Assessment of kidney function in lung transplant candidates.
BACKGROUND
Glomerular filtration rate (GFR) is the best measure of kidney function; however, 24-hour creatinine clearance (CrCl) is the initial screening test used for lung transplant candidates at most centers. Although creatinine-based formulas that estimate GFR have been derived, none have been validated in patients with severe lung disease.


METHODS
We performed a retrospective cohort study of patients evaluated for lung transplantation at Columbia Presbyterian Medical Center and compared the GFR estimated from the Modification of Diet in Renal Disease (MDRD) and other formulas to the CrCl. We then validated these results in a cohort of patients evaluated at the Hospital of the University of Pennsylvania.


RESULTS
There were strong and statistically significant direct correlations between estimated GFR and CrCl. An estimated GFR of <95 ml/min by the MDRD was very sensitive at detecting kidney dysfunction by CrCl in the derivation cohort. In the validation cohort, the negative predictive value of this cut-off was 97%.


CONCLUSIONS
Established formulas for estimating GFR are highly discriminating for kidney dysfunction in patients being evaluated for lung transplantation and may actually have greater validity than CrCl in some instances.
Al-Naamani
Nadine
N
Lung Transplant Program, Columbia University, New York, New York 10032, USA.
Maarouf
Omar H
OH
Ahya
Vivek N
VN
Lederer
David J
DJ
Mendez
James D
JD
Wilt
Jessie S
JS
Doyle
Alden M
AM
Rybak
Debbie
D
D'Ovidio
Frank
F
Sonett
Joshua R
JR
Arcasoy
Selim M
SM
Nickolas
Thomas L
TL
Kawut
Steven M
SM
D000328:Adult; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000503:physiopathology*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D003404:Creatinine