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Estimation of glomerular filtration rate with and without height: effect of age and renal function level

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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 99mTc 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 m2) 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.

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References

  1. Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637

    Article  PubMed Central  PubMed  Google Scholar 

  2. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263

    CAS  PubMed  Google Scholar 

  3. Pierrat A, Gravier E, Saunders C, Caira MV, Ait-Djafer Z, Legras B, Mallie JP (2003) Predicting GFR in children and adults: a comparison of the Cockcroft-Gault, Schwartz, and modification of diet in renal disease formulas. Kidney Int 64:1425–1436

    Article  PubMed  Google Scholar 

  4. Chehade H, Girardin E, Iglesias K, Ramseyer P, Frey P, Bardy D, Mosig D, Cachat F (2013) Assessment of adult formulas for glomerular filtration rate estimation in children. Pediatr Nephrol 28:105–114

    Article  PubMed  Google Scholar 

  5. Azzi A, Cachat F, Faouzi M, Mosig D, Ramseyer P, Girardin E, Chehade H (2014) Is there an age cutoff to apply adult formulas for GFR estimation in children? J Nephrol. doi:10.1007/s40620-014-0148-y

    PubMed  Google Scholar 

  6. Zappitelli M, Zhang X, Foster BJ (2010) Estimating glomerular filtration rate in children at serial follow-up when height is unknown. Clin J Am Soc Nephrol 5:1763–1769

    Article  PubMed Central  PubMed  Google Scholar 

  7. Pottel H, Hoste L, Martens F (2012) A simple height-independent equation for estimating glomerular filtration rate in children. Pediatr Nephrol 27:973–979

    Article  PubMed  Google Scholar 

  8. Pottel H, Vrydags N, Mahieu B, Vandewynckele E, Croes K, Martens F (2008) Establishing age/sex related serum creatinine reference intervals from hospital laboratory data based on different statistical methods. Clin Chim Acta 396:49–55

    Article  CAS  PubMed  Google Scholar 

  9. Pottel H, Mottaghy FM, Zaman Z, Martens F (2010) On the relationship between glomerular filtration rate and serum creatinine in children. Pediatr Nephrol 25:927–934

    Article  PubMed  Google Scholar 

  10. Blufpand HN, Westland R, van Wijk JA, Roelandse-Koop EA, Kaspers GJ, Bokenkamp A (2013) Height-independent estimation of glomerular filtration rate in children: an alternative to the Schwartz equation. J Pediatr 163:1722–1727

    Article  PubMed  Google Scholar 

  11. Hoste L, Dubourg L, Selistre L, De Souza VC, Ranchin B, Hadj-Aissa A, Cochat P, Martens F, Pottel H (2014) A new equation to estimate the glomerular filtration rate in children, adolescents and young adults. Nephrol Dial Transplant 29:1082–1091

    Article  CAS  PubMed  Google Scholar 

  12. Zappitelli M, Parvex P, Joseph L, Paradis G, Grey V, Lau S, Bell L (2006) Derivation and validation of cystatin C-based prediction equations for GFR in children. Am J Kidney Dis 48:221–230

    Article  CAS  PubMed  Google Scholar 

  13. Gao A, Cachat F, Faouzi M, Bardy D, Mosig D, Meyrat BJ, Girardin E, Chehade H (2013) Comparison of the glomerular filtration rate in children by the new revised Schwartz formula and a new generalized formula. Kidney Int 83:524–530

    Article  CAS  PubMed  Google Scholar 

  14. Zappitelli M, Joseph L, Gupta IR, Bell L, Paradis G (2007) Validation of child serum creatinine-based prediction equations for glomerular filtration rate. Pediatr Nephrol 22:272–281

    Article  PubMed  Google Scholar 

  15. National High Blood Pressure Education Program Working Group on High Blood Pressure in C, Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

  16. KDOQI; National Kidney Foundation (2006) KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis 47:S11–145

    Article  Google Scholar 

  17. Piepsz A, Colarinha P, Gordon I, Hahn K, Olivier P, Roca I, Sixt R, van Velzen J, Paediatric Committee of the European Association of Nuclear M (2001) Guidelines for 99mTc-DMSA scintigraphy in children. Eur J Nucl Med 28:BP37–41

    CAS  PubMed  Google Scholar 

  18. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  CAS  PubMed  Google Scholar 

  19. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, Ckd EPI (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    Article  PubMed Central  PubMed  Google Scholar 

  20. Fadrowski JJ, Neu AM, Schwartz GJ, Furth SL (2011) Pediatric GFR estimating equations applied to adolescents in the general population. Clin J Am Soc Nephrol 6:1427–1435

    Article  PubMed Central  PubMed  Google Scholar 

  21. Staples A, LeBlond R, Watkins S, Wong C, Brandt J (2010) Validation of the revised Schwartz estimating equation in a predominantly non-CKD population. Pediatr Nephrol 25:2321–2326

    Article  PubMed  Google Scholar 

  22. Bacchetta J, Cochat P, Rognant N, Ranchin B, Hadj-Aissa A, Dubourg L (2011) Which creatinine and cystatin C equations can be reliably used in children? Clin J Am Soc Nephrol 6:552–560

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Pottel H, Hoste L, Delanaye P, Cavalier E, Martens F (2012) Demystifying ethnic/sex differences in kidney function: is the difference in (estimating) glomerular filtration rate or in serum creatinine concentration? Clin Chim Acta 413:1612–1617

    Article  CAS  PubMed  Google Scholar 

  24. Filler G, Foster J, Acker A, Lepage N, Akbari A, Ehrich JH (2005) The Cockcroft-Gault formula should not be used in children. Kidney Int 67:2321–2324

    Article  PubMed  Google Scholar 

  25. Selistre L, De Souza V, Cochat P, Antonello IC, Hadj-Aissa A, Ranchin B, Dolomanova O, Varennes A, Beyerle F, Bacchetta J, Dubourg L (2012) GFR estimation in adolescents and young adults. J Am Soc Nephrol 23:989–996

    Article  CAS  PubMed  Google Scholar 

  26. Pottel H, Hoste L, Delanaye P (2014) Abnormal glomerular filtration rate in children, adolescents and young adults starts below 75 mL/min/1.73 m. Pediatr Nephrol. doi:10.1007/s00467-014-3002-5

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, McGill University Health Centre, Montreal Children’s Hospital, 2300 Tupper, Room E-213, Montreal, QC, Canada, H3H 1P3

    Nikki Rink & Michael Zappitelli

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  1. Nikki Rink
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  2. Michael Zappitelli
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Correspondence to Michael Zappitelli.

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Rink, N., Zappitelli, M. Estimation of glomerular filtration rate with and without height: effect of age and renal function level. Pediatr Nephrol 30, 1327–1336 (2015). https://doi.org/10.1007/s00467-015-3063-0

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  • DOI: https://doi.org/10.1007/s00467-015-3063-0

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