Estimating glomerular filtration rate at the transition from pediatric to adult care
(2019) In Kidney International 95(5). p.1234-1243- 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... (More)
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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/1.73m
2
) 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/1.73m
2
), resulting in a mean change of 23 mL/min/1.73m
2
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/1.73m
2
, 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 m
2
/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.
- author
- organization
- publishing date
- 2019-02-28
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- estimated GFR, measured GFR, pediatric-adult transition, serum creatinine
- in
- Kidney International
- volume
- 95
- issue
- 5
- pages
- 1234 - 1243
- publisher
- Nature Publishing Group
- external identifiers
-
- pmid:30922665
- scopus:85063155095
- ISSN
- 0085-2538
- DOI
- 10.1016/j.kint.2018.12.020
- project
- Shrunken Pore Syndrome (SPS) - morbidity and mortality in a population with measured glomerular filtration rate (GFR)
- language
- English
- LU publication?
- yes
- id
- 22b1e90a-51fa-4977-ad11-cfbe45b6a377
- date added to LUP
- 2019-04-02 14:45:36
- date last changed
- 2024-04-16 03:07:17
@article{22b1e90a-51fa-4977-ad11-cfbe45b6a377,
abstract = {{<p><br>
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/1.73m <br>
<sup>2</sup><br>
) 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/1.73m <br>
<sup>2</sup><br>
), resulting in a mean change of 23 mL/min/1.73m <br>
<sup>2</sup><br>
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/1.73m <br>
<sup>2</sup><br>
, 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 m <br>
<sup>2</sup><br>
/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. <br>
</p>}},
author = {{Pottel, Hans and Björk, Jonas and Bökenkamp, Arend and Berg, Ulla and Åsling-Monemi, Kajsa and Selistre, Luciano and Dubourg, Laurence and Hansson, Magnus and Littmann, Karin and Jones, Ian and Sjöström, Per and Nyman, Ulf and Delanaye, Pierre}},
issn = {{0085-2538}},
keywords = {{estimated GFR; measured GFR; pediatric-adult transition; serum creatinine}},
language = {{eng}},
month = {{02}},
number = {{5}},
pages = {{1234--1243}},
publisher = {{Nature Publishing Group}},
series = {{Kidney International}},
title = {{Estimating glomerular filtration rate at the transition from pediatric to adult care}},
url = {{http://dx.doi.org/10.1016/j.kint.2018.12.020}},
doi = {{10.1016/j.kint.2018.12.020}},
volume = {{95}},
year = {{2019}},
}