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Updated height- and creatinine-based equation and its validation for estimation of glomerular filtration rate in children from developing countries

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Abstract

Background

Since the original Schwartz formula overestimates glomerular filtration rate (GFR), it is proposed that the constant (k) that accounts for the method of creatinine estimation be derived locally. We derived a new k for height (cm)/serum creatinine (mg/dl) (ht/scr) equation by regression analysis.

Methods

In a cross-sectional observational study, 197 children (2–18 years) with chronic kidney disease (CKD), who underwent reference GFR measurement by plasma clearance of diethylenetriamine pentaacetic acid (dGFR) at a tertiary care hospital, formed the index dataset for deriving the prediction equations for estimating GFR. Serum creatinine was estimated by the kinetic Jaffe method. The prediction equations were validated on a separate cohort of 225 children with CKD.

Results

The median creatinine was 0.7 mg/dl and dGFR was 80.5 (interquartile range 18.1–137.5) ml/min/1.73 m2. The new k (regression coefficient of height/creatinine) was 0.42 (R 2 = 0.61) and the updated equation was GFR = 0.42 × (ht/scr). Addition of age and mid-arm circumference (MAC) to this equation improved R 2 to 62.3%. Based on the above parameters, the new equation for estimating GFR was GFR (ml/min/1.73 m2) = 0.257 × [ht/scr]0.95 × [age (year)]−0.19 × [MAC (cm)]0.397.

The two equations performed comparably, with a mean bias <2 ml/min/1.73 m2. The updated ht/scr equation yielded 74% and 24% estimated GFR values that were within 30% and 10% of the measured dGFR, respectively.

Conclusions

The updated equation, with a k value of 0.42, provides a reasonably accurate bedside estimate of GFR in children in countries where creatinine is estimated by the kinetic Jaffe method.

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References

  1. Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol. 2009;4:1832–43.

    Article  PubMed  Google Scholar 

  2. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics. 1976;58:259–63.

    PubMed  CAS  Google Scholar 

  3. Seikaly MG, Browne R, Bajaj G, Arant BS Jr. Limitations to body length/serum creatinine ratio as an estimate of glomerular filtration in children. Pediatr Nephrol. 1996;10:709–11.

    Article  PubMed  CAS  Google Scholar 

  4. Hari P, Bagga A, Mahajan P, Lakshmy R. Effect of malnutrition on serum creatinine and cystatin C levels. Pediatr Nephrol. 2007;22:1757–61.

    Article  PubMed  Google Scholar 

  5. Skinner R, Cole M, Pearson AD, Keir MJ, Price L, Wyllie RA, et al. Inaccuracy of glomerular filtration rate estimation from height/plasma creatinine ratio. Arch Dis Child. 1994;70:387–90.

    Article  PubMed  CAS  Google Scholar 

  6. Guignard JP, Torrado A, Feldman H, Gautier E. Assessment of glomerular filtration rate in children. Helv Paediatr Acta. 1980;35:437–47.

    PubMed  CAS  Google Scholar 

  7. Hellerstein S, Alon U, Warady BA. Creatinine for estimation of glomerular filtration rate. Pediatr Nephrol. 1992;6:507–11.

    Article  PubMed  CAS  Google Scholar 

  8. Van Rossum LK, Mathor RA, Cransberg K, Zietse R, Vulto AG. Estimation of GFR in children: which algorithm should be used? Pediatr Nephrol. 2005;20:1769–75.

    Article  PubMed  Google Scholar 

  9. Brion LP, Boeck MA, Gauthier B, Nussbaum MP, Schwartz GJ. Estimation of glomerular filtration rate in anorectic adolescents. Pediatr Nephrol. 1989;3:16–21.

    Article  PubMed  CAS  Google Scholar 

  10. Hellerstein S, Berenbom M, DiMaggio S, Erwin P, Simon SD, Wilson N. Comparison of two formulae for estimation of glomerular filtration rate in children. Pediatr Nephrol. 2004;19:780–4.

    Article  PubMed  Google Scholar 

  11. Zappitelli M, Joseph L, Gupta IR, Bell L, Paradis G. Validation of child serum creatinine-based prediction equations for glomerular filtration rate. Pediatr Nephrol. 2007;22:272–81.

    Article  PubMed  Google Scholar 

  12. Mattman A, Eintracht S, Mock T, Schick G, Seccombe DW, Hurley RM, White CT. Estimating pediatric glomerular filtration rates in the era of chronic kidney disease staging. J Am Soc Nephrol. 2006;17:487–96.

    Article  PubMed  Google Scholar 

  13. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009;20:629–37.

    Article  PubMed  Google Scholar 

  14. Sutphen JL. Growth as a measure of nutritional status. J Pediatr Gastroenterol Nutr. 1985;4:169–81.

    Article  PubMed  CAS  Google Scholar 

  15. Du Bois D, Du Bois EF. Clinical calorimetry and formula to estimate the appropriate surface area if height and weight be known. Arch Int Med. 1916;17:863.

    Google Scholar 

  16. Piepsz A, Colarinha P, Gordon I, Hahn K, Olivier P, Sixt R, et al. Guidelines for glomerular filtration rate determination in children. Eur J Nucl Med. 2001;28(Suppl):BP31–BP36.

    Google Scholar 

  17. Romeo J. Evaluation of a kinetic method for creatinine. Lab Med. 1975;6:15–8.

    CAS  Google Scholar 

  18. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.

    Article  PubMed  CAS  Google Scholar 

  19. National Centre for Health Statistics, Centre for Disease Control. NHS growth curves for children: birth 18 years, Vol. 78. Washington DC: US Government—printing office. Series 11, 165, DHEW publications (PHS); 1978. p. 1650.

  20. Léger F, Bouissou F, Coulais Y, Tafani M, Chatelut E. Estimation of glomerular filtration rate in children. Pediatr Nephrol. 2002;17:903–7.

    Article  PubMed  Google Scholar 

  21. Vachvanichsanong P, Saeteu P, Geater A. Simple estimation of the glomerular filtration rate in sick Thai children. Nephrology (Carlton). 2003;8:251–5.

    Article  Google Scholar 

  22. Cattaneo F, Bisaz E, Cattaneo AB, Lüthy C, Laux-End R, Bianchetti MG. Precision of glomerular filtration estimation by height/creatinine ratio in the child. Nephrologie. 1996;17:329–32.

    PubMed  CAS  Google Scholar 

  23. Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am. 1987;34:571–90.

    PubMed  CAS  Google Scholar 

  24. Léger F, Séronie-Vivien S, Makdessi J, Lochon I, Delord JP, Sarda C, et al. Impact of the biochemical assay for serum creatinine measurement on the individual carboplatin dosing: a prospective study. Eur J Cancer. 2002;38:52–6.

    Article  PubMed  Google Scholar 

  25. Filler G, Lepage N. Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol. 2003;18:981–5.

    Article  PubMed  Google Scholar 

  26. Counahan R, Chantler C, Ghazali S, Kirkwood B, Rose F, Barratt TM. Estimation of glomerular filtration rate from plasma creatinine concentration in children. Arch Dis Child. 1976;51:875–8.

    Article  PubMed  CAS  Google Scholar 

  27. Morris MC, Allanby CW, Toseland P, Haycock GB, Chantler C. Evaluation of a height/plasma creatinine formula in the measurement of glomerular filtration rate. Arch Dis Child. 1982;57:611–5.

    Article  PubMed  CAS  Google Scholar 

  28. Wang F, Yao Y, Zhu SN, Huang JP, Xiao HJ, Ding J, et al. Evaluation of the applicability of three prediction equations for estimating glomerular filtration rate in children with chronic kidney disease. Zhonghua Er Ke Za Zhi. 2010;48:855–9.

    PubMed  Google Scholar 

  29. Staples A, LeBlond R, Watkins S, Wong C, Brandt J. Validation of the revised Schwartz estimating equation in a predominantly non-CKD population. Pediatr Nephrol. 2010;25:2321–6.

    Article  PubMed  Google Scholar 

  30. LaFrance ND, Drew HH, Walser M. Radioisotopic measurement of glomerular filtration rate in severe chronic renal failure. J Nucl Med. 1988;29:1927–30.

    PubMed  CAS  Google Scholar 

  31. Van Acker BA, Koomen GC, Arisz L. Drawbacks of the constant-infusion technique for measurement of renal function. Am J Physiol. 1995;268:F543–52.

    PubMed  Google Scholar 

  32. Coresh J, Astor BC, McQuillan G, Kusek J, Greene T, Van Lente F, et al. Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate. Am J Kidney Dis. 2002;39:920–9.

    Article  PubMed  CAS  Google Scholar 

  33. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(Suppl 1):S1–S266.

    Google Scholar 

  34. Tidman M, Sjostrom P, Jones I. A comparison of GFR estimating formulae based upon s-cystatin C and s-creatinine and a combination of the two. Nephrol Dial Transplant. 2008;23:154–60.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Pankaj Hari, Bivas Biswas & Arvind Bagga

  2. Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Ravindra Pandey & Mani Kalaivani

  3. Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Rakesh Kumar

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  1. Pankaj Hari
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  2. Bivas Biswas
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  6. Arvind Bagga
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Correspondence to Pankaj Hari.

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Hari, P., Biswas, B., Pandey, R. et al. Updated height- and creatinine-based equation and its validation for estimation of glomerular filtration rate in children from developing countries. Clin Exp Nephrol 16, 697–705 (2012). https://doi.org/10.1007/s10157-012-0618-2

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  • DOI: https://doi.org/10.1007/s10157-012-0618-2

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