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Human renal function maturation: a quantitative description using weight and postmenstrual age

Rhodin, Malin M.; Anderson, Brian J.; Peters, A. Michael; Coulthard, Malcolm G.; Wilkins, Barry; Cole, Michael; Chatelut, Etienne; Grubb, Anders LU ; Veal, Gareth J. and Keir, Michael J., et al. (2009) In Pediatric Nephrology 24(1). p.67-76
Abstract
This study pools published data to describe the increase in glomerular filtration rate (GFR) from very premature neonates to young adults. The data comprises measured GFR (using polyfructose, Cr-51-EDTA, mannitol or iohexol) from eight studies (n=923) and involved very premature neonates (22 weeks postmenstrual age) to adulthood (31 years). A nonlinear mixed effects approach (NONMEM) was used to examine the influences of size and maturation on renal function. Size was the primary covariate, and GFR was standardized for a body weight of 70 kg using an allometric power model. Postmenstrual age (PMA) was a better descriptor of maturational changes than postnatal age (PNA). A sigmoid hyperbolic model described the nonlinear relationship... (More)
This study pools published data to describe the increase in glomerular filtration rate (GFR) from very premature neonates to young adults. The data comprises measured GFR (using polyfructose, Cr-51-EDTA, mannitol or iohexol) from eight studies (n=923) and involved very premature neonates (22 weeks postmenstrual age) to adulthood (31 years). A nonlinear mixed effects approach (NONMEM) was used to examine the influences of size and maturation on renal function. Size was the primary covariate, and GFR was standardized for a body weight of 70 kg using an allometric power model. Postmenstrual age (PMA) was a better descriptor of maturational changes than postnatal age (PNA). A sigmoid hyperbolic model described the nonlinear relationship between GFR maturation and PMA. Assuming an allometric coefficient of 3/4, the fully mature (adult) GFR is predicted to be 121.2 mL/min per 70 kg [95% confidence interval (CI) 117-125]. Half of the adult value is reached at 47.7 post-menstrual weeks (95% CI 45.1-50.5), with a Hill coefficient of 3.40 (95% CI 3.03-3.80). At 1-year postnatal age, the GFR is predicted to be 90% of the adult GFR. Glomerular filtration rate can be predicted with a consistent relationship from early prematurity to adulthood. We propose that this offers a clinically useful definition of renal function in children and young adults that is independent of the predictable changes associated with age and size. (Less)
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Contribution to journal
publication status
published
subject
keywords
Renal function, Postmenstrual age, Lean body weight, Glomerular filtration rate, Body composition, Allometry, Fat-free mass
in
Pediatric Nephrology
volume
24
issue
1
pages
67 - 76
publisher
Springer
external identifiers
  • wos:000263064300010
  • scopus:59849122627
ISSN
1432-198X
DOI
10.1007/s00467-008-0997-5
language
English
LU publication?
yes
id
15bb8945-72b8-4bf4-b7a2-afd27f2aa67f (old id 1374829)
date added to LUP
2009-05-08 14:28:36
date last changed
2017-12-10 04:06:59
@article{15bb8945-72b8-4bf4-b7a2-afd27f2aa67f,
  abstract     = {This study pools published data to describe the increase in glomerular filtration rate (GFR) from very premature neonates to young adults. The data comprises measured GFR (using polyfructose, Cr-51-EDTA, mannitol or iohexol) from eight studies (n=923) and involved very premature neonates (22 weeks postmenstrual age) to adulthood (31 years). A nonlinear mixed effects approach (NONMEM) was used to examine the influences of size and maturation on renal function. Size was the primary covariate, and GFR was standardized for a body weight of 70 kg using an allometric power model. Postmenstrual age (PMA) was a better descriptor of maturational changes than postnatal age (PNA). A sigmoid hyperbolic model described the nonlinear relationship between GFR maturation and PMA. Assuming an allometric coefficient of 3/4, the fully mature (adult) GFR is predicted to be 121.2 mL/min per 70 kg [95% confidence interval (CI) 117-125]. Half of the adult value is reached at 47.7 post-menstrual weeks (95% CI 45.1-50.5), with a Hill coefficient of 3.40 (95% CI 3.03-3.80). At 1-year postnatal age, the GFR is predicted to be 90% of the adult GFR. Glomerular filtration rate can be predicted with a consistent relationship from early prematurity to adulthood. We propose that this offers a clinically useful definition of renal function in children and young adults that is independent of the predictable changes associated with age and size.},
  author       = {Rhodin, Malin M. and Anderson, Brian J. and Peters, A. Michael and Coulthard, Malcolm G. and Wilkins, Barry and Cole, Michael and Chatelut, Etienne and Grubb, Anders and Veal, Gareth J. and Keir, Michael J. and Holford, Nick H. G.},
  issn         = {1432-198X},
  keyword      = {Renal function,Postmenstrual age,Lean body weight,Glomerular filtration rate,Body composition,Allometry,Fat-free mass},
  language     = {eng},
  number       = {1},
  pages        = {67--76},
  publisher    = {Springer},
  series       = {Pediatric Nephrology},
  title        = {Human renal function maturation: a quantitative description using weight and postmenstrual age},
  url          = {http://dx.doi.org/10.1007/s00467-008-0997-5},
  volume       = {24},
  year         = {2009},
}