Kinetic Estimation of GFR Improves Prediction of Dialysis and Recovery after Kidney Transplantation.
BACKGROUND
The early prediction of delayed graft function (DGF) would facilitate patient management after kidney transplantation.


METHODS
In a single-centre retrospective analysis, we investigated kinetic estimated GFR under non-steady-state conditions, KeGFR, in prediction of DGF. KeGFR(sCr) was calculated at 4h, 8h and 12h in 56 recipients of deceased donor kidneys from initial serum creatinine (sCr) concentrations, estimated creatinine production rate, volume of distribution, and the difference between consecutive sCr values. The utility of KeGFR(sCr) for DGF prediction was compared with, sCr, plasma cystatin C (pCysC), and KeGFR(pCysC) similarly derived from pCysC concentrations.


RESULTS
At 4h, the KeGFR(sCr) area under the receiver operator characteristic curve (AUC) for DGF prediction was 0.69 (95% CI: 0.56-0.83), while sCr was not useful (AUC 0.56, (CI: 0.41-0.72). Integrated discrimination improvement analysis showed that the KeGFR(sCr) improved a validated clinical prediction model at 4h, 8h, and 12h, increasing the AUC from 0.68 (0.52-0.83) to 0.88 (0.78-0.99) at 12h (p = 0.01). KeGFR(pCysC) also improved DGF prediction. In contrast, sCr provided no improvement at any time point.


CONCLUSIONS
Calculation of KeGFR from sCr facilitates early prediction of DGF within 4 hours of renal transplantation.
Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Melbourne Medical School, University of Melbourne, Melbourne, Australia.
Timothy J
TJ
Pianta
Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Department of Medicine, University of Otago, Christchurch, New Zealand.
Zoltan H
ZH
Endre
Department of Medicine, University of Otago, Christchurch, New Zealand.
John W
JW
Pickering
Clinical Pharmacology, University of Sydney, Sydney, Australia.
Nicholas A
NA
Buckley
Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
Philip W
PW
Peake
D015415:Biomarkers; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D051799:Delayed Graft Function; D019468:Disease Management; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment
D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine