title: The impact of estimated glomerular filtration rate equations on chronic kidney disease staging in pediatric renal or heart transplant recipients.
abstract: The aim of this study was to evaluate the performance of selected pediatric estimated glomerular filtration rate (eGFR) equations in relation to the clinical management of children after renal or heart transplantation or post-chemotherapy treatment.
  
  
  
  This study was a retrospective cross-sectional analysis of 61 children whose glomerular function (GFR) had been determined using a single-dose inulin clearance (iGFR) method. Eight equations for estimating the GFR were evaluated for bias, agreement, accuracy, and clinical stratification.
  
  
  
  The outcome of all eight eGFR equations differed from the value determined using the iGFR method, with the mean bias ranging from -3.4 to 20.7 ml/min/1.73 m(2) and 90 % accuracy ranging from 16 to 26 %. All eGFR equations overestimated renal function in patients with decreased kidney function as determined by the iGFR method and underestimated renal function in patients with normal kidney function. Consequently, based on the eGFR values, patients with low GFR values according to the iGFR method were staged in a less severe chronic kidney disease (CKD) category, and patients with normal GFR values according to the iGFR method were staged in a more severe CKD category. The percentage of correctly classified patients ranged from 32.6 to 41.6 %.
  
  
  
  In our cohort we found the CKiDIII equation to be the best alternative to calculating the GFR using the inulin clearance method, closely followed by the Hoste and the revised Grubb equations. The performances of all eight eGFR equations assessed were moderate at best and only slightly better than the easy-to-do bedside Schwartz equation.
authors: Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Aram Ben
authors: AB
authors: Vroling
authors: Department of Pediatric Nephrology, Erasmus University Medical Center-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. e.dorresteijn@erasmusmc.nl.
authors: Eiske Margaretha
authors: EM
authors: Dorresteijn
authors: Department of Pediatric Nephrology, Erasmus University Medical Center-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
authors: Karlien
authors: K
authors: Cransberg
authors: Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Yolanda Brigitta
authors: YB
authors: de Rijke
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D016027:Heart Transplantation; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods*; D016030:Kidney Transplantation; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Chemotherapy; Children; Chronic kidney disease; Estimated glomerular filtration rate; Heart transplantation; Renal transplantation; Schwartz equation