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Nkoy AB, Matoka TT, Bukabau JB, Sumaili EK, Labarque V, van den Heuvel LP, Levtchenko E, Cavalier E, Delanaye P, Ekulu PM, Pottel H. Estimated glomerular filtration rate: applicability of creatinine-based equations in African children. Pediatr Nephrol 2024; 39:3013-3022. [PMID: 38546762 DOI: 10.1007/s00467-024-06349-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND The Schwartz equation is the most widely used serum creatinine (SCr)-based formula to estimate the glomerular filtration rate (GFR) in children of European descent, but whether this applies to African children is unclear. METHODS In a cross-sectional study, 513 apparently healthy African children aged 6 to 16 years were randomly recruited in school area of Kinshasa, the Democratic Republic of Congo (DRC). SCr was measured using calibrated enzymatic method. SCr was normalized using Q-values designed for European descent children, due to the absence of Q-values for African children. Commonly used eGFR equations were applied in this population. RESULTS Normalization of SCr using Q-values for European descent children was effective in this cohort. The majority of African children (93.4%) have normalized SCr (SCr/Q) values within the reference interval (0.67-1.33) of children of European descent. The bedside-Schwartz equation was associated with significant age and sex dependency. However, the FAS-Age formula showed no sex and age dependency. The new CKiDU25 equation did not show a significant sex dependency. The recently introduced EKFC and LMR18 equations also showed no age and sex dependency, although the distribution of eGFR-values was not symmetrical. On the other hand, the FAS-Height and the Schwartz-Lyon equations showed significant sex dependency but no age dependency. CONCLUSIONS The reference interval for SCr designed for European descent children can be applied to African children. Of all the equations studied, FAS-Age performed best and is most suitable because no height measurements are required. Establishment of specific Q-values for the widespread Jaffe-measured creatinine in Africa can further broaden applicability.
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Affiliation(s)
- Agathe Bikupe Nkoy
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| | - Therance Tobo Matoka
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Justine Busanga Bukabau
- Division of Nephrology, Department of Internal Medicine, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Ernest Kiswaya Sumaili
- Division of Nephrology, Department of Internal Medicine, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Veerle Labarque
- Department of Pediatric Hematology, University Hospital Leuven, Leuven, Belgium
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Lambertus P van den Heuvel
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pediatric Nephrology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Elena Levtchenko
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pediatric Nephrology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Etienne Cavalier
- Division of Clinical Chemistry, CHU Sart Tilman, University of Liège, Liège, Belgium
| | - Pierre Delanaye
- Department of Nephrology, Dialysis, Hypertension and Transplantation, CHU Sart Tilman, University of Liège , Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Pépé Mfutu Ekulu
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Zhao X, Chang TI, Winkelmayer WC, Long J, Liu S, Marsenic O. Intradialytic Hypotension and Mortality in Adolescents and Young Adults With Kidney Failure Receiving Maintenance Hemodialysis. Kidney Med 2024; 6:100773. [PMID: 38317757 PMCID: PMC10839769 DOI: 10.1016/j.xkme.2023.100773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Rationale & Objective Intradialytic hypotension (IDH) is associated with mortality in adults with kidney failure requiring hemodialysis (HD); however, large-scale pediatric studies are lacking. Moreover, there is no evidence-based consensus definition of IDH in pediatric literature. We aimed to examine the association of commonly used definitions of IDH with mortality in adolescents and young adults. Study Design This was a retrospective observational cohort study. Setting & Participants In total, 1,199 adolescents and young adults (N = 320, aged 10-18 years and N = 879, aged 19-21 years) who initiated HD in a large dialysis organization were included. Exposures This study used different definitions of IDH. Outcome The study outcome was 2-year all-cause mortality. Analytical Approach Several definitions of IDH were selected a priori based on a literature review. Patients were classified as having IDH if it was present in at least 30% of HD treatments during the first 90 days after dialysis initiation. Cox proportional hazards regression was used to test whether IDH associated with 2-year all-cause mortality. Results Over a 2-year follow-up period, 54 (4.5%) patients died. Dependent on its definition, IDH was present in 2.9%-61.1% of patients. After the multivariable adjustment for sociodemographic and clinical characteristics, we found no association of IDH with mortality. Results were consistent across subgroups stratified by age (aged <18 and 19-21 years) and predialysis systolic blood pressure (<120, 120-150, and >150 mm Hg). We also examined IDH as occurring in <5%, 5%-29%, 30%-50%, and >50% of baseline treatments, and did not find a dose-response association with mortality (P > 0.05). Limitations Owing to low event rates, our current sample size may have been too small to detect a difference in mortality. Conclusions Our study found that IDH was not associated with mortality in adolescents and young adults.
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Affiliation(s)
- Xixi Zhao
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California
- Division of Pediatric Nephrology, Department of Pediatrics, Stanford University, Stanford, California
| | - Tara I. Chang
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California
| | - Wolfgang C. Winkelmayer
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
| | - Jin Long
- Division of Pediatric Nephrology, Department of Pediatrics, Stanford University, Stanford, California
| | - Sai Liu
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California
| | - Olivera Marsenic
- Division of Pediatric Nephrology, Department of Pediatrics, Stanford University, Stanford, California
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Nawawi FA, Wan Md Adnan WAH, Ismail M, Jalaludin MY, Majid HA. Changes in Kidney Function Among Malaysian Adolescents and Its Determinants. Kidney Int Rep 2023; 8:1965-1977. [PMID: 37850001 PMCID: PMC10577368 DOI: 10.1016/j.ekir.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/18/2023] [Accepted: 07/31/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction The health and wellbeing of adolescents are often neglected, including the knowledge of chronic kidney disease (CKD), especially in its early stages. Methods A total of 607 adolescents were recruited from the Malaysian Health and Adolescents Longitudinal Research Team (MyHeART) study, a prospective cohort study conducted from March 2012 to May 2016 that explored the noncommunicable diseases (NCDs) risk factors among 13 to 17 years old students in 3 states of Peninsular Malaysia. Students who participated in all 3 data collection periods in 2012, 2014, and 2016 with kidney function assessment across all 3-time points were included in the current study. The students' estimated glomerular filtration rate (eGFR) was calculated from isotope-dilution mass spectrometry-traceable Schwartz's equation and categorized based on Kidney Disease: Improving Global Outcomes (KDIGO) classification. Changes in kidney function were examined, and the longitudinal relationship between eGFR and multiple NCD risk factors was analyzed using the generalized estimating equation (GEE). Results The prevalence of decreased eGFR (60-89 ml/min per 1.73 m2) among the students increased from 6.1% (2012) to 30.0% (2014) and 40.2% (2016). Based on the GEE, the student's eGFR decreased over time, with a steeper decline during early to midadolescence. Males and rural students had lower eGFR compared to their counterparts. Students who are morbidly obese had lower eGFR than those with normal body mass index (BMI). Protein consumption also has a potential moderating effect on eGFR in adolescents. Conclusion Kidney function changes can be detected as early as adolescence and are likely attributable to multiple NCD risk factors. Therefore, more comprehensive prevention efforts from various stakeholders are needed to identify health issues like CKD.
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Affiliation(s)
- Fathhullah Azmie Nawawi
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Maslinor Ismail
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Hazreen Abdul Majid
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- School of Health and Rehabilitation Sciences, AECC University College, Parkwood Campus, Bournemouth, UK
- Department of Nutrition, Faculty of Public Health, Universitas of Airlangga, Surabaya, Indonesia
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Hopkin RJ, Cabrera GH, Jefferies JL, Yang M, Ponce E, Brand E, Feldt-Rasmussen U, Germain DP, Guffon N, Jovanovic A, Kantola I, Karaa A, Martins AM, Tøndel C, Wilcox WR, Yoo HW, Burlina AP, Mauer M. Clinical outcomes among young patients with Fabry disease who initiated agalsidase beta treatment before 30 years of age: An analysis from the Fabry Registry. Mol Genet Metab 2023; 138:106967. [PMID: 36709533 DOI: 10.1016/j.ymgme.2022.106967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/26/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Clinical manifestations of classic Fabry disease (α-galactosidase A deficiency) usually occur in childhood, while complications involving major organs typically develop in adulthood. Outcomes of Fabry-specific treatment among young patients have not been extensively reported. Our aim was to analyze clinical outcomes among patients aged 5-30 years at initiation of treatment with agalsidase beta using data from the Fabry Registry (NCT00196742, sponsor: Sanofi). METHODS Reported GLA variants were predicted to be associated with the classic phenotype or not classified in fabry-database.org. Linear mixed models were conducted to assess changes over ≥2-year follow-up in the estimated glomerular filtration rate (eGFR) stratified by low (LRI) and high (HRI) renal involvement (defined by proteinuria/albuminuria levels), and changes in interventricular septal thickness (IVST) and left ventricular posterior wall thickness (LVPWT) Z-scores stratified by median age at first treatment. Self-reports ('yes'/'no') of abdominal pain, diarrhea, chronic peripheral pain (denoting neuropathic pain), and acute pain crises at baseline were compared with reports after ≥0.5-year and ≥2.5-year follow-up using McNemar's test. RESULTS Male (n = 117) and female patients (n = 59) with LRI initiated treatment at a median age of 19.9 and 23.6 years, respectively, and were followed for a median of 6.3 and 5.0 years, respectively. The eGFR slopes were -1.18 (Pfrom 0 <0.001) and -0.92 mL/min/1.73 m2/year (Pfrom 0 = 0.040), respectively. Males with HRI (n = 23, median UPCR 1.0 g/g), who started treatment at a median age of 26.7 years, had an eGFR slope of -2.39 mL/min/1.73 m2/year (Pfrom 0 <0.001; Pdifference = 0.055, as compared with the slope of -1.18 mL/min/1.73 m2/year for LRI males) during a median follow-up of 5.6 years. Echocardiographic variables were stable among males, regardless of age, and among young females (median follow-up >5.5 years and ≥4.5 years, respectively). Older females (treatment initiation at median age 27.5 years) had a slope of LVPWT Z-scores of 0.18/year (n = 12, Pfrom 0 = 0.028), whereas IVST Z-scores remained stable (n = 13, 0.10/year, Pfrom 0 = 0.304) during a median follow-up of ≥3.7 years. These slopes did not significantly differ from slopes of younger females. Reports of chronic peripheral pain and acute pain crises by males, and of diarrhea and acute pain crises by females, significantly reduced after a median follow-up of ≥4.0 years. After a median follow-up of ≥5.4 years, reports of all four symptoms significantly decreased among males, whereas among females only reports of abdominal pain significantly decreased. CONCLUSIONS During sustained treatment with agalsidase beta in young Fabry patients with a predicted classic phenotype or with unclassified GLA variants with similar characteristics, the decline in eGFR was modest among male and female patients with LRI. The greater decline in eGFR among older, proteinuric (i.e., HRI) males may suggest a benefit of earlier treatment. Overall, echocardiographic variables remained stable, particularly among males and younger females. Significant reductions in symptom reports occurred primarily among males after longer follow-up and were less noticeable among females. These observed trends are suggestive of an overall improvement after treatment in young patients, but warrant larger longitudinal studies.
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Affiliation(s)
- Robert J Hopkin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | | | - John L Jefferies
- The Cardiovascular Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Münster, Münster, Germany
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, and Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Dominique P Germain
- French Referral Center for Fabry disease, Division of Medical Genetics, University of Versailles and APHP - Paris Saclay University, Garches, France
| | - Nathalie Guffon
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Femme Mère Enfant, Bron Cedex, France
| | - Ana Jovanovic
- Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Ilkka Kantola
- Division of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Amel Karaa
- Department of Genetics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana M Martins
- Reference Center for Inborn Errors of Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Camilla Tøndel
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway, and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - William R Wilcox
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Han-Wook Yoo
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Michael Mauer
- Departments of Pediatrics and Medicine, University of Minnesota, Minneapolis, MN, USA
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5
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The New 2021 CKD-EPI Equation Without Race in a European Cohort of Renal Transplanted Patients. Transplantation 2022; 106:2443-2447. [PMID: 35915546 DOI: 10.1097/tp.0000000000004234] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Whether the new chronic kidney disease-epidemiology (CKD-EPI) equation without the race variable remains accurate enough for glomerular filtration rate (GFR) estimation in non-US kidney transplant recipients (KTRs) is unclear. We sought to compare the predictive performance between this equation and the classical CKD-EPI equation in a French cohort of KTRs. We also evaluated the performance of the European Kidney Function Consortium (EKFC) equation, an estimate that has proved very accurate in nontransplant patients and that does not include race variable. METHODS We retrospectively selected 489 KTRs for whom GFR was measured by inulin clearance. Performances of GFR equations were compared according to median bias, imprecision, and accuracy within 30% (P30) and 20% (P20). Differences in P20/P30 were tested using the exact McNemar test. RESULTS Although the 4 equations exhibited a similar level of imprecision, the bias of the new CKD-EPI equation was +5.5 (4.0; 6.6) mL/min/1.73 m², much higher than the bias of the classical CKD-EPI, EKFC, and Modified Diet in Renal Diseases (MDRD) equation (2.4 [1.7;3.5], 2.2 [1.1;3.1], and -0.5 [-1.5; 1.0] mL/min/1.73 m², respectively). The new CKD-EPI equation was significantly less accurate with a P30 of 68.3% as compared with 74.2%, 75.3%, and 77.1% for the classical CKD-EPI, EKFC, and MDRD equation, respectively. The EKFC equation outperformed both versions of the CKD-EPI equation in terms of P20. CONCLUSIONS The new CKD-EPI equation is suboptimal for the care and follow-up of European transplanted patients. The EKFC equation shows at least a similar performance to the MDRD and the classical CKD-EPI equation. Further validation of the EKFC equation in KTRs from a diverse ethnic background is needed.
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Grootjans H, Verschuuren EAM, van Gemert JP, Kerstjens HAM, Bakker SJL, Berger SP, Gan CT. Chronic kidney disease after lung transplantation in a changing era. Transplant Rev (Orlando) 2022; 36:100727. [PMID: 36152358 DOI: 10.1016/j.trre.2022.100727] [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: 06/03/2022] [Revised: 08/26/2022] [Accepted: 09/10/2022] [Indexed: 10/14/2022]
Abstract
Lung transplant (LTx) physicians are responsible for highly complex post-LTx care, including monitoring of kidney function and responding to kidney function loss. Better survival of the LTx population and changing patient characteristics, including older age and increased comorbidity, result in growing numbers of LTx patients with chronic kidney disease (CKD). CKD after LTx is correlated with worse survival, decreased quality of life and high costs. Challenges lie in different aspects of post-LTx renal care. First, serum creatinine form the basis for estimating renal function, under the assumption that patients have stable muscle mass. Low or changes in muscle mass is frequent in the LTx population and may lead to misclassification of CKD. Second, standardizing post-LTx monitoring of kidney function and renal care might contribute to slow down CKD progression. Third, new treatment options for CKD risk factors, such as diabetes mellitus, proteinuria and heart failure, have entered clinical practice. These new treatments have not been studied in LTx yet but are of interest for future use. In this review we will address the difficult aspects of post-LTx renal care and evaluate new and promising future approaches to slow down CKD progression.
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Affiliation(s)
- Heleen Grootjans
- Department of Pulmonology and Tuberculosis, Lung Transplantation Program, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Erik A M Verschuuren
- Department of Pulmonology and Tuberculosis, Lung Transplantation Program, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Johanna P van Gemert
- Department of Pulmonology and Tuberculosis, Lung Transplantation Program, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonology and Tuberculosis, Lung Transplantation Program, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Stefan P Berger
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - C Tji Gan
- Department of Pulmonology and Tuberculosis, Lung Transplantation Program, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Falcone MP, Pritchard-Jones K, Brok J, Mifsud W, Williams RD, Nakata K, Tugnait S, Al-Saadi R, Side L, Anderson J, Duncan C, Marks SD, Bockenhauer D, Chowdhury T. Long-term kidney function in children with Wilms tumour and constitutional WT1 pathogenic variant. Pediatr Nephrol 2022; 37:821-832. [PMID: 34608521 PMCID: PMC8960606 DOI: 10.1007/s00467-021-05125-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/25/2021] [Accepted: 05/05/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Wilms tumour (WT) survivors, especially patients with associated syndromes or genitourinary anomalies due to constitutional WT1 pathogenic variant, have increased risk of kidney failure. We describe the long-term kidney function in children with WT and WT1 pathogenic variant to inform the surgical strategy and oncological management of such complex children. METHODS Retrospective analysis of patients with WT and constitutional WT1 pathogenic variant treated at a single centre between 1993 and 2016, reviewing genotype, phenotype, tumour histology, laterality, treatment, patient survival, and kidney outcome. RESULTS We identified 25 patients (60% male, median age at diagnosis 14 months, range 4-74 months) with WT1 deletion (4), missense (2), nonsense (8), frameshift (7), or splice site (4) pathogenic variant. Thirteen (52%) had bilateral disease, 3 (12%) had WT-aniridia, 1 had incomplete Denys-Drash syndrome, 11 (44%) had genitourinary malformation, and 10 (40%) had no phenotypic anomalies. Patient survival was 100% and 3 patients were in remission after relapse at median follow-up of 9 years. Seven patients (28%) commenced chronic dialysis of which 3 were after bilateral nephrectomies. The overall kidney survival for this cohort as mean time to start of dialysis was 13.38 years (95% CI: 10.3-16.4), where 7 patients experienced kidney failure at a median of 5.6 years. All of these 7 patients were subsequently transplanted. In addition, 2 patients have stage III and stage IV chronic kidney disease and 12 patients have albuminuria and/or treatment with ACE inhibitors. Four patients (3 frameshift; 1 WT1 deletion) had normal blood pressure and kidney function without proteinuria at follow-up from 1.5 to 12 years. CONCLUSIONS Despite the known high risk of kidney disease in patients with WT and constitutional WT1 pathogenic variant, nearly two-thirds of patients had sustained native kidney function, suggesting that nephron-sparing surgery (NSS) should be attempted when possible without compromising oncological risk. Larger international studies are needed for accurate assessment of WT1genotype-kidney function phenotype correlation.
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Affiliation(s)
- Maria Pia Falcone
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Paediatric Residency Program, University of Foggia, Foggia, Italy
| | - Kathryn Pritchard-Jones
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Jesper Brok
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Dept. of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - William Mifsud
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Richard D Williams
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Kayo Nakata
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Suzanne Tugnait
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Reem Al-Saadi
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Dept. of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lucy Side
- Dept. of Clinical Genetics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - John Anderson
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Catriona Duncan
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Stephen D Marks
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Dept. of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Detlef Bockenhauer
- Dept. of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Department of Renal Medicine, London, UK
| | - Tanzina Chowdhury
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
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Creatinine-based GFR-estimating equations in children with overweight and obesity. Pediatr Nephrol 2022; 37:2393-2403. [PMID: 35211793 PMCID: PMC9395456 DOI: 10.1007/s00467-021-05396-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND With the increasing prevalence of childhood obesity and related development of chronic kidney disease (CKD), there is a critical need to understand how best to assess kidney function in children with obesity. Since serum creatinine (SCr) is recommended as marker of first choice for GFR estimation, we evaluated and compared creatinine-based GFR equations in children with overweight and obesity. METHODS Six hundred children with overweight and obesity (53.5% female; mean age 12.20 ± 3.28 years; mean BMI z-score 3.31 ± 0.75) were included from the Centre for Overweight Adolescent and Children's Healthcare (COACH). RESULTS Serum creatinine (SCr), normalized using Q-age polynomials obtained from reference values, results in median and mean SCr/Q value close to "1" for all age groups, and 96.5% of the children have a SCr/Q within the reference band [0.67-1.33], corresponding to the 2.5th and 97.5th percentile. eGFR CKiD (bedside Schwartz equation) and Schwartz-Lyon decreased with age, whereas eGFR EKFC and modified CKD-EPI40 showed no age-dependency, but the distribution of eGFR values was not symmetrical. eGFR CKiD under 25 (CKiDU25) demonstrated no age-dependency but major sex differences were observed. eGFR FAS age, FAS height, and adjusted-creatinine revised Lund-Malmö (LMR18) showed a relatively symmetrical distribution and no age-dependency. CONCLUSIONS Serum creatinine (SCr) values of children with overweight and obesity are mostly within the reference range for children. Normalization of SCr using reference Q-age polynomials works very well in this cohort. After evaluation of the different equations, we suggest that FAS age, FAS height, and LMR18 are the preferred creatinine-based GFR-estimating equations in children with overweight and obesity. CLINICALTRIAL gov; Registration Number: NCT02091544. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Gaebe K, White CA, Mahmud FH, Scholey JW, Elia YT, Sochett EB, Cherney DZ. Evaluation of novel glomerular filtration rate estimation equations in adolescents and young adults with type 1 diabetes. J Diabetes Complications 2022; 36:108081. [PMID: 34756765 DOI: 10.1016/j.jdiacomp.2021.108081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 12/25/2022]
Abstract
AIMS Individuals with type 1 diabetes (T1D) are at an increased risk of chronic kidney disease making estimation of glomerular filtration rate (eGFR) an important component of diabetes care. Which eGFR equation is most appropriate to use in patients with T1D during the transition to adult care is unclear. We, therefore, sought to evaluate the performance of five eGFR equations in adolescents and young adults with T1D. METHODS Measured iohexol-based glomerular filtration rate was compared to the Chronic Kidney Disease and Epidemiology Collaboration (CKD-EPI) eGFR, Chronic Kidney Disease in Children (CKiD) eGFR, and three recently developed age-adjusted versions of these in 53 patients with T1D and preserved GFR using bias, precision, and accuracy. RESULTS The best performance was found in the sex-dependent CKiD equation (bias: -0.8, accuracy: 11.8 ml/min/1.73 m2). Bias and accuracy (26.4 and 26.8 ml/min/1.73 m2) were worst in the CKD-EPI equation. Age-dependent adjustment improved performance for this equation (bias: 5.3, accuracy: 13.4 ml/min/1.73 m2), but not for the CKiD equation (bias: 15.5, accuracy: 18.8 ml/min/1.73 m2). CONCLUSION Age-adjustment improved performance for the CKD-EPI equation, but not for the CKiD equation. The sex-adjusted CKiD equation performed best out of all equations.
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Affiliation(s)
- Karolina Gaebe
- Division of Endocrinology and Metabolism, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Christine A White
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Farid H Mahmud
- Division of Endocrinology and Metabolism, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - James W Scholey
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Yesmino T Elia
- Division of Endocrinology and Metabolism, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Etienne B Sochett
- Division of Endocrinology and Metabolism, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Z Cherney
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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10
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Alfandary H, Haskin O, Goldberg O, Dagan A, Borovitz Y, Levi S, Davidovits M, Erlich T, Landau D, Pleniceanu O. Is the prognosis of congenital single functioning kidney benign? A population-based study. Pediatr Nephrol 2021; 36:2837-2845. [PMID: 33619660 DOI: 10.1007/s00467-021-04980-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated the risk of kidney injury among adolescents with and without a congenital single functioning kidney (SFK). METHODS This retrospective study is based on a medical evaluation database of 17-year-old Israeli conscripts, born during 1989-1999. Those with congenital SFK diagnosis, verified by a pediatric nephrologist's review of the original military medical committee classifications, were compared to the rest of the cohort. Kidney injury (KI) was defined as proteinuria, high blood pressure (BP), or estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73 m2 prior to army recruitment. Risk factors for KI were examined using logistic regression. RESULTS Of 979,630 screened candidates, 353 were diagnosed with SFK. The yearly incidence of SFK gradually increased in the first years of the study, reaching a plateau in 1995 (5.5 ± 1.2/10,000 births/year). The male to female ratio was 2.7:1. Concomitant genital malformations were documented in 5.5% of those with SFK. KI was more prevalent in the SFK than the control group (42.2% vs. 23.5%, p < 0.001). All three components of KI were more common in the SFK than the control group: high BP (31.7% vs. 23.1%, p < 0.001), proteinuria (18.2% vs. 0.4%, p < 0.001), and eGFR <90 ml/min/1.73m2 (12.0% vs 0.1%, p < 0.001). Multivariate analysis of the SFK group revealed associations of higher mean BMI, male sex, and smaller ultrasonographic kidney length with KI. CONCLUSIONS This large population-based study documents a significant risk for KI among adolescents with SFK. Obesity represents a major modifiable risk factor for KI, implicating the need for closer follow-up in this group during childhood.
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Affiliation(s)
- Hadas Alfandary
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orly Haskin
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Goldberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Amit Dagan
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Borovitz
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Levi
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Davidovits
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Erlich
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
- Urology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Daniel Landau
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Pleniceanu
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
- The Nephrology Research Lab, Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Hashomer, Israel
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11
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Björk J, Nyman U, Larsson A, Delanaye P, Pottel H. Estimation of the glomerular filtration rate in children and young adults by means of the CKD-EPI equation with age-adjusted creatinine values. Kidney Int 2021; 99:940-947. [DOI: 10.1016/j.kint.2020.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/24/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
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12
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Lindberg M, Brokner M, Strand MF, Fredriksen PM. Distribution of creatinine and estimated glomerular filtration rate in healthy schoolchildren: The Health Oriented Pedagogical Project (HOPP). Scand J Clin Lab Invest 2021; 81:244-249. [PMID: 33779452 DOI: 10.1080/00365513.2021.1904281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Glomerular filtration rate (GFR) measured by urinary clearance of inulin is considered the gold standard for assessment of kidney function in both adults and children. Because the procedure is cumbersome, GFR is estimated (eGFR) using algorithms based on the observed relationship between measured GFR (mGFR) and more accessible biomarkers such as creatinine and cystatin C. In children, most of the data on this relationship is retrieved from patients with reduced kidney function. Nonetheless, eGFR equations are widely in use in healthy children to evaluate kidney status and diagnose kidney disease. The aim of the present study was to compare the distribution of eGFR using two established pediatric eGFR equations incorporating age, height and serum creatinine (Schwartz-Lyon and Full Age Spectrum-height) and two recently published equations restricted to age and serum creatinine (Lund-Malmö Revised 18 and European Kidney Function Consortium equation) in 1200 healthy schoolchildren age 6-12 years. In addition, we present 2.5th, median and 97.5th percentiles for serum creatinine stratified by age and gender. Depending on the equation used, mean eGFR ranged from 101.6 to 115.4 mL/min/1.73 m2. The lower 2.5th percentile ranged from 83.3 to 89.0 mL/min/1.73 m2 and the fraction of children with eGFR < 90 mL/min/1.73 m2 ranged from 2.9% to 9.8%. In conclusion, expected values of eGFR in healthy children are significantly dependent on the equation used. When decision limits for diagnosis or classification are applied to eGFR results, the related equation should be clearly stated.
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Affiliation(s)
- Morten Lindberg
- Department of Medical Biochemistry, Vestfold Hospital Trust, Tønsberg, Norway
| | - Mette Brokner
- Department of Medical Biochemistry, Vestfold Hospital Trust, Tønsberg, Norway
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13
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Holness JL, Brink A, Davids MR, Warwick JM. Estimated glomerular filtration rate in children: adapting existing equations for a specific population. Pediatr Nephrol 2021; 36:669-683. [PMID: 32995921 DOI: 10.1007/s00467-020-04770-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/17/2020] [Accepted: 09/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Creatinine-based glomerular filtration rate (GFR)-estimating equations frequently do not perform well in populations that differ from the development populations in terms of mean GFR, age, pathology, ethnicity, and diet. After first evaluating the performance of existing equations, the aim of this study was to demonstrate the utility of an in-house modification of the equations to better fit a specific population. METHODS Estimated GFR using 8 creatinine-based equations was first compared to 2-sample 51Cr-ethylenediaminetetra-acetic acid plasma clearance in non-cancer and cancer groups independently. The groups were then divided into development and validation sets. Using the development set data, the Microsoft® Excel SOLVER add-in was used to modify the parameters of 7 equations to better fit the data. Using the validation set data, the performance of the original and modified equations was compared. RESULTS Two hundred fifty-six GFR measurements were performed in 160 children. GFR was overestimated in both groups (non-cancer 4.3-22.6 ml/min/1.73 m2, cancer 17.2-46.6 ml/min/1.73 m2). The root mean square error (RMSE) was 19.1-21.8 ml/min/1.73 m2 (non-cancer) and 18.6-20.8 ml/min/1.73 m2 (cancer). The P30 values were 49.1-73.0% (non-cancer) and 19.6-66.0% (cancer). Modifying the parameters of seven equations resulted in significant improvements in the P30 values in the non-cancer (65.0-85.0%) and cancer (79.6-87.8%) groups. CONCLUSIONS Modifying the parameters of pediatric GFR estimating-equations using a simple Excel-based tool significantly improved their accuracy in both non-cancer and cancer populations. Graphical abstract.
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Affiliation(s)
- Jennifer L Holness
- Nuclear Medicine Division, Department of Medical Imaging and Clinical Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
- Division of Nuclear Medicine, Department of Paediatrics and Child Health, University of Cape Town and Red Cross Children's Hospital, Cape Town, South Africa.
| | - Anita Brink
- Division of Nuclear Medicine, Department of Paediatrics and Child Health, University of Cape Town and Red Cross Children's Hospital, Cape Town, South Africa
| | - M Razeen Davids
- Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - James M Warwick
- Nuclear Medicine Division, Department of Medical Imaging and Clinical Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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14
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Atkinson MA, Ng DK, Warady BA, Furth SL, Flynn JT. The CKiD study: overview and summary of findings related to kidney disease progression. Pediatr Nephrol 2021; 36:527-538. [PMID: 32016626 PMCID: PMC7396280 DOI: 10.1007/s00467-019-04458-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 12/15/2022]
Abstract
The Chronic Kidney Disease in Children (CKiD) cohort study is a North American (USA and Canada) multicenter, prospective study of children with chronic kidney disease (CKD). The original aims of the study were (1) to identify novel risk factors for CKD progression; (2) to measure the impact of kidney function decline on growth, cognition, and behavior; and (3) to characterize the evolution of cardiovascular disease risk factors. CKiD has developed into a national and international resource for the investigation of a variety of factors related to CKD in children. This review highlights notable findings in the area of CKD progression and outlines ongoing opportunities to enhance understanding of CKD progression in children. CKiD's contributions to the clinical care of children with CKD include updated and more accurate glomerular filtration rate estimating equations for children and young adults, and resources designed to help estimate the CKD progression timeline. In addition, results from CKiD have strengthened the evidence that treatment of hypertension and proteinuria should continue as a primary strategy for slowing the rate of disease progression in children.
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Affiliation(s)
| | - Derek K Ng
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | | | - Susan L Furth
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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15
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Al-Shamsi S, Govender RD, King J. Predictive Value of Creatinine-based Equations of Kidney Function in the Long-term Prognosis in United Arab Emirates Patients. Oman Med J 2021; 36:e217. [PMID: 33520290 PMCID: PMC7818017 DOI: 10.5001/omj.2021.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/30/2020] [Indexed: 11/08/2022] Open
Abstract
Objectives Chronic kidney disease (CKD) is an independent predictor of mortality. Several creatinine-based equations are used to assess the estimated glomerular filtration rate or creatinine clearance and mortality prediction in various ethnic populations. Similarly, renal insufficiency is associated with poor prognosis of UAE nationals with cardiovascular disease (CVD) risk factors. However, the equation that best assesses prognosis among these patients is unknown. This study aimed to compare the prognostic abilities of different creatinine-based kidney function equations for predicting all-cause mortality in UAE nationals with vascular comorbidities. Methods This retrospective observational study analyzed 1186 patients (54.0% men) with CVD risk factors. Multivariable Cox regression analysis was used to evaluate the associations of categorical renal function stages with all-cause mortality. Measures of performance in each equation assessed with respect to all-cause mortality were evaluated and compared to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation by calculating the C-index, net reclassification index (NRI), and integrated discrimination index. Results Over a median follow-up of 8.9 years, the cumulative incidence of all-cause mortality was 9.4% (n = 112). After multivariable adjustment, the discriminative ability for all-cause mortality was significantly higher in the body surface area-adjusted Cockcroft-Gault (BSA-CG) formula than in the CKD-EPI equation (C-indices: 0.869 vs. 0.861, respectively, p = 0.037). NRI was significantly positive and favored the BSA-CG formula (0.54; 95% confidence interval: 0.35–0.64) compared to the CKD-EPI equation. Conclusions Our findings suggest that the BSA-CG equation may have the potential to slightly improve mortality prediction compared to the CKD-EPI equation in UAE nationals with vascular risk. Further large multicenter studies are warranted to confirm our findings.
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Affiliation(s)
- Saif Al-Shamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Romona D Govender
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Jeffrey King
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
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16
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Funamoto M, Osho AA, Li SS, Moonsamy P, Mohan N, Ong CS, Melnitchouk S, Sundt TM, Astor TL, Villavicencio MA. Factors Related to Survival in Low-Glomerular Filtration Rate Cohorts Undergoing Lung Transplant. Ann Thorac Surg 2021; 112:1797-1804. [PMID: 33421391 DOI: 10.1016/j.athoracsur.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 10/25/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Historically, a glomerular filtration rate (GFR) of less than 50 mL/min per 1.73 m2 has been considered a contraindication to lung transplantation. Combined or sequential lung-kidney transplantation is an option for those with a GFR less than 30 mL/min per 1.73 m2. Patients with a GFR of 30 to 50 mL/min per 1.73 m2 are provided with no options for transplantation. This study explores factors associated with improved survival in patients who undergo isolated lung transplantation with a GFR of 30 to 50 mL/min per 1.73 m2. METHODS The United Network for Organ Sharing database was queried for adult patients undergoing primary isolated lung transplantation between January 2007 and March 2018. Regression models were used to identify factors associated with improved survival in lung recipients with a preoperative GFR of 30 to 50 mL/min per 1.73 m2. The propensity score method was used to match highly performing patients (outpatient recipients aged less than 60 years) with a GFR of 30 to 50 mL/min per 1.73 m2 with patients who had a GFR greater than 50 mL/min per 1.73 m2. Kaplan-Meier, Cox, and logistic regression analyses compared outcomes in matched populations. RESULTS A total of 21,282 lung transplantations were performed during the study period. Compared with patients with a GFR greater than 50 mL/min per 1.73 m2, survival was significantly worse for patients with a GFR of 30 to 50 mL/min per 1.73 m2. Multivariate analysis of patients with a GFR of 30 to 50 mL/min per 1.73 m2 demonstrated outpatient status and age less than 60 years to be predictive of superior survival. After propensity matching, survival of this highly performing subset with a GFR of 30 to 50 mL/min per 1.73 m2 was no different from that of patients with a normal GFR. CONCLUSIONS Outpatient recipients aged less than 60 years represent an optimal subset of patients with a GFR of 30 to 50 mL/min per 1.73 m2. Lung transplant listing should not be declined based only on a GFR less than 50 mL/min per 1.73 m2.
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Affiliation(s)
- Masaki Funamoto
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Asishana A Osho
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Selena S Li
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Philicia Moonsamy
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Navyatha Mohan
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Chin Siang Ong
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Todd L Astor
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Mauricio A Villavicencio
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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17
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Lopez-Garcia SC, Downie ML, Kim JS, Boyer O, Walsh SB, Nijenhuis T, Papizh S, Yadav P, Reynolds BC, Decramer S, Besouw M, Perelló Carrascosa M, La Scola C, Trepiccione F, Ariceta G, Hummel A, Dossier C, Sayer JA, Konrad M, Keijzer-Veen MG, Awan A, Basu B, Chauveau D, Madariaga L, Koster-Kamphuis L, Furlano M, Zacchia M, Marzuillo P, Tse Y, Dursun I, Pinarbasi AS, Tramma D, Hoorn EJ, Gokce I, Nicholls K, Eid LA, Sartz L, Riordan M, Hooman N, Printza N, Bonny O, Arango Sancho P, Schild R, Sinha R, Guarino S, Martinez Jimenez V, Rodríguez Peña L, Belge H, Devuyst O, Wlodkowski T, Emma F, Levtchenko E, Knoers NVAM, Bichet DG, Schaefer F, Kleta R, Bockenhauer D. Treatment and long-term outcome in primary nephrogenic diabetes insipidus. Nephrol Dial Transplant 2020; 38:gfaa243. [PMID: 33367818 DOI: 10.1093/ndt/gfaa243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary nephrogenic diabetes insipidus (NDI) is a rare disorder and little is known about treatment practices and long-term outcome. METHODS Paediatric and adult nephrologists contacted through European professional organizations entered data in an online form. RESULTS Data were collected on 315 patients (22 countries, male 84%, adults 35%). Mutation testing had been performed in 270 (86%); pathogenic variants were identified in 258 (96%). The median (range) age at diagnosis was 0.6 (0.0-60) years and at last follow-up 14.0 (0.1-70) years. In adults, height was normal with a mean (standard deviation) score of -0.39 (±1.0), yet there was increased prevalence of obesity (body mass index >30 kg/m2; 41% versus 16% European average; P < 0.001). There was also increased prevalence of chronic kidney disease (CKD) Stage ≥2 in children (32%) and adults (48%). Evidence of flow uropathy was present in 38%. A higher proportion of children than adults (85% versus 54%; P < 0.001) received medications to reduce urine output. Patients ≥25 years were less likely to have a university degree than the European average (21% versus 35%; P = 0.003) but full-time employment was similar. Mental health problems, predominantly attention-deficit hyperactivity disorder (16%), were reported in 36% of patients. CONCLUSION This large NDI cohort shows an overall favourable outcome with normal adult height and only mild to moderate CKD in most. Yet, while full-time employment was similar to the European average, educational achievement was lower, and more than half had urological and/or mental health problems.
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Affiliation(s)
- Sergio C Lopez-Garcia
- Department of Renal Medicine, University College London, London,UK
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| | - Mallory L Downie
- Department of Renal Medicine, University College London, London,UK
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| | - Ji Soo Kim
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| | - Olivia Boyer
- Department of Pediatric Nephrology, Reference Center for Hereditary Kidney Diseases (MARHEA), Laboratory of Hereditary Kidney Diseases, Imagine Institute, INSERM U1163, Paris Descartes University, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris,France
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, London,UK
| | - Tom Nijenhuis
- Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboudumc Expertisecentrum Zeldzame Nierziekten, Radboud University Medical Center, Nijmegen, TheNetherlands
| | - Svetlana Papizh
- Department of Hereditary and Acquired Kidney Diseases, Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Pallavi Yadav
- Department of Hereditary and Acquired Kidney Diseases, Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Ben C Reynolds
- Department of Hereditary and Acquired Kidney Diseases, Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Stéphane Decramer
- Department of Paediatric Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds,UK
| | - Martine Besouw
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow,UK
| | | | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Woman, Child and Urological Diseases, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna,Italy
| | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Naples,Italy
| | - Gema Ariceta
- Department of Paediatric Nephrology, Hospital Universitario Vall d'Hebron, Barcelona,Spain
| | - Aurélie Hummel
- Department of Nephrology and Transplantation, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris,France
| | - Claire Dossier
- Department of Paediatric Nephrology, Hôpital Robert-Debre, Paris,France
| | - John A Sayer
- Translational and Clinical Medicine Institute, Faculty of Medical Sciences, Newcastle University, Central Parkway, Newcastle Upon Tyne,UK
- Renal Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne,UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne,UK
| | - Martin Konrad
- Department of Paediatric Nephrology, University Children's Hospital, Münster,Germany
| | - Mandy G Keijzer-Veen
- Department of Pediatric Nephrology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, TheNetherlands
| | - Atif Awan
- Department of Paediatric Nephrology, Temple Street Children's University Hospital, Dublin,Ireland
| | - Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics, N. R. S. Medical College & Hospital, Kolkata,India
| | - Dominique Chauveau
- Department of Nephrology and Transplantation, Centre de Référence des Maladies Rénales Rares, Centre Hospitalier Universitaire de Toulouse, Université Toulouse-III, Toulouse,France
| | - Leire Madariaga
- Department of Paediatric Nephrology, Cruces University Hospital, IIS Biocruces-Bizkaia, University of the Basque Country, Bizkaia,Spain
| | - Linda Koster-Kamphuis
- Department of Paediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, TheNetherlands
| | - Mónica Furlano
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Department of Medicine-Universitat Autónoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona,Spain
| | - Miriam Zacchia
- Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Naples,Italy
| | - Pierluigi Marzuillo
- Department of Women, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples,Italy
| | - Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne,UK
| | - Ismail Dursun
- Department of Paediatrics, Division of Nephrology, Erciyes University Faculty of Medicine, Kayseri,Turkey
| | - Ayse Seda Pinarbasi
- Department of Paediatrics, Division of Nephrology, Erciyes University Faculty of Medicine, Kayseri,Turkey
| | - Despoina Tramma
- 4th Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki,Greece
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, TheNetherlands
| | - Ibrahim Gokce
- Department of Paediatric Nephrology, Marmara University, Faculty of Medicine, İstanbul,Turkey
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Parkville,Australia
- Department of Nephrology, University of Melbourne, Parkville,Australia
| | - Loai A Eid
- Department of Paediatric Nephrology, Dubai Hospital-Dubai Health Authority, Dubai, United Arab Emirates
| | - Lisa Sartz
- Department of Clinical Sciences, Paediatric nephrology, Skåne University hospital, Lund University, Lund,Sweden
| | - Michael Riordan
- Department of Paediatric Nephrology, Temple Street Children's University Hospital, Dublin,Ireland
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center (ACRDC), Aliasghar Children Hospital, Iran University of Medical Sciences, Tehran,Iran
| | - Nikoleta Printza
- 1st Paediatric Department, Aristotle University, Thessaloniki,Greece
| | - Olivier Bonny
- Service of Nephrology, Rue du Bugnon 17, Lausanne University Hospital, Lausanne,Switzerland
| | - Pedro Arango Sancho
- Department of Paediatric Nephrology and Transplantation, Hospital Sant Joan De Déu, Esplugues De Llobregat, Barcelona,Spain
| | - Raphael Schild
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg,Germany
| | - Rajiv Sinha
- Division of Paediatric Nephrology, Institute of Child Health, Kolkata,India
| | - Stefano Guarino
- Department of Women, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples,Italy
| | - Victor Martinez Jimenez
- Department of Nephrology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia,Spain
| | - Lidia Rodríguez Peña
- Section of Medical Genetics, Department of Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia,Spain
| | - Hendrica Belge
- Center of Human Genetics, Institut de Pathologie et Genetique, Gosselies,Belgium
| | - Olivier Devuyst
- Institute of Physiology, Zurich Center for Integrative Human Physiology (ZHIP), Mechanism of Inherited Kidney Disorders Group, University of Zurich, Zurich,Switzerland
| | - Tanja Wlodkowski
- Department of Paediatric Nephrology, University Children's Hospital, Heidelberg,Germany
| | - Francesco Emma
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome,Italy
| | - Elena Levtchenko
- Department of development and regeneration, Laboratory of Paediatric Nephrology, University Hospital, Leuven,Belgium
| | - Nine V A M Knoers
- Department of Genetics, Center for Molecular Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, TheNetherlands
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, TheNetherlands
| | - Daniel G Bichet
- Nephrology Service, Department of Medicine, Pharmacology and Physiology, University of Montreal, Montreal, Quebec,Canada
| | - Franz Schaefer
- Department of Paediatric Nephrology, University Children's Hospital, Heidelberg,Germany
| | - Robert Kleta
- Department of Renal Medicine, University College London, London,UK
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| | - Detlef Bockenhauer
- Department of Renal Medicine, University College London, London,UK
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
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Bowen DK, Balmert LC, Meyer T, Rosoklija I, Hodgkins KS, Ghossein C, Cheng EY, Yerkes EB, Isakova T, Chu DI. Variability in Kidney Function Estimates in Emerging Adults With Spina Bifida: Implications for Transitioning From Pediatric to Adult Care. Urology 2020; 148:306-313. [PMID: 33242556 DOI: 10.1016/j.urology.2020.10.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine the variability of estimated glomerular filtration rate (eGFR) in emerging adults with spina bifida (SB) by comparing multiple equations across the transitional age period, hypothesizing that creatinine (Cr)-based equations show greater variability than cystatin-C (CysC)- or combination-based equations. METHODS A retrospective cohort study was performed from 2012 to 2017 at a multidisciplinary SB clinic. Emerging adults were defined as patients ages 18-28 years old. Four pediatric, 3 adult, and 3 averaged eGFR equations were considered. Cross-sectional variability in eGFR data was assessed using coefficients of variation, chronic kidney disease (CKD) stage classification, and pairwise percent relative difference in eGFR between analogous pediatric and adult equations based on included lab values. Longitudinal changes in eGFR over time were compared across equations using a covariance pattern model accounting for repeated measures. RESULTS Seventy-five emerging adults with SB (median age 21.8 years; 55% female; 83% with myelomeningocele) were included in cross-sectional analyses. Adult equations gave higher median eGFRs by 22%-27% and generally milder CKD stage classification than analogous pediatric equations. In longitudinal analyses (median follow-up of 22 months), all equations conferred negative eGFR changes over time (range -1.9 to -4.3 mL/min/1.73m2 per year) that were not significantly different. CONCLUSION In emerging adults with SB, adult equations demonstrated higher median eGFRs by 22%-27% compared to analogous pediatric equations, even with Cystatin-C, and generally downstaged CKD stage classification. The same eGFR equation should be used for serial kidney function monitoring in emerging adults with SB who transition care from pediatric to adult services.
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Affiliation(s)
- Diana K Bowen
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| | - Lauren C Balmert
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Theresa Meyer
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ilina Rosoklija
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Kavita S Hodgkins
- Division of Kidney Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Cybele Ghossein
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Earl Y Cheng
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Elizabeth B Yerkes
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David I Chu
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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19
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Odum JD, Kats A, VanSickle JS, Chadha V, Brewer B, Staggs VS, Warady BA. Characterizing the frequency of modifiable histological changes observed on surveillance biopsies in pediatric kidney allograft recipients. Pediatr Nephrol 2020; 35:2173-2182. [PMID: 32556543 DOI: 10.1007/s00467-020-04624-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Rejection is responsible for just under 50% of graft loss in the pediatric kidney transplant population. Early identification and treatment of allograft injury, specifically modifiable pathologies such as subclinical rejection (SCR), calcineurin inhibitor toxicity, and BK virus nephropathy, may improve allograft survival. Protocol surveillance biopsy (SB) currently offers the earliest opportunity for targeted interventions. METHODS This is a single-center retrospective review of 215 kidney SBs obtained from 2008 to 2016 in 97 pediatric kidney transplant recipients. SBs were obtained at 6, 12, and 24 months post-transplantation. Frequency of abnormal histologic findings, estimated glomerular filtration rate at time of SB, and SB-related complications were recorded. Data were analyzed to investigate possible time trends and the presence of demographic or clinical associations with abnormal histologic findings. RESULTS Potentially modifiable histologic findings were seen in 38.1% of all SBs. SCR was found with increasing frequency across all time points with an estimated 49% increase in the odds of a SCR finding per additional 6 months post-transplantation (aOR 1.49, 95% CI 1.06-2.09, p = 0.022). Among follow-up biopsies in patients who underwent treatment for SCR, 50% had no SCR and 18.8% showed histologic improvement. The complication rate associated with SB was 1.9% (4/215 SBs) and consisted of only minor complications. CONCLUSIONS SBs are safe and offer the opportunity to identify and treat modifiable histologic changes in the pediatric kidney transplant population. The performance of SBs for up to 2 years after transplantation can have meaningful clinical impact.
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Affiliation(s)
- James D Odum
- Division of Graduate Medical Education, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Alexander Kats
- Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Judith Sebestyen VanSickle
- Division of Pediatric Nephrology, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Vimal Chadha
- Division of Pediatric Nephrology, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Brenda Brewer
- Division of Pediatric Nephrology, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Vincent S Staggs
- Biostatistics & Epidemiology Core, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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20
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Ogbu EA, Chandrakasan S, Rouster-Stevens K, Greenbaum LA, Sanz I, Gillespie SE, Marion C, Okeson K, Prahalad S. Impact of autoimmune cytopenias on severity of childhood-onset systemic lupus erythematosus: A single-center retrospective cohort study. Lupus 2020; 30:109-117. [PMID: 33108953 DOI: 10.1177/0961203320969806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess whether children with autoimmune cytopenias prior to or at diagnosis of systemic lupus erythematosus (cSLE), differ phenotypically from other cSLE patients; and have a lower risk and severity of lupus nephritis (LN) as observed in prior adult studies. To assess the effect of prior immune therapy for autoimmune cytopenias on 2-year risk of LN. METHODS This was a retrospective cohort study of incident cSLE cases. We included patients aged less than 17 years at diagnosis. We excluded patients with LN at cSLE diagnosis. Our follow-up period was 2 years. We defined autoimmune cytopenias as either autoimmune hemolytic anemia, immune thrombocytopenia or Evan's syndrome. RESULTS Forty-three (33%) of the 130 patients had autoimmune cytopenias before or at cSLE diagnosis. Those with autoimmune cytopenias had significantly more neuropsychiatric symptoms and higher mean ESR but less arthritis, malar rash and myositis versus those without autoimmune cytopenias. They had lower 2-year incidence proportion of LN compared to other cSLE patients (7% vs 15%). Of the 16 patients who developed LN, those with autoimmune cytopenias had mostly class V (2 of 3 patients) versus mostly class III and IV in those without autoimmune cytopenias (6 of 12 patients). None of the 13 patients pre-treated for autoimmune cytopenias developed LN. CONCLUSION Patients with autoimmune cytopenias before or at cSLE diagnosis have intriguing differences from other cSLE patients. They may represent a unique sub-type of cSLE patients and should be further explored.
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Affiliation(s)
- Ekemini A Ogbu
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University, Baltimore, USA
| | - Shanmuganathan Chandrakasan
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia, USA
| | - Kelly Rouster-Stevens
- Department of Pediatrics, Division of Pediatric Rheumatology, Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia, USA
| | - Larry A Greenbaum
- Department of Pediatrics, Division of Pediatric Nephrology, Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia, USA
| | - Ignacio Sanz
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Georgia, USA
| | - Scott E Gillespie
- Department of Pediatrics, Emory University School of Medicine, Georgia, USA
| | | | - Karli Okeson
- Department of Pediatrics, Emory University School of Medicine, Georgia, USA
| | - Sampath Prahalad
- Department of Pediatrics, Division of Pediatric Rheumatology, Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia, USA
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21
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Crass RL, Pai MP. Optimizing Estimated Glomerular Filtration Rate to Support Adult to Pediatric Pharmacokinetic Bridging Studies in Patients with Cystic Fibrosis. Clin Pharmacokinet 2020; 58:1323-1332. [PMID: 30972695 DOI: 10.1007/s40262-019-00761-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The estimated glomerular filtration rate (eGFR) is often used to model drug clearance (CL) and scale doses across age and body size. Over their lifetime, patients with cystic fibrosis (CF) receive repeated courses of tobramycin, an antibiotic with eGFR-dependent CL, for the treatment of pulmonary exacerbations. Tobramycin population pharmacokinetic (PK) modeling can be used to decipher the best approach to define eGFR for pediatric bridging studies. METHODS Inpatients with CF who received intravenous tobramycin between 1 January 2006 and 30 May 2018 were eligible for inclusion. Encounters without tobramycin concentration measurement or missing covariate data were excluded. Population PK analysis was performed using NONMEM.Covariate models were built following identification of the base model, with specific emphasis on the effect of different methods of estimating renal function as a covariate of tobramycin CL. RESULTS A total of 296 CF patients contributed 1029 care encounters (420 pediatric, 609 adult) and 4352 tobramycin concentrations to this analysis. The median (minimum, maximum) age at encounter was 19 years (0.2, 60), with serum creatinine of 0.60 mg/dL (0.10, 3.41). A two-compartment model best described the observed data, with height and eGFR as significant covariates of tobramycin CL. eGFR was best modeled using a combination of the modified Schwartz and Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equations expressed in absolute units. CONCLUSIONS The CKDEPI equation bridges PK data generated in adults to adolescents with CF better than the current regulatory standard. The eGFR should be expressed in absolute units (mL/min) for PK analyses.
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Affiliation(s)
- Ryan L Crass
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, MI, 48109, USA
| | - Manjunath P Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, MI, 48109, USA.
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22
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Björk J, Nyman U, Courbebaisse M, Couzi L, Dalton RN, Dubourg L, Ebert N, Eriksen BO, Gaillard F, Garrouste C, Grubb A, Hansson M, Jacquemont L, Jones I, Kamar N, Lamb EJ, Legendre C, Littmann K, Mariat C, Melsom T, Rostaing L, Rule AD, Schaeffner E, Sundin PO, Turner S, Åkesson A, Delanaye P, Pottel H. Prospects for improved glomerular filtration rate estimation based on creatinine-results from a transnational multicentre study. Clin Kidney J 2020; 13:674-683. [PMID: 32905314 PMCID: PMC7467594 DOI: 10.1093/ckj/sfaa039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/04/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation is routinely used to assess renal function but exhibits varying accuracy depending on patient characteristics and clinical presentation. The overall aim of the present study was to assess if and to what extent glomerular filtration rate (GFR) estimation based on creatinine can be improved. METHODS In a cross-sectional analysis covering the years 2003-17, CKD-EPI was validated against measured GFR (mGFR; using various tracer methods) in patients with high likelihood of chronic kidney disease (CKD; five CKD cohorts, n = 8365) and in patients with low likelihood of CKD (six community cohorts, n = 6759). Comparisons were made with the Lund-Malmö revised equation (LMR) and the Full Age Spectrum equation. RESULTS 7In patients aged 18-39 years old, CKD-EPI overestimated GFR with 5.0-16 mL/min/1.73 m2 in median in both cohort types at mGFR levels <120 mL/min/1.73 m2. LMR had greater accuracy than CKD-EPI in the CKD cohorts (P30, the percentage of estimated GFR within 30% of mGFR, 83.5% versus 76.6%). CKD-EPI was generally the most accurate equation in the community cohorts, but all three equations reached P30 above the Kidney Disease Outcomes Quality Initiative benchmark of 90%. CONCLUSIONS None of the evaluated equations made optimal use of available data. Prospects for improved GFR estimation procedures based on creatinine exist, particularly in young adults and in settings where patients with suspected or manifest CKD are investigated.
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Affiliation(s)
- Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
| | - Marie Courbebaisse
- Physiology Department, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, INSERM U1151-CNRS UMR8253, Paris, France
| | - Lionel Couzi
- CHU de Bordeaux, Nephrologie–Transplantation–Dialyse, Université de Bordeaux, CNRS-UMR 5164 Immuno ConcEpT, Bordeaux, France
| | - R Neil Dalton
- The Wellchild Laboratory, Evelina London Children’s Hospital, London, UK
| | - Laurence Dubourg
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Natalie Ebert
- Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Björn O Eriksen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsö, Norway
| | - Francois Gaillard
- Renal Transplantation Department, Necker Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
| | - Cyril Garrouste
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Anders Grubb
- Department of Clinical Chemistry, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Magnus Hansson
- Function area Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Lola Jacquemont
- Renal Transplantation Department, CHU Nantes, Nantes University, Nantes, France
| | - Ian Jones
- Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR–BMT, University Paul Sabatier, Toulouse, France
| | - Edmund J Lamb
- Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | | | - Karin Littmann
- Function area Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, France
| | - Toralf Melsom
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsö, Norway
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, Hôpital Michallon, CHU Grenoble-Alpes, La Tronche, France
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Elke Schaeffner
- Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Per-Ola Sundin
- Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Stephen Turner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Anna Åkesson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Bojan M, Pieroni L, Mirabile C, Froissart M, Bonnet D. Chronic Kidney Disease in Adolescents after Surgery for Congenital Heart Disease. Cardiorenal Med 2020; 10:353-361. [PMID: 32721971 DOI: 10.1159/000508177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The onset of chronic kidney disease (CKD) is an important prognostic factor in young adults with congenital heart disease (CHD). Although it is likely that CKD is manifest early in CHD patients, the prevalence among adolescents is still unknown. The National Kidney Foundation's Kidney Disease Improving Global Outcomes guidelines 2012 recommend new equations for the estimated glomerular filtration rate (eGFR) and highlight the importance of albuminuria for CKD screening. The objective of the present study was to estimate the prevalence of CKD in CHD adolescents. METHODS This observational cross-sectional study included 115 patients aged 10-18 years attending the cardiologic outpatient clinic at our institution as a follow-up after cardiac surgery in infancy related to various CHDs. CKD assessment used the CKD criteria 2012, including eGFR equations based on serum creatinine and cystatin C, and measurement of albuminuria. RESULTS No patient had an eGFR <60 mL min-1 1.73 m-2. However, 28.7% of all patients (95% CI 20.7-37.9) had eGFRbetween 60 and 89 mL min-1 1.73 m-2 when estimated by the bedside Schwartz creatinine-based equation,and 17.4% (95% CI 11.2-24.1) had eGFRbetween 60 and 89 mL min-1 1.73 m-2 when estimated by the Zappitelli equation, combining creatinine and cystatin C. Of all patients, 20.0% (95% CI 12.1-26.7) had orthostatic proteinuria, and none had persistent albuminuria. CONCLUSIONS There was no evidence of CKD in the present population aged 10-18 years. The significance of an eGFR between 60 and 90 mL min-1 1.73 m-2 is not concordant for this age range and requires further investigations.
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Affiliation(s)
- Mirela Bojan
- Department of Anesthesiology, Congenital Cardiac Unit, Marie Lannelongue Hospital, Le Plessis-Robinson, France,
| | - Laurence Pieroni
- Department of Biochemistry, Lapeyronie Hospital, Montpellier, France
| | - Cristian Mirabile
- Department of Critical Care, Congenital Cardiac Unit, Marie Lannelongue Hospital, Le Plessis-Robinson, France
| | - Marc Froissart
- Clinical Research Center, Lausanne University Hospital, Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | - Damien Bonnet
- Pediatric Cardiology, Necker-Enfants Malades Hospital, Paris, France.,Paris Descartes University, Paris, France
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24
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Lopez-Garcia SC, Emma F, Walsh SB, Fila M, Hooman N, Zaniew M, Bertholet-Thomas A, Colussi G, Burgmaier K, Levtchenko E, Sharma J, Singhal J, Soliman NA, Ariceta G, Basu B, Murer L, Tasic V, Tsygin A, Decramer S, Gil-Peña H, Koster-Kamphuis L, La Scola C, Gellermann J, Konrad M, Lilien M, Francisco T, Tramma D, Trnka P, Yüksel S, Caruso MR, Chromek M, Ekinci Z, Gambaro G, Kari JA, König J, Taroni F, Thumfart J, Trepiccione F, Winding L, Wühl E, Ağbaş A, Belkevich A, Vargas-Poussou R, Blanchard A, Conti G, Boyer O, Dursun I, Pınarbaşı AS, Melek E, Miglinas M, Novo R, Mallett A, Milosevic D, Szczepanska M, Wente S, Cheong HI, Sinha R, Gucev Z, Dufek S, Iancu D, Kleta R, Schaefer F, Bockenhauer D. Treatment and long-term outcome in primary distal renal tubular acidosis. Nephrol Dial Transplant 2020; 34:981-991. [PMID: 30773598 DOI: 10.1093/ndt/gfy409] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary distal renal tubular acidosis (dRTA) is a rare disorder, and we aimed to gather data on treatment and long-term outcome. METHODS We contacted paediatric and adult nephrologists through European professional organizations. Responding clinicians entered demographic, biochemical, genetic and clinical data in an online form. RESULTS Adequate data were collected on 340 patients (29 countries, female 52%). Mutation testing had been performed on 206 patients (61%); pathogenic mutations were identified in 170 patients (83%). The median (range) presentation age was 0.5 (0-54) years and age at last follow-up was 11.0 (0-70.0) years. Adult height was slightly below average with a mean (SD score) of -0.57 (±1.16). There was an increased prevalence of chronic kidney disease (CKD) Stage ≥2 in children (35%) and adults (82%). Nephrocalcinosis was reported in 88%. Nephrolithiasis was more common with SLC4A1 mutations (42% versus 21%). Thirty-six percent had hearing loss, particularly in ATP6V1B1 (88%). The median (interquartile range) prescribed dose of alkali (mEq/kg/day) was 1.9 (1.2-3.3). Adequate metabolic control (normal plasma bicarbonate and normocalciuria) was achieved in 158 patients (51%), more commonly in countries with higher gross domestic product (67% versus 23%), and was associated with higher height and estimated glomerular filtration rate. CONCLUSION Long-term follow-up from this large dRTA cohort shows an overall favourable outcome with normal adult height for most and no patient with CKD Stage 5. However, 82% of adult patients have CKD Stages 2-4. Importance of adequate metabolic control was highlighted by better growth and renal function but was achieved in only half of patients.
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Affiliation(s)
- Sergio Camilo Lopez-Garcia
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Centre for Nephrology, University College London, London, UK
| | - Francesco Emma
- Division of Nephrology, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Stephen B Walsh
- Centre for Nephrology, University College London, London, UK
| | - Marc Fila
- Pediatric Nephrology-CHU Arnaud de Villeneuve, Montpellier University Hospital, Montpellier, France
| | - Nakysa Hooman
- Ali-Asghar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marcin Zaniew
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland
| | | | | | - Kathrin Burgmaier
- Department of Pediatrics, University Hospital of Cologne, Cologne, Germany
| | | | | | | | - Neveen A Soliman
- Department of Pediatrics, Center of Pediatric Nephrology & Transplantation, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Gema Ariceta
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Biswanath Basu
- Division of Pediatric Nephrology, NRS Medical College, Kolkata, India
| | - Luisa Murer
- Pediatric Nephrology, Dialysis and Transplant Unit, Azienda Ospedaliera & University of Padova, Padova, Italy
| | - Velibor Tasic
- University Children's Hospital, Medical School, Skopje, Macedonia
| | - Alexey Tsygin
- National Medical and Research Centre for Children's Health, Moscow, Russia
| | - Stéphane Decramer
- Centre Hospitalier Universitaire de Toulouse, Service de Nephrologie Pediatrique, Hopital des Enfants, Centre De Reference des Maladies Rénales Rares du Sud Ouest, Toulouse, France
| | | | | | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Woman, Child and Urological Diseases, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | - Marc Lilien
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | | | - Despoina Tramma
- Fourth Pediatric Department, Aristotle University, Thessaloniki, Greece
| | - Peter Trnka
- Lady Cilento Children's Hospital, Brisbane, Australia.,School of Medicine, the University of Queensland, Brisbane, Australia
| | - Selçuk Yüksel
- Department of Pediatric Nephrology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Maria Rosa Caruso
- Nephrology Unit Azienda Ospedaliera, Papa Giovani XXIII, Bergamo, Italy
| | | | - Zelal Ekinci
- Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Giovanni Gambaro
- Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jameela A Kari
- Pediatric Nephrology Center of Excellence and Pediatric Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Jens König
- University Children's Hospital, Münster, Germany
| | - Francesca Taroni
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Louise Winding
- Pediatric Department, Lillebaelt Hospital Kolding, Kolding, Denmark
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ayşe Ağbaş
- Haseki Education and Research Hospital, Istanbul, Turkey
| | | | - Rosa Vargas-Poussou
- Department of Genetics, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne Blanchard
- Department of Genetics, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Giovanni Conti
- Pediatric Nephrology Unit, AOU Policlinic G Martino, Messina, Italy
| | | | - Ismail Dursun
- Faculty of Medicine, Department of Pediatric Nephrology, Erciyes University, Kayseri, Turkey
| | - Ayşe Seda Pınarbaşı
- Faculty of Medicine, Department of Pediatric Nephrology, Erciyes University, Kayseri, Turkey
| | | | - Marius Miglinas
- Nephrology Centre, Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | | | - Andrew Mallett
- School of Medicine, the University of Queensland, Brisbane, Australia.,Department of Renal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | | | - Sarah Wente
- Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Hae Il Cheong
- Department of Pediatrics, Seoul University Children's Hospital, Seoul, Korea
| | | | - Zoran Gucev
- Medical School, University Children's Hospital, Skopje, Macedonia
| | - Stephanie Dufek
- Centre for Nephrology, University College London, London, UK
| | - Daniela Iancu
- Centre for Nephrology, University College London, London, UK
| | | | - Robert Kleta
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Centre for Nephrology, University College London, London, UK
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Detlef Bockenhauer
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Centre for Nephrology, University College London, London, UK
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Szymanski KM, Szymanski AJ, Salama AK, Hains DS, Cain MP, Misseri R. Estimating and tracking renal function in children and adults with spina bifida. J Pediatr Urol 2020; 16:169-177. [PMID: 31956092 DOI: 10.1016/j.jpurol.2019.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/10/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Estimated glomerular filtration rate (eGFR) in the general population is stable in children after 2 years of age until adulthood. In the first three decades after age 18, eGFR decreases by 0.3-0.8 ml/min/1.73 m2/year. Little data exists regarding eGFR changes in the spina bifida (SB) population given variability in muscle mass. In the absence of a validated SB-specific eGFR formula, the performance of different eGFR formulas may vary. We performed a cross-sectional study (1) to determine trends in eGFR with increasing age in children and adults with SB and (2) to compare eGFRs calculated using different formulas. METHODS We retrospectively reviewed records of patients 2-50 years old with SB followed at our institution (2014-2019). We determined eGFR using four pediatric formulas (2-17 years: CKiDSCr, CKiDCys, CKiDSCr-Cys, ZappitelliSCr-Cys) and four adult formulas (18 + years: MDRDSCr, CKD-EPISCr, CKD-EPICys, CKD-EPISCr-Cys). One eGFR per patient was included (most recent eGFR for those with serial measurements). Patients were categorized as chronic kidney disease (CKD) stage 2 (eGFR 60-89) and Stage 3+ (<60). Non-parametric tests, linear regression, and Spearman's correlation were used for analysis. RESULTS Among 209 children with SB (median age 10.3 years), depending on the formula used, eGFR decreased by -0.7 to -1.8 ml/min/1.73 m2/year (CKiDCys, CKiDScr, p ≤ 0.001), remained stable (CKiDSCr-Cys, p = 0.41), or increased by +2.7/year (ZappitelliSCr-Cys, p < 0.001) (Figure). The proportion of children with CKD 2 or higher varied between formulas (11.5-58.9%, p < 0.001). Correlations between pediatric formulas were negligible to moderate. Comparing any two formulas, 12.0-65.6% of children were assigned a different CKD stage. Among 164 adults (median age 26.3), eGFR decreased for each formula (range: -1.3 to -2.2/year, p ≤ 0.01) (Figure). The proportion of adults with CKD 2 or higher varied between formulas (9.2-30.5%, p < 0.001). Correlations between adult formulas were moderate to very high. Comparing any two formulas, 8.5-26.8% of adults were assigned a different CKD stage. COMMENT We cannot reliably determine whether eGFR changed during childhood. Among adults, eGFR decreased with age for every formula evaluated at greater than twice the general population rate. Without a validated SB-specific eGFR formula, we are left with formulas providing different results. CONCLUSIONS Estimated GFR among adults with SB appears to deteriorate at a higher rate than in the general population. Due to lack of precision of accepted eGFR formulas in the SB population, this may be a real phenomenon, an artifact of inaccurate eGFR formulas, or both. A validated SB-specific eGFR formula is needed.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA.
| | - Arthur J Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA
| | - Amr K Salama
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA
| | - David S Hains
- Department of Pediatrics, Division of Nephrology, Riley Hospital for Children at IU Health, Indiana, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA
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Ubetagoyena Arrieta M, Areses Trapote R, Mendia Ubetagoyena J, Perez Revuelta M, García Albizua I. [Basal renal function in paediatric patients: correlation of methods that depend on a 24h urine collection with simpler methods that do not require a timed urine]. An Pediatr (Barc) 2020; 92:65-70. [PMID: 31668896 DOI: 10.1016/j.anpedi.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/15/2019] [Accepted: 08/30/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In daily clinical practice a quick, easy and accessible method is needed to adequately assess renal function. The objectives of this study were: 1. To quantify the relationship and concordance of the glomerular filtration rate (GF) calculated by the clearance of creatinine in 24h urine (CCr) and the original and modified Schwartz equation (SE); and 2. To correlate urine elimination of substances that depends on the volume of excreted urine in a unit of time with other parameters that are calculated measuring the concentration of these substances in blood and urine. MATERIAL AND METHODS The study included 401 healthy children with ages between 3 to 14 years (187 male and 214 female). The analysis between the variables was carried out using Pearson's correlation coefficient and the intraclass correlation coefficient (ICC). RESULTS The correlation between values of CCr and the original SE (non-standardised creatinine measurement) was r=0.58 (P<0.001) and the concordance, ICC=0.74. The correlation between CCr values and the modified SE (standardised creatinine measurement) was r=0.68 (P<.001), and the concordance ICC=0.78. There was a very significant correlation between the elimination of sodium in a 24h urine (mEq/kg/24h) and the Na-Fractional-Excretion (EFNa): r=0.8 (P<.001). There was a correlation between the potassium elimination in 24h (mEq/kg/24h) and EFK: r=0.85 (P<.001). Between volume/min/1.73m2 and the urine volume percent of GF was: r=0.88 (P<.001). CONCLUSIONS These equations provide valuable information of the state of the basal renal function without having to use a timed urine.
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Affiliation(s)
| | - Ramón Areses Trapote
- Sección de Nefrología Pediátrica, Hospital Universitario Donostia, San Sebastián, España
| | | | - Marisol Perez Revuelta
- Sección de Nefrología Pediátrica, Hospital Universitario Donostia, San Sebastián, España
| | - Irati García Albizua
- Sección de Nefrología Pediátrica, Hospital Universitario Donostia, San Sebastián, España
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27
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Basal renal function in paediatric patients: Correlation of methods that depend on a 24 h urine collection with simpler methods that do not require a timed urine. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.08.005] [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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28
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Zhao X, Kratzke AK, Ballout F, Kimura RE, Jandeska SE. Retrospective cohort study of individuals born with low birthweight: implications for screening practices. Clin Kidney J 2019; 14:167-173. [PMID: 33564415 PMCID: PMC7857780 DOI: 10.1093/ckj/sfz130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 08/27/2019] [Indexed: 11/13/2022] Open
Abstract
Background Previous studies have established an association between low birthweight (LBW) and future kidney disease, but few have explored the progression of kidney dysfunction through the pediatric years leading up through adolescence and young adulthood. Methods To better understand the temporal effects of birthweight on kidney disease progression, we conducted a retrospective cohort study comparing the glomerular filtration rate (GFR) between LBW (<2500 grams) and normal birthweight (NBW) infants who were admitted to the neonatal intensive care unit (NICU) at our institution from 1992 to 2006. Results Age at follow-up ranged 1–26 years old. GFR was found to be significantly lower in participants born with LBW than those born with NBW, with a mean difference of 5.5 mL/min/1.73m2 (P < 0.01). These differences were found in the adolescent and young adult age group over 9 years of age, specifically in the extremely low birthweight group (ELBW) whose birthweight was less than 1000 grams. Conclusions We recommend screening for CKD in ELBW individuals starting at the age of 9 years old, regardless of their previous medical history.
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Affiliation(s)
- Xixi Zhao
- Department of Internal Medicine and Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | - Andrea K Kratzke
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Fatima Ballout
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Robert E Kimura
- Department of Neonatal-Perinatal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sara E Jandeska
- Department of Pediatric Nephrology, Rush University Medical Center, Chicago, IL, USA
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Zahr RS, Yee ME, Weaver J, Twombley K, Matar RB, Aviles D, Sreedharan R, Rheault MN, Malatesta-Muncher R, Stone H, Srivastava T, Kapur G, Baddi P, Volovelsky O, Pelletier J, Gbadegesin R, Seeherunvong W, Patel HP, Greenbaum LA. Kidney biopsy findings in children with sickle cell disease: a Midwest Pediatric Nephrology Consortium study. Pediatr Nephrol 2019; 34:1435-1445. [PMID: 30945006 DOI: 10.1007/s00467-019-04237-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Renal damage is a progressive complication of sickle cell disease (SCD). Microalbuminuria is common in children with SCD, while a smaller number of children have more severe renal manifestations necessitating kidney biopsy. There is limited information on renal biopsy findings in children with SCD and subsequent management and outcome. METHODS This is a multicenter retrospective analysis of renal biopsy findings and clinical outcomes in children and adolescents with SCD. We included children and adolescents (age ≤ 20 years) with SCD who had a kidney biopsy performed at a pediatric nephrology unit. The clinical indication for biopsy, biopsy findings, subsequent treatments, and outcomes were analyzed. RESULTS Thirty-six SCD patients (ages 4-19 years) were identified from 14 centers with a median follow-up of 2.6 years (0.4-10.4 years). The indications for biopsy were proteinuria (92%) and elevated creatinine (30%). All biopsies had abnormal findings, including mesangial hypercellularity (75%), focal segmental glomerulosclerosis (30%), membranoproliferative glomerulonephritis (16%), and thrombotic microangiopathy (2%). There was increased use of hydroxyurea, angiotensin-converting-enzyme inhibitors, and angiotensin receptor blockers following renal biopsy. At last follow-up, 3 patients were deceased, 2 developed insulin-dependent diabetes mellitus, 6 initiated chronic hemodialysis, 1 received a bone marrow transplant, and 1 received a kidney transplant. CONCLUSIONS Renal biopsies, while not commonly performed in children with SCD, were universally abnormal. Outcomes were poor in this cohort of patients despite a variety of post-biopsy interventions. Effective early intervention to prevent chronic kidney disease (CKD) is needed to reduce morbidity and mortality in children with SCD.
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Affiliation(s)
- Rima S Zahr
- Department of Pediatrics, Division Nephrology and Hypertension, The University of Tennessee and Le Bonheur Children's Hospital, 49 N. Dunlap, Memphis, TN, 38105, USA.
| | - Marianne E Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jack Weaver
- Levine Children's Hospital, Charlotte, NC, USA
| | | | | | - Diego Aviles
- Division of Pediatric Nephrology, LSU Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA
| | | | | | | | | | | | - Gaurav Kapur
- Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA
| | - Poornima Baddi
- Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA
| | | | | | | | | | | | - Larry A Greenbaum
- Department of Pediatrics, Division of Nephrology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
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da Silva Selistre L, Rech DL, de Souza V, Iwaz J, Lemoine S, Dubourg L. Diagnostic Performance of Creatinine-Based Equations for Estimating Glomerular Filtration Rate in Adults 65 Years and Older. JAMA Intern Med 2019; 179:796-804. [PMID: 31034005 PMCID: PMC6547158 DOI: 10.1001/jamainternmed.2019.0223] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/20/2019] [Indexed: 12/27/2022]
Abstract
Importance Estimating glomerular filtration rate (GFR) is useful in many clinical conditions. However, very few studies have evaluated the performance of GFR-estimating equations in older adults at various degrees of kidney impairment. Objective To determine the performance of plasma-creatinine-based equations Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI), Lund-Malmö Revised, (LMR), full age spectrum (FAS), and Berlin Initiative Study (BIS) 1 in older adults across a broad spectrum of GFRs. Design, Setting, and Participants Single-center cross-sectional study performed in France including 2247 participants aged 65 to 90 years who underwent inulin GFR measurements from July 1, 2003, to July 30, 2017, for suspected or established renal dysfunction, for renal risk, before kidney donation, or after kidney transplant. Main Outcomes and Measures The main outcome measure was GRF measured by inulin clearance. Equation performance criteria considered bias (difference between estimated and measured GFR), precision (interquartile range of the median difference), and accuracy P30 (percentage of estimated GFRs lying between [measured GFR - 30% of measured GFR] and [measured GFR + 30% of measured GFR]). Results The mean (SD) age of the 2247 participants was 71.5 (5) years and 1192 (53.0%) were male. The difference in median (95% CI) bias was significant between CKD-EPI vs LMR (-4.0 [-4.0 to -3.5 mL/min/1.73 m2; P < .001]) and CKD-EPI vs FAS (-2.0 [-3.5 to -2.5] mL/min/1.73 m2, P < .001) but not significant between CKD-EPI vs BIS 1 (0.0 [-1.5 to 0.5], P = .07, Mood test). In patients aged 65 to 74 years with measured GFR<45 mL/min/1.73 m2, the difference in median P30 (95% CI) was not significant between CKD-EPI vs LMR (P = .08) and CKD-EPI vs FAS (P = .48) but significant vs BIS 1 (P = .004, McNemar test). In subjects 75 years and older, with measured GFR less than 45 mL/min/1.73 m2, LMR and BIS 1 were more accurate than CKD-EPI and FAS (P30 = 74.5 [70.0-79.5] and 73.0 [68.0-78.0] vs 69.0 [64.5-74.0] and 69.0 [65.5-72.0]). In all patients, despite small statistical differences, the performance of CKD-EPI equation was not clinically different from that of LMR, FAS, or BIS 1. Conclusions and Relevance In a referral group of patients 65 years and older who had GFR estimated using CDK-EPI, LMR, BIS 1, and FAS equations, a comparison with renal inulin clearance found that none of the equations had a superior diagnostic performance. Each had limitations regarding accuracy.
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Affiliation(s)
- Luciano da Silva Selistre
- Service de Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Programa de Pós-graduação em Ciências da Saúde Universidade de Caxias do Sul, Caxias do Sul, Brazil
- CAPES Foundation, Ministry of Education of Brazil, Brasilia
- Núcleo de Apoio à Pesquisa–COEDI, Hospital Geral de Caxias do Sul, Caxias do Sul, Brasil
| | - Dener L. Rech
- Programa de Pós-graduação em Ciências da Saúde Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | - Vandréa de Souza
- Service de Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Programa de Pós-graduação em Ciências da Saúde Universidade de Caxias do Sul, Caxias do Sul, Brazil
- Núcleo de Apoio à Pesquisa–COEDI, Hospital Geral de Caxias do Sul, Caxias do Sul, Brasil
| | - Jean Iwaz
- Université Claude Bernard Lyon 1, Lyon, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Sandrine Lemoine
- Service de Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Laboratoire CarMeN, Institution National de la Santé et de la Recherche Médicale 1060Université Lyon 1, Lyon, France
| | - Laurence Dubourg
- Service de Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Programa de Pós-graduação em Ciências da Saúde Universidade de Caxias do Sul, Caxias do Sul, Brazil
- Université Claude Bernard Lyon 1, Lyon, France
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique (UMR 5305 CNRS/Université Claude Bernard, Lyon 1), Lyon, France
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Validation of standardized creatinine and cystatin C GFR estimating equations in a large multicentre European cohort of children. Pediatr Nephrol 2019; 34:1087-1098. [PMID: 30715595 DOI: 10.1007/s00467-018-4185-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 12/08/2018] [Accepted: 12/18/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Most validations of paediatric glomerular filtration rate (GFR) estimating equations using standardized creatinine (CR) and cystatin C (CYS) assays have comprised relatively small cohorts, which makes accuracy across subgroups of GFR, age, body mass index (BMI) and gender uncertain. To overcome this, a large cohort of children referred for GFR determination has been established from several European medical centres. METHODS Three thousand four hundred eight measurements of GFR (mGFR) using plasma clearance of exogenous substances were performed in 2218 children aged 2-17 years. Validated equations included Schwartz-2009CR/2012CR/CYS/CR+CYS, FASCR/CYS/CR+CYS, LMRCR, Schwartz-LyonCR, BergCYS, CAPACYS, CKD-EPICYS, AndersenCR+CYS and arithmetic means of the best single-marker equations in explorative analysis. Five metrics were used to compare the performance of the GFR equations: bias, precision and three accuracy measures including the percentage of GFR estimates (eGFR) within ± 10% (P10) and ± 30% (P30) of mGFR. RESULTS Three of the cystatin C equations, BergCYS, CAPACYS and CKD-EPICYS, exhibited low bias and generally satisfactory accuracy across all levels of mGFR; CKD-EPICYS had more stable performance across gender than the two other equations. Among creatinine equations, Schwartz-LyonCR had the best performance but was inaccurate at mGFR < 30 mL/min/1.73 m2 and in underweight patients. Arithmetic means of the best creatinine and cystatin C equations above improved bias compared to the existing composite creatinine+cystatin C equations. CONCLUSIONS The present study strongly suggests that cystatin C should be the primary biomarker of choice when estimating GFR in children with decreased GFR. Arithmetic means of well-performing single-marker equations improve accuracy further at most mGFR levels and have practical advantages compared to composite equations.
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Pottel H, Björk J, Bökenkamp A, Berg U, Åsling-Monemi K, Selistre L, Dubourg L, Hansson M, Littmann K, Jones I, Sjöström P, Nyman U, Delanaye P. Estimating glomerular filtration rate at the transition from pediatric to adult care. Kidney Int 2019; 95:1234-1243. [PMID: 30922665 DOI: 10.1016/j.kint.2018.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/07/2018] [Accepted: 12/13/2018] [Indexed: 01/11/2023]
Abstract
The current Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend the use of the bedside creatinine-based Chronic Kidney Disease in Children (CKiD) equation to estimate glomerular filtration rate (GFR) in children and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in adults. However, this approach causes implausible changes in estimated GFR (eGFR) at the transition from pediatric to adult care. We investigated the performance of the KDIGO strategy and various creatinine-based eGFR equations in a cross-sectional dataset of 5,764 subjects (age 10-30 years), using directly measured GFR (mGFR) as reference. We also evaluated longitudinal GFR slopes in 136 subjects who transitioned to adult care. Implausible changes in eGFR resulted from the large overestimation (bias=+21 mL/min/1.73m2) and poor precision of the CKD-EPI equation in the 18-20 year age group, compared to CKiD in the 16-18 year age group (bias=-2.7 mL/min/1.73m2), resulting in a mean change of 23 mL/min/1.73m2 at the transition to adult care. Averaging the CKiD and CKD-EPI estimates in young adults only partially mitigated this issue. The Full Age Spectrum equation (with and without height), the Lund-Malmö Revised equation, and an age-dependent weighted average of CKiD and CKD-EPI resulted in much smaller changes in eGFR at the transition (change of 0.6, -2.1, -0.9 and -1.8 mL/min/1.73m2, respectively). The longitudinal analysis revealed a significant difference in average GFR slope between mGFR and the KDIGO strategy (-2.2 vs. +2.9 mL/min/1.73 m2/year), which was not observed with the other approaches. These results suggest that the KDIGO recommendation for GFR estimation at the pediatric-adult care transition should be revisited.
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Affiliation(s)
- Hans Pottel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium.
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Arend Bökenkamp
- Emma Children's Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ulla Berg
- Department of Clinical Science, Intervention, and Technology, Division of Pediatrics, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Kajsa Åsling-Monemi
- Department of Clinical Science, Intervention, and Technology, Division of Pediatrics, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Luciano Selistre
- Mestrado em Ciências da Saúde-Universidade Caxias do Sul Foundation, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil
| | - Laurence Dubourg
- Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Magnus Hansson
- Department of Laboratory Medicine, Division of Clinical Chemistry, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Karin Littmann
- Department of Laboratory Medicine, Division of Clinical Chemistry, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ian Jones
- Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden
| | - Per Sjöström
- Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden
| | - Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
| | - Pierre Delanaye
- Nephrology-Dialysis-Transplantation, University of Liège, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium
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Haws RM, McIntee TJ, Green CB. Cutaneous findings in Bardet‐Biedl syndrome. Int J Dermatol 2019; 58:1160-1164. [DOI: 10.1111/ijd.14412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/26/2018] [Accepted: 01/29/2019] [Indexed: 11/28/2022]
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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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Ng DK, Schwartz GJ, Schneider MF, Furth SL, Warady BA. Combination of pediatric and adult formulas yield valid glomerular filtration rate estimates in young adults with a history of pediatric chronic kidney disease. Kidney Int 2018; 94:170-177. [PMID: 29735307 PMCID: PMC6015546 DOI: 10.1016/j.kint.2018.01.034] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/19/2018] [Accepted: 01/25/2018] [Indexed: 02/06/2023]
Abstract
As patients with chronic kidney disease (CKD) transition from pediatric nephrology care to adult care, their kidney function is clinically assessed by estimated glomerular filtration rate (eGFR) using both pediatric and adult equations, which may not be congruent. Here we evaluated commonly used eGFR equations and directly measured iohexol GFR (iGFR) among participants between ages 18 and 26 with a diagnosis of pediatric CKD in the Chronic Kidney Disease in Children (CKiD) cohort. The bedside serum creatinine (SCr)-only equation (CKiDSCr), the SCr-only CKD-EPI (CKD-EPISCr), the cystatin C (Cys)-only CKD-EPI (CKD-EPICys) and the combined SCr and Cys CKD-EPI (CKD-EPISCr-Cys) were compared with a) 279 measured iGFRs obtained from 187 participants and b) 548 eGFRs from the SCr and Cys-based CKiD equation (CKiDSCr-Cys) obtained from 219 participants. Among emerging adults with a median iGFR of 49 ml/min/1.73m2, the CKiDSCr-Cys equation had low bias (+1.5 ml/min/1.73m2) and high correlation (0.94), while CKiDSCr underestimated iGFR and CKiDSCr-Cys (-5.6 and -7.4 ml/min/1.73m2, respectively) and CKD-EPISCr had an overestimation bias (+8.2 and +6.1 ml/min/1.73m2, respectively). However, the CKD-EPICys and CKD-EPISCr-Cys exhibited strong agreement with both iGFR and CKiDSCr-Cys. GFR may also be validly estimated in this population by taking the simple average of CKiDSCr and CKD-EPISCr (average bias +1.3 compared to iGFR and -0.6 compared to CKiDSCr-Cys). Clinicians should be aware that individually the pediatric and adult SCr-based estimates of GFR had large discrepancies among emerging adults with pediatric CKD. Thus, when cystatin C is not available, we recommend the average of pediatric and adult SCr-based eGFR as a valid tool for clinical use.
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Affiliation(s)
- Derek K Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - George J Schwartz
- Department of Pediatrics, Division of Pediatric Nephrology, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael F Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan L Furth
- Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri, USA
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Alcorta MD, Alvarez PC, Cabetas RN, Martín MJA, Valero M, Candela CG. The importance of serum albumin determination method to classify patients based on nutritional status. Clin Nutr ESPEN 2018; 25:110-113. [DOI: 10.1016/j.clnesp.2018.03.124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/24/2018] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
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Koruyucu M, Seymen F, Gencay G, Gencay K, Tuna E, Shin T, Hyun HK, Kim YJ, Kim JW. Nephrocalcinosis in Amelogenesis Imperfecta Caused by the FAM20A Mutation. Nephron Clin Pract 2018; 139:189-196. [DOI: 10.1159/000486607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/27/2017] [Indexed: 01/03/2023] Open
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den Bakker E, Gemke RJBJ, Bökenkamp A. Endogenous markers for kidney function in children: a review. Crit Rev Clin Lab Sci 2018; 55:163-183. [DOI: 10.1080/10408363.2018.1427041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Emil den Bakker
- Department of Pediatric Nephrology, VU Medical Centre, Amsterdam, The Netherlands
| | | | - Arend Bökenkamp
- Department of Pediatric Nephrology, VU Medical Centre, Amsterdam, The Netherlands
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Mian AN, Schwartz GJ. Measurement and Estimation of Glomerular Filtration Rate in Children. Adv Chronic Kidney Dis 2017; 24:348-356. [PMID: 29229165 DOI: 10.1053/j.ackd.2017.09.011] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Rapid, accurate, and precise measures of kidney function are essential for daily management of patients. While plasma and urinary clearances provide the greatest accuracy for assessing glomerular filtration rate (GFR), these are often impractical particularly for the care of children. Serum creatinine, the most commonly used endogenous marker, is simple, convenient, and practical but less accurate because of the influence of non-GFR determinants such as muscle mass, which increases with age in children. GFR estimating equations have been developed for adults and children to improve the accuracy of endogenous biomarkers, such as creatinine and cystatin C, by accounting for some of the non-GFR determinants, thus enhancing the practitioner's ability to assess GFR. In the steady state, when height is used as a surrogate for growth, there is a strong correlation between height/SCr and GFR. Current national guidelines recommend routine reporting of the estimated GFR alongside the serum creatinine value for adults using the Chronic Kidney Disease Epidemiology Collaboration creatinine-based formula and the updated Schwartz "bedside" formula (CKiD 2009) for children.
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Banga A, Mohanka M, Mullins J, Bollineni S, Kaza V, Torres F, Tanriover B. Interaction of pre-transplant recipient characteristics and renal function in lung transplant survival. J Heart Lung Transplant 2017; 37:S1053-2498(17)31951-4. [PMID: 28947250 DOI: 10.1016/j.healun.2017.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND There has been little investigation into the potential interaction of recipient characteristics with the association of pre-transplant renal functions and survival after lung transplantation. In this study we tested the hypothesis that association of pre-transplant renal function and post-transplant mortality varies among recipient subgroups. METHODS We queried the United Network for Organ Sharing (UNOS) database for adult patients (≥18 years of age) undergoing lung transplantation between May 2005 and March 2015. The study population (n = 15,540) was split into 3 groups (90 to 150, 60 to 89.9 and 30 to 59.9 ml/min/1.73 m2) based on the estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration equation) at the time of listing. We utilized multivariable inverse probability weighted Cox proportional hazard models to compare the association of glomerular filtration rate (GFR) groups with mortality among recipient subgroups. RESULTS Overall, there was an independent and graded inverse association between the estimated GFR (eGFR) and mortality, with the hazard of mortality significantly rising with listing eGFR <60 ml/min/1.73 m2. The association between low eGFR and mortality was more consistent and stronger for older (>45 years), non-African-American and non-diabetic patients as well as those with low lung allocation score (LAS <40). Among the diagnosis groups, patients with vascular diseases had the strongest association between low eGFR and poor survival. Sensitivity analyses conducted using an alternate equation to estimate the GFR (Modification of Diet in Renal Disease) supported these associations. CONCLUSIONS Prognostic significance of pre-transplant renal functions varies significantly among recipient subgroups. It may be appropriate to develop a customized approach toward assessing and interpreting renal function to determine transplant candidacy.
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Affiliation(s)
- Amit Banga
- Lung Transplant Program, Division of Pulmonary & Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Manish Mohanka
- Lung Transplant Program, Division of Pulmonary & Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jessica Mullins
- Lung Transplant Program, Division of Pulmonary & Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Srinivas Bollineni
- Lung Transplant Program, Division of Pulmonary & Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vaidehi Kaza
- Lung Transplant Program, Division of Pulmonary & Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Fernando Torres
- Lung Transplant Program, Division of Pulmonary & Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bekir Tanriover
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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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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Hamdani G, Nehus EJ, Hooper DK, Mitsnefes MM. Masked hypertension and allograft function in pediatric and young adults kidney transplant recipients. Pediatr Transplant 2016; 20:1026-1031. [PMID: 27353352 DOI: 10.1111/petr.12752] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 11/27/2022]
Abstract
Masked hypertension is a common complication of pediatric kidney transplantation. While office hypertension is known to be associated with worse short- and long-term graft function, the role of masked hypertension in allograft dysfunction is not clear. We conducted a retrospective cross-sectional analysis of 77 consecutive pediatric kidney transplant recipients who had routine 24-h ambulatory blood pressure monitoring with the aims to estimate the prevalence of masked hypertension and examine its association with allograft function. Masked hypertension was defined as a 24-h systolic or diastolic blood pressure load ≥25%. Twenty-nine percent of patients had masked hypertension. Patients with masked hypertension had significantly lower allograft function estimated using the creatinine-based Schwartz-Lyon formula, a cystatin C-based formula, and combined cystatin C and creatinine-based formulas than patients with normal blood pressure (all p values <0.05). In a multivariable analysis, masked hypertension remained independently associated with worse allograft function after adjustment for age, sex, race, time post-transplant, rejection history, antihypertensive treatment, and hemoglobin level. We conclude that in young kidney transplant recipients, masked hypertension is common and is associated with worse allograft function. These results support the case for routine ambulatory blood pressure monitoring as the standard of care in these patients to detect and treat masked hypertension.
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Affiliation(s)
- Gilad Hamdani
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Edward J Nehus
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David K Hooper
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mark M Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Duclaux-Loras R, Bacchetta J, Berthiller J, Rivet C, Demède D, Javouhey E, Dubois R, Dijoud F, Lachaux A, Badet L, Boillot O, Cochat P. Pediatric combined liver-kidney transplantation: a single-center experience of 18 cases. Pediatr Nephrol 2016; 31:1517-29. [PMID: 27060059 DOI: 10.1007/s00467-016-3324-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 11/18/2015] [Accepted: 12/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Experience in combined liver-kidney transplantation (CLKT) in children is limited. METHODS We conducted a retrospective study of all pediatric CLKTs performed at our medical institution between 1992 and 2013. RESULTS We identified 18 pediatric patients (9 girls) who had undergone CLKT at our institution during the study period. The median age [range] and body weight [range] of this patient group was 3.6 [1.0-18.6] years and 13 [10-40] kg, respectively; 11 patients weighed <15 kg at the time of CLKT. Indications for CLKT were primary hyperoxaluria (PH1; n = 14), association of hepatic fibrosis and end-stage renal disease (n = 3) and methylmalonic acidemia (n = 1). In the early postoperative period, eight patients required dialysis. Median stay in the pediatric intensive care unit was 10 [6-29] days. One patient died from cardiovascular disease 10 years after CLKT. There were no liver graft losses despite six acute liver rejection episodes, whereas four kidney grafts were lost. At last follow-up (6 [0.5-21] years) for patients with a functioning renal graft, the glomerular filtration rate was 71 [26-146] mL/min/1.73 m(2). In PH1 patients, urine oxalate normalized in six patients within 3 years after CLKT, but three patients still presented with elevated oxaluria at 1, 2 and 3 years after CLKT. CONCLUSIONS Pediatric CLKT provides encouraging results in the long term, even in the youngest patients.
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Affiliation(s)
- Rémi Duclaux-Loras
- Centre de Référence des Maladies Rénales Rares Néphrogones, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
- Université Claude-Bernard Lyon 1, Lyon, France.
- Hépatologie Gastro-Entérologie et Nutrition Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron cedex, France.
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares Néphrogones, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Université Claude-Bernard Lyon 1, Lyon, France
| | - Julien Berthiller
- Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Christine Rivet
- Hépatologie Gastro-Entérologie et Nutrition Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron cedex, France
| | - Delphine Demède
- Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Etienne Javouhey
- Université Claude-Bernard Lyon 1, Lyon, France
- Réanimation Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Rémi Dubois
- Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Frédérique Dijoud
- Université Claude-Bernard Lyon 1, Lyon, France
- Anatomie Pathologique, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Alain Lachaux
- Université Claude-Bernard Lyon 1, Lyon, France
- Hépatologie Gastro-Entérologie et Nutrition Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron cedex, France
| | - Lionel Badet
- Université Claude-Bernard Lyon 1, Lyon, France
- Chirurgie Urologique et chirurgie de la transplantation, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Boillot
- Université Claude-Bernard Lyon 1, Lyon, France
- Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Pierre Cochat
- Centre de Référence des Maladies Rénales Rares Néphrogones, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Université Claude-Bernard Lyon 1, Lyon, France
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Association of Microalbuminuria with Metabolic Syndrome among Aged Population. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9241278. [PMID: 27200378 PMCID: PMC4856886 DOI: 10.1155/2016/9241278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 01/06/2023]
Abstract
Background. The impact of the various components of metabolic syndrome (MetS) on chronic kidney disease has been conflicting. We aim to investigate the association between MetS and microalbuminuria and identify the major contributing components of MetS that result in microalbuminuria in the Chinese aged population. Methods. A total of 674 adults aged 55–98 years (males: 266; mean age: 66.5 ± 7.5 years) were studied. MetS was defined by the 2004 Chinese Diabetes Society criteria and microalbuminuria by urine albumin-creatinine ratio (UACR) ≥3 mg/mmoL. Results. The prevalence of microalbuminuria was gradually increased with increasing number of MetS components (P < 0.05). In multivariate regression, after adjusting for age and sex, MetS was the strongest correlate of microalbuminuria (OR = 1.781, 95% CI = 1.226–2.587; P < 0.05) followed by the fasting plasma glucose (FPG) (OR = 1.217, 95% CI = 1.044–1.092; P < 0.05), systolic blood pressure (SBP) (OR = 1.011, 95% CI = 1.107–1.338; P < 0.05), and high-density lipoprotein cholesterol (HDL-C) (OR = 0.576, 95% CI = 0.348–0.953; P < 0.05). Conclusions. MetS is independently associated with microalbuminuria in the Chinese aged population. Elevated FPG is the most predominant component of metabolic syndrome associated with microalbuminuria followed by elevated SBP and reduced HDL-C.
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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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Mahmood I, Staschen CM. Prediction of Human Glomerular Filtration Rate from Preterm Neonates to Adults: Evaluation of Predictive Performance of Several Empirical Models. AAPS J 2016; 18:445-54. [PMID: 26801317 PMCID: PMC4779094 DOI: 10.1208/s12248-016-9868-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 01/05/2016] [Indexed: 12/16/2022] Open
Abstract
The objective of this study was to evaluate the predictive performance of several allometric empirical models (body weight dependent, age dependent, fixed exponent 0.75, a data-dependent single exponent, and maturation models) to predict glomerular filtration rate (GFR) in preterm and term neonates, infants, children, and adults without any renal disease. In this analysis, the models were developed from GFR data obtained from inulin clearance (preterm neonates to adults; n = 93) and the predictive performance of these models were evaluated in 335 subjects (preterm neonates to adults). The primary end point was the prediction of GFR from the empirical allometric models and the comparison of the predicted GFR with measured GFR. A prediction error within ±30% was considered acceptable. Overall, the predictive performance of the four models (BDE, ADE, and two maturation models) for the prediction of mean GFR was good across all age groups but the prediction of GFR in individual healthy subjects especially in neonates and infants was erratic and may be clinically unacceptable.
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Affiliation(s)
- Iftekhar Mahmood
- Division of Hematology Clinical Review Branch, Office of Blood Review & Research (OBRR), Center for Biologic Evaluation and Research, Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland, 20993-0002, USA.
| | - Carl-Michael Staschen
- Division of Hematology Clinical Review Branch, Office of Blood Review & Research (OBRR), Center for Biologic Evaluation and Research, Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland, 20993-0002, USA
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Selistre L, Rabilloud M, Cochat P, de Souza V, Iwaz J, Lemoine S, Beyerle F, Poli-de-Figueiredo CE, Dubourg L. Comparison of the Schwartz and CKD-EPI Equations for Estimating Glomerular Filtration Rate in Children, Adolescents, and Adults: A Retrospective Cross-Sectional Study. PLoS Med 2016; 13:e1001979. [PMID: 27023756 PMCID: PMC4811544 DOI: 10.1371/journal.pmed.1001979] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 02/09/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Estimating kidney glomerular filtration rate (GFR) is of utmost importance in many clinical conditions. However, very few studies have evaluated the performance of GFR estimating equations over all ages and degrees of kidney impairment. We evaluated the reliability of two major equations for GFR estimation, the CKD-EPI and Schwartz equations, with urinary clearance of inulin as gold standard. METHODS AND FINDINGS The study included 10,610 participants referred to the Renal and Metabolic Function Exploration Unit of Edouard Herriot Hospital (Lyon, France). GFR was measured by urinary inulin clearance (only first measurement kept for analysis) then estimated with isotope dilution mass spectrometry (IDMS)-traceable CKD-EPI and Schwartz equations. The participants' ages ranged from 3 to 90 y, and the measured GFRs from 3 to 160 ml/min/1.73 m2. A linear mixed-effects model was used to model the bias (mean ratio of estimated GFR to measured GFR). Equation reliability was also assessed using precision (interquartile range [IQR] of the ratio) and accuracy (percentage of estimated GFRs within the 10% [P10] and 30% [P30] limits above and below the measured GFR). In the whole sample, the mean ratio with the CKD-EPI equation was significantly higher than that with the Schwartz equation (1.17 [95% CI 1.16; 1.18] versus 1.08 [95% CI 1.07; 1.09], p < 0.001, t-test). At GFR values of 60-89 ml/min/1.73 m2, the mean ratios with the Schwartz equation were closer to 1 than the mean ratios with the CKD-EPI equation whatever the age class (1.02 [95% CI 1.01; 1.03] versus 1.15 [95% CI 1.13; 1.16], p < 0.001, t-test). In young adults (18-40 y), the Schwartz equation had a better precision and was also more accurate than the CKD-EPI equation at GFR values under 60 ml/min/1.73 m2 (IQR: 0.32 [95% CI 0.28; 0.33] versus 0.40 [95% CI 0.36; 0.44]; P30: 81.4 [95% CI 78.1; 84.7] versus 63.8 [95% CI 59.7; 68.0]) and also at GFR values of 60-89 ml/min/1.73 m2. In all patients aged ≥65 y, the CKD-EPI equation performed better than the Schwartz equation (IQR: 0.33 [95% CI 0.31; 0.34] versus 0.40 [95% CI 0.38; 0.41]; P30: 77.6 [95% CI 75.7; 79.5] versus 67.5 [95% CI 65.4; 69.7], respectively). In children and adolescents (2-17 y), the Schwartz equation was superior to the CKD-EPI equation (IQR: 0.23 [95% CI 0.21; 0.24] versus 0.33 [95% CI 0.31; 0.34]; P30: 88.6 [95% CI 86.7; 90.4] versus 29.4 [95% CI 26.8; 32.0]). This study is limited by its retrospective design, single-center setting with few non-white patients, and small number of patients with severe chronic kidney disease. CONCLUSIONS The results from this study suggest that the Schwartz equation may be more reliable than the CKD-EPI equation for estimating GFR in children and adolescents and in adults with mild to moderate kidney impairment up to age 40 y.
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Affiliation(s)
- Luciano Selistre
- Exploration Fonctionnelle Rénale et Métabolique, Groupement Hospitalier Est Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Coordenação de Aperfeiçoamento do Pessoal de Nível Superior (CAPES), Brasilia, Brazil
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Universidade de Caxias do Sul, Caxias do Sul, Brazil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
| | - Muriel Rabilloud
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Lyon, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Pierre Cochat
- Université de Lyon, Lyon, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
- UMR 5305, Biologie Tissulaire et Ingénierie Thérapeutique, Université Claude Bernard, Lyon, France
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France
| | - Vandréa de Souza
- Exploration Fonctionnelle Rénale et Métabolique, Groupement Hospitalier Est Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Coordenação de Aperfeiçoamento do Pessoal de Nível Superior (CAPES), Brasilia, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | - Jean Iwaz
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Lyon, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Sandrine Lemoine
- Exploration Fonctionnelle Rénale et Métabolique, Groupement Hospitalier Est Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- UMR 5305, Biologie Tissulaire et Ingénierie Thérapeutique, Université Claude Bernard, Lyon, France
- INSERM UMR 1060, Université Claude Bernard Lyon I, Lyon, France
| | - Françoise Beyerle
- Exploration Fonctionnelle Rénale et Métabolique, Groupement Hospitalier Est Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biochimie et Biologie Moléculaire, Groupement Hospitalier Est Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Carlos E. Poli-de-Figueiredo
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laurence Dubourg
- Exploration Fonctionnelle Rénale et Métabolique, Groupement Hospitalier Est Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Lyon, France
- UMR 5305, Biologie Tissulaire et Ingénierie Thérapeutique, Université Claude Bernard, Lyon, France
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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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Choi HY, Joo DJ, Song MK, Kim MS, Park HC, Kim YS, Kim BS. The Power of Renal Function Estimation Equations for Predicting Long-Term Kidney Graft Survival: A Retrospective Comparison of the Chronic Kidney Disease Epidemiology Collaboration and the Modification of Diet in Renal Disease Study Equations. Medicine (Baltimore) 2016; 95:e2682. [PMID: 26886606 PMCID: PMC4998606 DOI: 10.1097/md.0000000000002682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/04/2016] [Accepted: 01/09/2016] [Indexed: 01/06/2023] Open
Abstract
Evaluation of renal function using an accurate estimation equation is important for predicting long-term graft survival. We designed this retrospective cohort study to evaluate the predictive power of renal function estimation by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) study equations for graft survival. We reviewed data of 3290 adult kidney transplant recipients who underwent transplantation at a single center between April 1979 and September 2012. The reliability and agreement of chronic kidney disease (CKD) stages based on the estimated glomerular filtration rate (eGFR) as calculated by the CKD-EPI and MDRD equations were evaluated using Bland-Altman plots and Cohen weighted kappa analyses. The predictive power of CKD stages as classified by each equation for graft survival was investigated using Cox regression models. Additionally, Pearson and Spearman correlation coefficients were used to reveal the relationship between graft survival and eGFR equations. Of 3290 kidney transplant recipients, 3040 were included in the analysis. The mean follow-up duration was 128.08 ± 83.54 months, and 29.8% of participants were reclassified to higher eGFR categories by the CKD-EPI equation compared to the category classification by the MDRD equation. eGFR calculated using the MDRD equation was underestimated compared to that calculated using the CKD-EPI equation, based on the Bland-Altman plot. In Cohen weighted kappa analysis, agreement across CKD stages classified using the 2 equations was reliable, but all CKD stages classified using the MDRD equation appeared to be in lower eGFR categories than those classified using the CKD-EPI equation. Pearson and Spearman correlation analyses indicated that the CKD stage as classified by the CKD-EPI equation, but not the MDRD equation, was significantly correlated with the risk of graft failure. In multivariable Cox regression analysis for graft failure after adjustment for CKD stage as determined using the MDRD equation, but not the CKD-EPI equation, stage reclassification was significantly associated with a lower graft failure risk. Our data from this long-term follow-up study indicate that the CKD-EPI equation has a stronger predictive power for kidney graft survival than does the MDRD equation in transplantation settings.
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Affiliation(s)
- Hoon Young Choi
- From the Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea (HYC, HCP, BSK); Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea (DJJ, MSK, YSK); The Research Institute for Transplantation (DJJ, MSK, YSK, BSK); and Department of Biostatistics Collaboration Unit (MKS), Yonsei University College of Medicine, Seoul, Korea
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Kang M, Lee JK, Im YJ, Choi H, Park K. Predictive Factors of Chronic Kidney Disease in Patients with Vesicoureteral Reflux Treated Surgically and Followed after Puberty. J Urol 2015; 195:1100-6. [PMID: 26555955 DOI: 10.1016/j.juro.2015.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE We delineated clinical features and determined predictors of chronic kidney disease during long-term postpubertal followup in patients with vesicoureteral reflux treated surgically. MATERIALS AND METHODS We analyzed the data of 101 patients who were surgically treated for vesicoureteral reflux and had gone through puberty. Patients underwent preoperative and postoperative voiding cystourethrography to assess reflux status, and dimercaptosuccinic acid scan to assess renal cortical defects. We compared several variables preoperatively and postpubertally, including body mass index; blood urea nitrogen, creatinine and uric acid levels; estimated glomerular filtration rate; microalbuminuria; blood pressure; renal function and renal scarring. Kaplan-Meier analysis was used to predict chronic kidney disease-free survival rates throughout the followup periods. Cox regression model was adopted to identify independent predictors of chronic kidney disease. We defined chronic kidney disease as estimated glomerular filtration rate less than 60 ml/minute/1.73 m(2). RESULTS Median followup was 100.0 months (IQR 69.0 to 136.5). Median age was 16 years at last followup (IQR 14 to 18). A total of 11 patients (10.9%) were diagnosed with de novo chronic kidney disease during postpubertal followup. It is noteworthy that serum uric acid levels (HR 1.96) and presence of high grade reflux (HR 7.40) were significant predictors of chronic kidney disease on multivariate analysis. CONCLUSIONS In children who were treated surgically for vesicoureteral reflux preoperative uric acid levels and high grade reflux were independent predictors of de novo chronic kidney disease during postpubertal followup. Our results offer valuable information for predicting long-term renal outcomes in patients with vesicoureteral reflux treated surgically.
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Affiliation(s)
- Minyong Kang
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Jung Keun Lee
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Young Jae Im
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Hwang Choi
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Kwanjin Park
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea.
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