title: Predicting glomerular filtration rate in kidney transplantation: are the K/DOQI guidelines applicable?
abstract: 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.
authors.affiliation: 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
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariat
authors.forename: Eric
authors.initials: E
authors.lastname: Alamartine
authors.forename: Aida
authors.initials: A
authors.lastname: Afiani
authors.forename: Lise
authors.initials: L
authors.lastname: Thibaudin
authors.forename: Blandine
authors.initials: B
authors.lastname: Laurent
authors.forename: Patricia
authors.initials: P
authors.lastname: Berthoux
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: De Filippis
authors.forename: Damien
authors.initials: D
authors.lastname: Thibaudin
authors.forename: Brice
authors.initials: B
authors.lastname: Mayor
authors.forename: Abdel Basset
authors.initials: AB
authors.lastname: Elessawy
authors.forename: François
authors.initials: F
authors.lastname: Berthoux
mesh_terms: 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
chemical_list: D015415:Biomarkers; D007444:Inulin