Nikki Rink1, Michael Zappitelli. 1. Department of Pediatrics, McGill University Health Centre, Montreal Children's Hospital, 2300 Tupper, Room E-213, Montreal, QC, Canada, H3H 1P3.
Abstract
BACKGROUND: The current glomerular filtration rate (GFR) equation (CKiD) may be less accurate in adolescents and children with higher GFR. METHODS: This was a retrospective study (n = 161, 247 (99)mTc DTPA-GFRs). Six equations were evaluated for bias, accuracy, and low GFR diagnosis: (1) CKiD; (2) historic center; (3) Hoste(age); (4) Hoste(height); (5) modified Pottel; (6) Gao. Children with ≥ vs. <90 ml/min/1.73 m(2)) and < vs. ≥16 years were compared. Two adult equations were evaluated in children ≥16 years. RESULTS: Most equations underestimated GFR by 1-14 % in the higher GFR group, least so for Hoste(age). In the low GFR group, Hoste(age) and historic center overestimated GFR significantly more than CKiD (p < 0.05). Accuracy (within 30 % GFR) was similar across equations and GFR subgroups (66-86 %). In the ≥16 years group, CKiD underestimated GFR by ∼10 %, vs. ∼3 % for Hoste(height). Accuracy was 5-10 % lower in the older group and most equations were more sensitive than specific for detecting low GFR; this discrepancy was less for the Hoste equations. Adult equations were highly inaccurate. CONCLUSIONS: GFR estimation in older children and with higher GFR is suboptimal. The Hoste(height) may be an alternative GFR estimation method; Hoste(age) may allow for height-independent GFR estimation in patients with normal GFR.
BACKGROUND: The current glomerular filtration rate (GFR) equation (CKiD) may be less accurate in adolescents and children with higher GFR. METHODS: This was a retrospective study (n = 161, 247 (99)mTc DTPA-GFRs). Six equations were evaluated for bias, accuracy, and low GFR diagnosis: (1) CKiD; (2) historic center; (3) Hoste(age); (4) Hoste(height); (5) modified Pottel; (6) Gao. Children with ≥ vs. <90 ml/min/1.73 m(2)) and < vs. ≥16 years were compared. Two adult equations were evaluated in children ≥16 years. RESULTS: Most equations underestimated GFR by 1-14 % in the higher GFR group, least so for Hoste(age). In the low GFR group, Hoste(age) and historic center overestimated GFR significantly more than CKiD (p < 0.05). Accuracy (within 30 % GFR) was similar across equations and GFR subgroups (66-86 %). In the ≥16 years group, CKiD underestimated GFR by ∼10 %, vs. ∼3 % for Hoste(height). Accuracy was 5-10 % lower in the older group and most equations were more sensitive than specific for detecting low GFR; this discrepancy was less for the Hoste equations. Adult equations were highly inaccurate. CONCLUSIONS: GFR estimation in older children and with higher GFR is suboptimal. The Hoste(height) may be an alternative GFR estimation method; Hoste(age) may allow for height-independent GFR estimation in patients with normal GFR.
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Jennifer Palermo; Allison B Dart; Alanna De Mello; Prasad Devarajan; Ronald Gottesman; Gonzalo Garcia Guerra; Greg Hansen; Ari R Joffe; Cherry Mammen; Nick Majesic; Catherine Morgan; Peter Skippen; Michael Pizzi; Ana Palijan; Michael Zappitelli Journal: Pediatr Crit Care Med Date: 2017-06 Impact factor: 3.624
Authors: Hans Pottel; Liesbeth Hoste; Laurence Dubourg; Natalie Ebert; Elke Schaeffner; Bjørn Odvar Eriksen; Toralf Melsom; Edmund J Lamb; Andrew D Rule; Stephen T Turner; Richard J Glassock; Vandréa De Souza; Luciano Selistre; Christophe Mariat; Frank Martens; Pierre Delanaye Journal: Nephrol Dial Transplant Date: 2016-02-29 Impact factor: 5.992