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Estimating glomerular filtration rate at the transition from pediatric to adult care

Pottel, Hans; Björk, Jonas LU ; Bökenkamp, Arend; Berg, Ulla; Åsling-Monemi, Kajsa; Selistre, Luciano; Dubourg, Laurence; Hansson, Magnus; Littmann, Karin and Jones, Ian, et al. (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)


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.

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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
  • scopus:85063155095
ISSN
0085-2538
DOI
10.1016/j.kint.2018.12.020
language
English
LU publication?
yes
id
22b1e90a-51fa-4977-ad11-cfbe45b6a377
date added to LUP
2019-04-02 14:45:36
date last changed
2019-06-27 14:05:20
@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},
  keyword      = {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},
  volume       = {95},
  year         = {2019},
}