced magnetic resonance angiography (FeMRA) can be used as an alternate and safe method to diagnose patients with compromised renal function who present with acute pulmonary embolus in the emergency department (ED) setting. Case Report A 62-year old man with a history of renal transplant and lymphoproliferative disease described new onset of breathlessness. His clinical symptoms were suggestive of pulmonary embolus. He underwent FeMRA in the ED to avoid exposure to intravenous iodinated contrast. FeMRA demonstrated a left main pulmonary artery embolus, which extended to the left interlobar pulmonary artery. Afterward, the patient initiated anticoagulation therapy. With preserved renal function he was able to continue his outpatient chemotherapy regimen. Conclusion This case highlights a safe imaging technique for emergency physicians to diagnose pulmonary embolus and subsequently guide anticoagulation therapy for patients in whom use of conventional contrast is contraindicated.
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Affiliation(s)
- Ayaz Aghayev
- Brigham and Women's Hospital, Department of Radiology, Boston, Massachusetts
| | - Aliza A Memon
- Brigham and Women's Hospital, Department of Internal Medicine, Boston, Massachusetts
| | - Paul Gregg Greenough
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | | | | | - Andrew M Siedlecki
- Brigham and Women's Hospital, Department of Internal Medicine, Boston, Massachusetts
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Selistre LDS, Lemoine S, Dantec A, Buron F, de Souza VC, Bertoldo M, Poli-de-Figueiredo CE, Rimmelé T, Thaunat O, Badet L, Morelon E, Sicard A, Dubourg L. Comparison of creatinine-based equations for estimating glomerular filtration rate in deceased donor renal transplant recipients. PLoS One 2020; 15:e0231873. [PMID: 32343691 PMCID: PMC7188287 DOI: 10.1371/journal.pone.0231873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/26/2020] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Luciano da Silva Selistre
- 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
| | - Sandrine Lemoine
- 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
| | - Allyriane Dantec
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
| | - Fanny Buron
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
| | - Vandréa Carla de Souza
- 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
| | - Mariana Bertoldo
- Universidade de Caxias do Sul—Programa de Pós-Graduação em Ciências da Saúde, Caxias do Sul, Brazil
| | | | - Thomas Rimmelé
- CarMeN: Cardiovasculaire, Métabolisme, Diabétologie & Nutrition-INSERM U1060/Lyon 1, Lyon, France
- Service d'anesthésie-réanimation, hôpital Edouard-Herriot, Lyon, France
| | - Olivier Thaunat
- Université Lyon 1, Lyon, France
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
- Unité INSERM U1111, Lyon, France
| | - Lionel Badet
- Université Lyon 1, Lyon, France
- Service d’Urologie et Transplantation, Hôpital Edouard Herriot, Lyon, France
| | - Emmanuel Morelon
- Université Lyon 1, Lyon, France
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
- Unité INSERM U1111, Lyon, France
| | - Antoine Sicard
- Université Lyon 1, Lyon, France
- Unité INSERM U1111, Lyon, France
| | - Laurence Dubourg
- 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
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Moralidis E, Papanastasiou E, Didangelos T, Hilidis I, Siountas A, Arsos G. Determination of the glomerular filtration rate in patients with type 2 diabetes: An assessment of the agreement between 51Cr-EDTA plasma clearance and 99mTc-DTPA plasma clearance, 99mTc-DTPA renography and plasma creatinine prediction equation. Diabetes Res Clin Pract 2020; 161:108079. [PMID: 32057963 DOI: 10.1016/j.diabres.2020.108079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
AIMS To investigate the agreement of glomerular filtration rate (GFR) determination between 51Cr-ethylenediaminetetraacetic acid (51Cr-EDTA) plasma clearance (GFREDTA) and 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) plasma clearance (GFRDTPA), the Gates 99mTc-DTPA renographic method (GFRGates) and the serum creatinine Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI, GFRSCr) in patients with type 2 diabetes mellitus (T2DM). METHODS Ninety-nine T2DM patients underwent GFR determinations simultaneously with 51Cr-EDTA and 99mTc-DTPA (using the slope-intercept technique and the Brochner-Mortensen correction) and also with GFRGates and GFRSCr. RESULTS In the comparison between GFREDTA versus GFRDTPA, GFRGates and GFRSCr, the Bland-Altman statistic provided 0.0 ± 13.2, 17.4* ± 28.8 and -5.9* ± 30.1 (*p < 0.001 for the difference from 0). Lin's concordance correlation coefficient showed substantial (0.976), poor (0.737) and poor (0.872) agreement, respectively. The proportion of the index results within the 30% and 10% of GFREDTA measurements were 95% and 74% for GFRDTPA, 53% and 19% for GFRGates, and 83% and 26% for GFRSCr, respectively. CONCLUSION In T2DM patients, a clinically acceptable agreement is demonstrated between 51Cr-EDTA and 99mTc-DTPA plasma clearance for GFR measurements, suggesting conditional interchangeability between those compounds. Both the CKD-EPI prediction equation and the Gates' renographic method cannot assess GFR reliably, the latter appearing less unfailing than the former.
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Affiliation(s)
- Efstratios Moralidis
- Department of Nuclear Medicine, Papageorgiou Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ring Road, Nea Efkarpia, 56429 Thessaloniki, Greece.
| | - Emmanouil Papanastasiou
- Laboratory of Medical Physics, AHEPA University Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 1 Stilponos Kyriakidi Str, 54636 Thessaloniki, Greece.
| | - Triantafyllos Didangelos
- 1st Propedeutic Department of Internal Medicine, AHEPA University Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 1 Stilponos Kyriakidi Str, 54636 Thessaloniki, Greece.
| | - Ilias Hilidis
- Department of Nuclear Medicine, AHEPA University Hospital, Thessaloniki, 1 Stilponos Kyriakidi Str, 54636 Thessaloniki, Greece
| | - Anastasios Siountas
- Laboratory of Medical Physics, AHEPA University Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 1 Stilponos Kyriakidi Str, 54636 Thessaloniki, Greece.
| | - Georgios Arsos
- Department of Nuclear Medicine, Papageorgiou Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ring Road, Nea Efkarpia, 56429 Thessaloniki, Greece.
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Houlind MB, Petersen KK, Palm H, Jørgensen LM, Aakjær M, Christrup LL, Petersen J, Andersen O, Treldal C. Creatinine-Based Renal Function Estimates and Dosage of Postoperative Pain Management for Elderly Acute Hip Fracture Patients. Pharmaceuticals (Basel) 2018; 11:E88. [PMID: 30231578 PMCID: PMC6160960 DOI: 10.3390/ph11030088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022] Open
Abstract
Many analgesics and their metabolites are renally excreted. The widely used Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-estimated glomerular filtration rate (eGFR) equations are not developed for use in the elderly, while the recent Berlin Initiative Study (BIS), Full Age Spectrum (FAS), and Lund-Malmö revised (LMR) equations are. This observational study investigated differences between creatinine-based eGFR equations and how the choice of equation influences dosage of analgesics in elderly (≥70 years) patients admitted with acute hip fracture. eGFR was calculated by the CKD-EPI, BIS, Cockcroft-Gault (CG), FAS, LMR, and Modification of Diet in Renal Disease (MDRD) equations. Standard daily dose for postoperative pain medications ibuprofen, morphine and gabapentin was simulated for each equation according to dosage recommendations in Renbase®. For 118 patients, mean eGFR from the CKD-EPI, BIS, CG, FAS, LMR, and MDRD equations was 67.3 mL/min/1.73 m², 59.1 mL/min/1.73 m², 56.9 mL/min/1.73 m², 60.3 mL/min/1.73 m², 58.9 mL/min/1.73 m², and 79.1 mL/min/1.73 m², respectively (p < 0.0001). Mean difference to CKD-EPI was -10.4 mL/min/1.73 m² to 11.8 mL/min/1.73 m². Choice of eGFR equation significantly influenced the recommended dose (p < 0.0001). Shifting to BIS, FAS, or LMR equations led to a lower recommended dose in 20% to 31% of patients. Choice of eGFR equation significantly influenced dosing of ibuprofen, morphine, and gabapentin.
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Affiliation(s)
- Morten Baltzer Houlind
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark.
| | - Kristian Kjær Petersen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7, building A2-206, 9220 Aalborg Ø, Denmark.
| | - Henrik Palm
- Orthopedic Department, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark.
| | - Lillian Mørch Jørgensen
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
| | - Mia Aakjær
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark.
| | - Lona Louring Christrup
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark.
| | - Janne Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Enterance B, 2nd floor, 1014 København, Denmark.
| | - Ove Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- Emergency Department, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 436, 2650 Hvidovre, Denmark.
| | - Charlotte Treldal
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
- Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark.
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