title: Estimated GFR for Living Kidney Donor Evaluation.
abstract: All living kidney donor candidates undergo evaluation of GFR. Guidelines recommend measured GFR (mGFR), using either an endogenous filtration marker or creatinine clearance, rather than estimated GFR (eGFR), but measurement methods are difficult, time consuming and costly. We investigated whether GFR estimated from serum creatinine (eGFRcr) with or without sequential cystatin C is sufficiently accurate to identify donor candidates with high probability that mGFR is above or below thresholds for clinical decision making. We combined the pretest probability for mGFR thresholds <60, <70, ≥80, and ≥90 mL/min per 1.73 m(2) based on demographic characteristics (from the National Health and Nutrition Examination Survey) with test performance of eGFR (categorical likelihood ratios from the Chronic Kidney Disease Epidemiology Collaboration) to compute posttest probabilities. Using data from the Scientific Registry of Transplant Recipients, 53% of recent living donors had predonation eGFRcr high enough to ensure ≥95% probability that predonation mGFR was ≥90 mL/min per 1.73 m(2) , suggesting that mGFR may not be necessary in a large proportion of donor candidates. We developed a Web-based application to compute the probability, based on eGFR, that mGFR for a donor candidate is above or below a range of thresholds useful in living donor evaluation and selection.
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, MA.|Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: N
authors.initials: N
authors.lastname: Huang
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, MA.
authors.forename: M C
authors.initials: MC
authors.lastname: Foster
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Saint Louis University, St. Louis, MO.
authors.forename: K L
authors.initials: KL
authors.lastname: Lentine
authors.affiliation: Division of Nephrology, Western University, London, Ontario, Canada.
authors.forename: A X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: E D
authors.initials: ED
authors.lastname: Poggio
authors.affiliation: Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN.
authors.forename: B L
authors.initials: BL
authors.lastname: Kasiske
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, MA.
authors.forename: L A
authors.initials: LA
authors.lastname: Inker
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, MA.
authors.forename: A S
authors.initials: AS
authors.lastname: Levey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006305:Health Status Indicators; D006801:Humans; D007668:Kidney / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000601:surgery*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine
keywords: clinical research; donor evaluation; donors and donation; kidney transplantation; living donor; nephrology; practice