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Estimated glomerular filtration rate is unreliable in detecting renal function loss during follow-up after cystectomy and urinary diversion

  • Urology - Original Paper
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Abstract

Purpose

To evaluate the accuracy of estimated glomerular filtration rate (eGFR) against the reference standard of isotopic GFR (iGFR) in monitoring renal function during follow-up after cystectomy and urinary diversion.

Methods

Patients who had undergone cystectomy and ileal conduit urinary diversion at two centres between August 2001 and August 2006 were identified. eGFR calculated using the MDRD formula was compared to 51Cr EDTA measured iGFR values measured at similar time-points during follow-up.

Results

Six hundred and fourteen paired iGFR and eGFR results were analysed from 166 patients (18 % female, median age 70 years). There was a significant difference between paired iGFR and eGFR measurements (p < 0.0001) with a mean bias of +1.8 mls/min/1.73m2 (SD 18.0) and a 95 % limit of agreement of −33.5 to 37.2 mls/min/1.73m2. iGFR and eGFR values converged at a GFR of approximately 45 mls/min/1.73m2. 70.6 % of patients experienced a loss of renal function greater than expected (>0.58 mls/min/1.73m2/year). In 22.4 % of these patients, a decline of greater than 10 % in iGFR occurred that was undetected by eGFR measurements, which overestimated GFR. There was no significant relationship between patient height, weight or body mass index and the accuracy of eGFR measurements.

Conclusions

iGFR measurement is recommended following ileal conduit urinary diversion if early signs of renal function loss are to be detected. eGFR overestimates GFR in critically relevant ranges and fails to detect loss in a clinically significant proportion of patients.

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Acknowledgments

No funding was obtained for the purposes of this study.

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Authors and Affiliations

  1. Department of Urology, The Christie Hospital, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK

    R. Robinson, C. D. Tait, M. W. Lau, V. K. Sangar, V. A. C. Ramani & N. W. Clarke

  2. Department of Urology, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK

    R. Robinson, C. D. Tait, P. Somov, M. W. Lau & N. W. Clarke

  3. University Hospital of South Manchester, Wythenshawe, Manchester, M23 9LT, UK

    V. K. Sangar & V. A. C. Ramani

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  1. R. Robinson
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  2. C. D. Tait
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  3. P. Somov
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  4. M. W. Lau
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  5. V. K. Sangar
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  6. V. A. C. Ramani
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  7. N. W. Clarke
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Corresponding author

Correspondence to R. Robinson.

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Conflict of interest

All of the authors declare that they have no conflicts of interest to declare.

Ethical approval

Ethical approval was not deemed necessary for the purposes of this study as it was based upon anonymised patient data and did not involve patient intervention or the use of human tissue samples.

Informed consent

Informed consent was not required for the purposes of this study as it was based upon anonymised patient data and did not involve patient intervention or the use of human tissue samples.

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Robinson, R., Tait, C.D., Somov, P. et al. Estimated glomerular filtration rate is unreliable in detecting renal function loss during follow-up after cystectomy and urinary diversion. Int Urol Nephrol 48, 511–515 (2016). https://doi.org/10.1007/s11255-016-1216-0

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  • DOI: https://doi.org/10.1007/s11255-016-1216-0

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