Performance of different prediction equations for estimating renal function in kidney transplantation.
Numerous formulas have been developed to estimate renal function from biochemical, demographic and anthropometric data. Here we compared renal function derived from 12 published prediction equations with glomerular filtration rate (GFR) measurement by plasma iohexol clearance as reference method in a group of 81 renal transplant recipients enrolled in the Mycophenolate Mofetil Steroid Sparing (MY.S.S.) trial. Iohexol clearances and prediction equations were carried out in all patients at months 6, 9 and 21 after surgery. All equations showed a tendency toward GFR over-estimation: Walser and MDRD equations gave the best performance, however not more than 45% of estimated values were within +/-10% error. These formulas showed also the lowest bias and the highest precision: 0.5 and 9.2 mL/min/1.73 m2 (Walser), 2.7 and 10.4 mL/min/1.73 m2 (MDRD) in predicting GFR. A significantly higher rate of GFR decline ranging from -5.0 mL/min/1.73 m2/year (Walser) to -7.4 mL/min/1.73 m2/year (Davis-Chandler) was estimated by all the equations as compared with iohexol clearance (-3.0 mL/min/1.73 m2/year). The 12 prediction equations do not allow a rigorous assessment of renal function in kidney transplant recipients. In clinical trials of kidney transplantation, graft function should be preferably monitored using a reference method of GFR measurement, such as iohexol plasma clearance.
Department of Medicine and Transplantation, Azienda Ospedaliera, Ospedali Riuniti di Bergamo, Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
Flavio
F
Gaspari
Silvia
S
Ferrari
Nadia
N
Stucchi
Emmanuel
E
Centemeri
Fabiola
F
Carrara
Marisa
M
Pellegrino
Giulia
G
Gherardi
Eliana
E
Gotti
Giuseppe
G
Segoloni
Maurizio
M
Salvadori
Paolo
P
Rigotti
Umberto
U
Valente
Donato
D
Donati
Silvio
S
Sandrini
Vito
V
Sparacino
Giuseppe
G
Remuzzi
Norberto
N
Perico
D000328:Adult; D002102:Cadaver; D003710:Demography; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007472:Iohexol / Q000493:pharmacokinetics; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D014019:Tissue Donors
D007472:Iohexol