Performance of creatinine-based glomerular filtration rate estimating equations in solid-organ transplant recipients.

摘要

Accurate assessment of kidney function is of critical importance for the management of solid-organ transplant recipients. In the general population, glomerular filtration rate (GFR) is most commonly estimated using the Chronic Kidney Disease-Epidemiology (CKD-EPI) equation and the Modification of Diet in Renal Disease (MDRD) Study equation. However, the accuracy of these and other GFR estimating equations in solid organ transplant recipients has not been carefully studied and there has been some hesitation among transplant physicians to use them. We performed a comprehensive review to identify all published creatinine-based eGFR equations and compared their performance to the CKD-EPI equation and the MDRD Study equation in a cohort of solid organ transplant recipients, all of whom had GFR measured (mGFR) by a gold standard method. Performance was evaluated using absolute bias (mean absolute error), P30 and P20 (absolute percent error less than 30% and 20% respectively). We also assessed the influence of various subject and equation level characteristics on equation performance. A total of 26 equations were included in the systematic review and were tested in the solid organ transplant recipient cohort (n=2050, mean age 53 years, mean mGFR 55 ml/min/1.73 m 2 BSA). The CKD-EPI equation was the most accurate (P30 0.79; 99% CI 0.77, 0.81) followed by the MDRD Study equation (P 30 0.78; CI 0.75, 0.8). The CKD-EPI and the MDRD Study equation performed better than or as well as the alternative equations in various categories based on subject characteristics. Equations that were developed using >1000 subjects or included race variable were more accurate than those developed on smaller cohorts or did not included race. In solid organ transplant recipients, the CKD-EPI and the MDRD Study equations perform as well as or better than alternative equations. Since the CKD-EPI and the MDRD are the preferred equations in the general population, practical reasons support their use in transplant patients.