Pierre Delanaye1,2, François Gaillard3, Jessica van der Weijden4, Geir Mjøen5, Ingela Ferhman-Ekholm6, Laurence Dubourg7, Natalie Ebert8, Elke Schaeffner8, Torbjörn Åkerfeldt9, Karolien Goffin10,11, Lionel Couzi12, Cyril Garrouste13, Lionel Rostaing14, Marie Courbebaisse15, Christophe Legendre16, Maryvonne Hourmant17, Nassim Kamar18, Etienne Cavalier19, Laurent Weekers1, Antoine Bouquegneau1, Martin H de Borst4, Christophe Mariat20, Hans Pottel21, Marco van Londen4. 1. Department of Nephrology-Dialysis-Transplantation, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium. 2. Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France. 3. Department of Nephrology, Bichat Hospital and University of Paris, Paris, France. 4. Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands. 5. Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital Rikshospitalet, Oslo, Norway. 6. Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden. 7. Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. 8. Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany. 9. Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden. 10. Department of Nuclear Medicine, University Hospital Leuven, Leuven, Belgium. 11. Department of Imaging and Pathology, KU Leuven, Leuven, Belgium. 12. Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France. 13. Nephrology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France. 14. Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation Department, CHU Grenoble-Alpes, Grenoble, France. 15. Physiology Department and INSERM, AP-HP, Georges Pompidou European Hospital, Paris, France. 16. Nephrolgy and Renal Transplantation Department, Necker Hospital and University of Paris, Paris, France. 17. Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France. 18. Departments of Clinical Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France. 19. Department of Clinical Chemistry, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium. 20. Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France. 21. Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium.
Abstract
OBJECTIVES: Most data on glomerular filtration rate (GFR) originate from subjects <65 years old, complicating decision-making in elderly living kidney donors. In this retrospective multi-center study, we calculated percentiles of measured GFR (mGFR) in donors <65 years old and extrapolated these to donors ≥65 years old. METHODS: mGFR percentiles were calculated from a development cohort of French/Belgian living kidney donors <65 years (n=1,983), using quantiles modeled as cubic splines (two linear parts joining at 40 years). Percentiles were extrapolated and validated in an internal cohort of donors ≥65 years (n=147, France) and external cohort of donors and healthy subjects ≥65 years (n=329, Germany, Sweden, Norway, France, The Netherlands) by calculating percentages within the extrapolated 5th-95th percentile (P5-P95). RESULTS: Individuals in the development cohort had a higher mGFR (99.9 ± 16.4 vs. 86.4 ± 14 and 82.7 ± 15.5 mL/min/1.73 m2) 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. CONCLUSIONS: We demonstrate that extrapolation of mGFR from younger donors is possible and might aid with decision-making in elderly donors.
OBJECTIVES: Most data on glomerular filtration rate (GFR) originate from subjects <65 years old, complicating decision-making in elderly living kidney donors. In this retrospective multi-center study, we calculated percentiles of measured GFR (mGFR) in donors <65 years old and extrapolated these to donors ≥65 years old. METHODS: mGFR percentiles were calculated from a development cohort of French/Belgian living kidney donors <65 years (n=1,983), using quantiles modeled as cubic splines (two linear parts joining at 40 years). Percentiles were extrapolated and validated in an internal cohort of donors ≥65 years (n=147, France) and external cohort of donors and healthy subjects ≥65 years (n=329, Germany, Sweden, Norway, France, The Netherlands) by calculating percentages within the extrapolated 5th-95th percentile (P5-P95). RESULTS: Individuals in the development cohort had a higher mGFR (99.9 ± 16.4 vs. 86.4 ± 14 and 82.7 ± 15.5 mL/min/1.73 m2) 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. CONCLUSIONS: We demonstrate that extrapolation of mGFR from younger donors is possible and might aid with decision-making in elderly donors.
Authors: Anna Maria Meyer; Lena Pickert; Annika Heeß; Ingrid Becker; Christine Kurschat; Malte P Bartram; Thomas Benzing; Maria Cristina Polidori Journal: Biomolecules Date: 2022-03-09