Age-adapted percentiles of measured glomerular filtration in healthy individuals: extrapolation to living kidney donors over 65years.

Abstract

Most data on glomerular filtration rate (GFR) originate from subjects <65years old, complicating decision-making in elderly living kidney donors. In this retrospective multi-center study, we calculated percentiles of measured GFR (mGFR) in donors <65years old and extrapolated these to donors≥65years old. mGFR percentiles were calculated from a development cohort of French/Belgian living kidney donors <65years (n=1,983), using quantiles modeled as cubic splines (two linear parts joining at 40years). Percentiles were extrapolated and validated in an internal cohort of donors≥65years (n=147, France) and external cohort of donors and healthy subjects≥65years (n=329, Germany, Sweden, Norway, France, The Netherlands) by calculating percentages within the extrapolated 5th-95th percentile (P5-P95). Individuals in the development cohort had a higher mGFR (99.9±16.4 vs. 86.4±14 and 82.7±15.5mL/min/1.73m2) compared to the individuals in the validation cohorts. In the internal validation cohort, none (0%) had mGFR below the extrapolated P5, 12 (8.2%) above P95 and 135 (91.8%) between P5-P95. In the external validation cohort, five subjects had mGFR below the extrapolated P5 (1.5%), 25 above P95 (7.6%) and 299 (90.9%) between P5-P95. We demonstrate that extrapolation of mGFR from younger donors is possible and might aid with decision-making in elderly donors.