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Validation of child serum creatinine-based prediction equations for glomerular filtration rate

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Abstract

Equations for estimating glomerular filtration rate (GFR) are vital in caring for patients with renal disease and the current standard, the Schwartz formula, lacks precision. We evaluated several child serum creatinine-based GFR prediction equations. Subjects aged 2–21 years who underwent iothalamate GFR (IoGFR) testing between 1999 and 2004 were studied retrospectively. GFR was estimated using: (1) Schwartz formula (SchwartzGFR), using a local k value; (2) Schwartz model (SchwartzMod) using regression-derived coefficients; (3) Leger GFR (LegerGFR) using original coefficients; and (4) Leger model (LegerMod) using regression-derived coefficients. Bias, precision, and diagnostic characteristics were evaluated. There were 195 subjects [61% male; mean (SD) age 12.4 (4.5) years; mean (SD) IoGFR 78.9 (33.4) ml/min per 1.73 m2]. Only the LegerGFR overestimated IoGFR (5.5 ml/min per 1.73 m2). Precision for all formulae was poor (95% limits of agreement approximately −40 to 40 ml/min per 1.73 m2), but ≥72% of estimates were within 30% of IoGFR. Sensitivities for detecting IoGFR <30 and 90 ml/min per 1.73 m2 were highest using the SchwartzGFR (80%) and SchwartzMod (90%), respectively. The LegerGFR was most specific. Using local coefficients, the Schwartz and Leger models were imprecise estimates of GFR, but the Schwartz model was most unbiased and sensitive. Future research should derive more precise equations for GFR in children.

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Acknowledgments

The authors acknowledge the support of the Kidney Research Core Education and National Training (KRESCENT) program for the research fellowship support of Dr. Michael Zappitelli, during the period that much of the work for this study was performed. The address for request of reprints is: Montreal Children’s Hospital, 2300 Tupper Avenue, Room E-222, Montreal, Quebec, Canada, H3H 1P3.

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Authors and Affiliations

  1. Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Michael Zappitelli

  2. Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada

    Lawrence Joseph & Gilles Paradis

  3. Department of Pediatrics and Department of Genetics, MUHC, Montreal Children’s Hospital, Montreal, Quebec, Canada

    Indra R. Gupta

  4. Department of Pediatrics, MUHC, Montreal Children’s Hospital, Montreal, Quebec, Canada

    Lorraine Bell

  5. Care of Jennifer P. Martin, Montreal Children’s Hospital, 2300, Tupper Ave, Room E-222, Montreal, Quebec, H3H 1P3, Canada

    Michael Zappitelli

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  1. Michael Zappitelli
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  2. Lawrence Joseph
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  3. Indra R. Gupta
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  4. Lorraine Bell
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  5. Gilles Paradis
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Corresponding author

Correspondence to Michael Zappitelli.

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The work was performed at McGill University Health Centre, Montreal, Quebec, Canada.

There were no direct sources of support for this research. However, a significant portion was performed while Dr. Zappitelli was receiving research fellowship funding by the Kidney Research Scientist Core Education and National Training (KRESCENT) Program (Kidney Foundation of Canada, Canadian Society of Nephrology, and Canadian Institutes of Health Research).

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Zappitelli, M., Joseph, L., Gupta, I.R. et al. Validation of child serum creatinine-based prediction equations for glomerular filtration rate. Pediatr Nephrol 22, 272–281 (2007). https://doi.org/10.1007/s00467-006-0322-0

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  • DOI: https://doi.org/10.1007/s00467-006-0322-0

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