Predicting glomerular filtration rate in kidney transplantation: are the K/DOQI guidelines applicable?
The kidney disease outcomes quality initiative (K/DOQI) guidelines introduced a classification of chronic kidney disease (CKD) based on the level of kidney function. In order to predict the glomerular filtration rate (GFR), they specifically recommended the use of the modification of diet in renal disease (MDRD) study and Cockcroft-Gault (C-G) equations. Since the performance of these estimates has been questioned, we sought to determine whether these recommendations might be applicable in renal transplantation. Following the K/DOQI methodology, we compared the GFR estimated by the MDRD and C-G equations with 476 inulin clearances performed in 284 renal transplant recipients. Even though the MDRD equations provided a better prediction than C-G formula, none of them reached the level of accuracy required by the K/DOQI standards. At least, 25% of the calculated GFR gave a prediction beyond 30% of the corresponding inulin clearance value. In addition, when classified according to their predicted GFR, less than two-thirds of the transplant patients turned out to be assigned to the correct stage of CKD. We conclude that, in renal transplantation, the predictive performance of both C-G and MDRD study equations appears to be particularly impaired and may potentially compromise the validity of the K/DOQI guidelines if implemented in their current form.
Mariat
Christophe
C
Service de Néphrologie, Dialyse et Transplantation Rénale et Laboratoire d'Explorations Fonctionnelles Rénales, Hôpital Nord, C-H-U de Saint-Etienne, Saint-Etienne, 42055 France. christophe.mariat@univ-st-etienne.fr
Alamartine
Eric
E
Afiani
Aida
A
Thibaudin
Lise
L
Laurent
Blandine
B
Berthoux
Patricia
P
De Filippis
Jean-Pierre
JP
Thibaudin
Damien
D
Mayor
Brice
B
Elessawy
Abdel Basset
AB
Berthoux
François
F
D015415:Biomarkers; D005919:Glomerular Filtration Rate; D006801:Humans; D007444:Inulin / Q000493:pharmacokinetics; D016030:Kidney Transplantation / Q000502:physiology* / Q000592:standards; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D016896:Treatment Outcome
D015415:Biomarkers; D007444:Inulin