Abstract
Background
Glomerular filtration rate (GFR) is a key measure of kidney function but often inaccurately ascertained by serum creatinine and cystatin C in pediatrics. In this pilot trial, we evaluated the relationship between GFR calculated by using phase-contrast MRI (PC-MRI) biomarkers and GFR by 125I-iothalamate clearance in youth undergoing bone marrow transplantation (BMT).
Methods
A total of twenty-one pediatric BMT candidates (8–21 years of age) were recruited for a research kidney PC-MRI. After completion of 125I-iothalamate clearance, same-day PC-MRI measurements were completed of the kidney circulation without a gadolinium-based contrast agent. MRI included a non-contrast balanced-SSFP–triggered angiography to position ECG-gated breath-held 2D PC-MRI flow measurements (1.2 × 1.2 × 6 mm3). A multivariate model of MRI biomarkers estimating GFR (GFR-MRI) was selected using the elastic net approach.
Results
The GFR-MRI variables selected by elastic net included average heart rate during imaging (bpm), peak aorta flow below the kidney artery take-offs (ml/s), average kidney artery blood flow, average peak kidney vein blood flow, and average kidney vein blood flow (ml/s). The GFR-MRI model demonstrated strong agreement with GFR by 125I-iothalamate (R2 = 0.65), which was stronger than what was observed with eGFR by the full age spectrum and Chronic Kidney Disease in Children under 25 (CKiD U25) approaches.
Conclusion
In this pilot study, noninvasive GFR-MRI showed strong agreement with gold standard GFR in youth scheduled for BMT. Further work is needed to evaluate whether non-contrast GFR-MRI holds promise to become a superior alternative to eGFR and GFR by clearance techniques.
Graphical abstract
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
This brief report is limited to 6 co-authors, and thus, we would like to acknowledge Kristen J. Nadeau, M.D., M.S., in Pediatric Endocrinology, Laura Pyle, Ph.D., in Biostatistics, Takashi Fujiwara, Ph.D, and Nicholas Stence, M.D., in Radiology, and the entire Bone Marrow Transplant team at Children’s Hospital Colorado, and in particular Amy Keating, M.D., Michael Verneris, M.D., Hesham Eissa, M.D., Chris McKinney, M.D., Taizo Nakano, M.D., and Roger Giller, M.D.
Funding
This project was funded by a Novel Method Development grant from the CCTSI at the University of Colorado Anschutz Medical Campus (CTSA Grant UL1 TR002535, KL2 TR002534, & TL1 TR002533). P.B. receives salary and research support from NIDDK (R01 DK129211, R01 DK132399, R21 DK129720, K23 DK116720, UC2 DK114886), NHLBI (R01 HL165433), JDRF (3-SRA-2022–1097-M-B, 3-SRA-2022–1243-M-B, 3-SRA-2022–1230-M-B), the Boettcher Foundation, the American Heart Association (20IPA35260142), the Ludeman Family Center for Women’s Health Research at the University of Colorado, the Department of Pediatrics, Section of Endocrinology, and the Barbara Davis Center for Diabetes at University of Colorado School of Medicine. AJB receives funding from NHLBI (R01 HL133504).
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P.B. reports serving as a consultant for AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly, LG Chemistry, Sanofi, Novo Nordisk, and Horizon Pharma. P.B. also serves on the advisory boards and/or steering committees of AstraZeneca, Bayer, Boehringer Ingelheim, Novo Nordisk, and XORTX. The other authors have no relationships relevant to the contents of this paper to disclose.
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Barker, A.J., Berthusen, A., Vigers, T. et al. Estimation of glomerular filtration rate in a pediatric population using non-contrast kidney phase contrast magnetic resonance imaging. Pediatr Nephrol 38, 2877–2881 (2023). https://doi.org/10.1007/s00467-022-05832-7
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DOI: https://doi.org/10.1007/s00467-022-05832-7