title: Renal function assessment in child and adolescent heart transplant recipients during routine cardiac catheterization.
abstract: CKD identification after pediatric heart transplantation (PHT) is limited by inaccuracies in estimates of GFR. We hypothesized that GFR can be measured by a modified iohexol clearance protocol in PHT recipients and that the CKiD formula provides a better estimate of GFR than other estimating equations. A cross-sectional study of PHT recipients, ages 2-18 yr, undergoing coronary angiography was undertaken. The angiography dose of iohexol was divided by the area under the curve from three iohexol levels post-infusion to calculate GFR. Agreement between iGFR and multiple estimating equations (eGFR) was assessed. In 31 subjects, median age was 15.0 yr (IQR 7.6, 16.6). Mean iGFR was 93.8 (s.d. 22.5) mL/min/1.73 m(2) ; 16 (52%) had an iGFR <90 mL/min/1.73 m(2) . The full CKiD formula (mean eGFR 88.9, s.d. 14.9) had low bias (-5.0), narrowest 95% limits of agreement (-42.0, 32.1), highest 30% (94%) and 10% (52%) accuracy, and highest correlation coefficient (0.576) relative to iGFR. We describe a novel modified iohexol clearance method to assess GFR after PHT. Over half of the cohort had an iGFR <90, suggesting CKD. The full CKiD formula performs best with respect to bias, accuracy, and correlation.
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Kimberly Y
authors.initials: KY
authors.lastname: Lin
authors.forename: Susan L
authors.initials: SL
authors.lastname: Furth
authors.forename: George J
authors.initials: GJ
authors.lastname: Schwartz
authors.forename: Robert E
authors.initials: RE
authors.lastname: Shaddy
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Ruebner
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications* / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007472:Iohexol / Q000737:chemistry; D007668:Kidney / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male
chemical_list: D007472:Iohexol
keywords: glomerular filtration rate; heart transplant; pediatric; renal