Abstract
The aim of this study is to investigate the usefulness of the GFR-estimating equations to predict renal function in kidney donors before and after transplantation. We compared the performance of 24-hour-urine–based creatinine clearance (24 hr urine-CrCl), the Cockcroft-Gault formula (eGFRCG), the Modification of Diet in Renal Disease equation (eGFRMDRD), and the Chronic Kidney Disease Epidemiology Collaboration equation (eGFRCKD-EPI) with technetium-diethylenetriaminepentaacetic acid (99mTc-DTPA) clearance (mGFR) in 207 potential kidney donors and 108 uninephric donors. Before donation, eGFRCKD-EPI showed minimal bias and did not show a significant difference from mGFR (P = 0.65, respectively) while 24 hr urine-CrCl and eGFRMDRD significantly underestimated mGFR (P<0.001 for each). Precision and accuracy was highest in eGFRCKD-EPI and this better performance was more dominant when renal function is higher than 90 mL·min−1·1.73 m−2. After kidney donation, eGFRMDRD was superior to other equations in precision and accuracy in contrast to before donation. Within individual analysis, eGFRMDRD showed better performance at post-donation compared to pre-donation, but eGFRCKD-EPI and eGFRCG showed inferior performance at post-donation. In conclusion, eGFRCKD-EPI showed better performance compared to other equations before donation. In a uninephric donor, however, eGFRMDRD is more appropriate for the estimation of renal function than eGFRCKD-EPI.
Highlights
Assessment of renal function is a critical component of donor evaluation in kidney transplantation and regular monitoring of it is recommended for the long-term safety of kidney donors
The 2 equations most commonly used are the Modification of Diet in Renal Disease (MDRD) Study equation and the CockcroftGault (CG) formula. These formulas have some limitations for use in kidney donor workup, because they were developed based on data from patients with reduced renal function. [4,5,6] Recently, the Chronic Kidney Disease Epidemiology Collaboration developed a new equation (CKD-EPI)
This study investigated the performance of formulas for estimating mGFR in both the pre-donation state and the post-donation state
Summary
Assessment of renal function is a critical component of donor evaluation in kidney transplantation and regular monitoring of it is recommended for the long-term safety of kidney donors. [1] In many centers, measurement of GFR using the 125I-iothalamate GFR or technetium-99 m diethylenetriaminepentaacetic acid (99mTc DTPA) clearance is performed before kidney donation. [2,3] those studies are available only in a limited number of institutions. [2,3] those studies are available only in a limited number of institutions They are not feasible for the post-donation monitoring of GFR in everyday clinical practice. The 2 equations most commonly used are the Modification of Diet in Renal Disease (MDRD) Study equation and the CockcroftGault (CG) formula. These formulas have some limitations for use in kidney donor workup, because they were developed based on data from patients with reduced renal function. [7] Its aim was to eliminate the weak point of the MDRD formula and the underestimation of GFR; the data set of the CKD-EPI formula included many participants with normal GFR in the development process. During the validation process in several populations, it has shown greater precision and reliability compared with those of the MDRD formula, especially for subjects with GFR of .60 mL?min21?1.73 m22. [7,8,9]
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