Estimated or Measured GFR in Living Kidney Donors Work-up?
The value of estimated glomerular filtration rate (eGFR) in living kidney donors screening is unclear. A recently published web-based application derived from large cohorts, but not living donors, calculates the probability of a measured GFR (mGFR) lower than a determined threshold. Our objectives were to validate the clinical utility of this tool in a cohort of living donors and to test two other strategies based on chronic kidney disease epidemiology collaboration (CKD-EPI) and on MDRD-eGFR. GFR was measured using51Cr- ethylene-diamine tetraacetic acid urinary clearance in 311 potential living kidney donors (178 women, mean age 50 ± 11.6 years). The web-based tool was used to predict those with mGFR < 80 mL/min/1.73 m2. Inputs to the application were sex, age, ethnicity, and plasma creatinine. In our cohort, a web-based probability of mGFR <90 mL/min/1.73 m2higher than 2% had 100% sensitivity for detection of actual mGFR <80 mL/min/1.73 m2. The positive predictive value was 0.19. A CKD-EPI-eGFR threshold of 104 mL/min/1.73 m2and an MDRD-eGFR threshold of 100 mL/min/1.73 m2had 100% sensitivity to detect donors with actual mGFR <80 mL/min/1.73 m2. We obtained similar results in an external cohort of 354 living donors. We confirm the usefulness of the web-based application to identify potential donors who should benefit from GFR measurement.
AP-HP, Hôpital Necker-Enfants Malades, Renal Transplantation Department, Paris Descartes University, Paris, France.
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Gaillard
AP-HP, Hôpital Bichat, Department of Renal Physiology, DHU Fire and Paris Diderot University, Sorbonne Paris Cité, Paris, France.
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Flamant
Hospices civils de Lyon, Hôpital Edouard Herriot, Exploration fonctionnelle rénale Department and INSERM CARMEN 1060, University of Lyon, Lyon, France.
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Lemoine
AP-HP, Hôpital Européen Georges Pompidou, Physiology Department, Paris Descartes University, Paris, France.
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Baron
AP-HP, Hôpital Européen Georges Pompidou, Urology Department, Paris Descartes University, Paris, France.
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Timsit
AP-HP, Hôpital Européen Georges Pompidou, Physiology Department, Paris Descartes University, and INSERM, Unit 970, Paris, France.
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Eladari
AP-HP, Hôpital Necker-Enfants Malades, Renal Transplantation Department, Paris Descartes University, Paris, France.
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Fournier
AP-HP, Hôpital Européen Georges Pompidou, Physiology Department, Paris Descartes University, Paris, France.
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Prot-Bertoye
AP-HP, Hôpital Européen Georges Pompidou, Physiology Department, Paris Descartes University, Paris, France.
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JP
Bertocchio
AP-HP, Hôpital Bichat, Department of Renal Physiology, DHU Fire and Paris Diderot University, Sorbonne Paris Cité, Paris, France.
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Vidal-Petiot
AP-HP, Hôpital Necker-Enfants Malades, Anesthesia Department and Intensive Care Unit, Paris Descartes University, Paris, France.
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Lamhaut
Hospices civils de Lyon, Hôpital Edouard Herriot, Transplantation Department, INSERM U 851, University of Lyon, Centaure Network, Lyon, France.
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Morelon
AP-HP, Hôpital Saint-Louis, Department of Nephrology and Renal Transplantation, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
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Péraldi
AP-HP, Hôpital Bichat, Department of Nephrology, DHU Fire and Paris Diderot University, Sorbonne Paris Cité, Paris, France.
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Vrtovsnik
AP-HP, Hôpital Européen Georges Pompidou, Physiology Department, Paris Descartes University, and INSERM, Unit 1151, Paris, France.
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Friedlander
AP-HP, Hôpital Européen Georges Pompidou, Urology Department, Paris Descartes University, Paris, France.
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Méjean
AP-HP, Hôpital Européen Georges Pompidou, Physiology Department, Paris Descartes University, INSERM, Unit umrs1138, and CNRS Unit erl8228, Paris, France.
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Houillier
AP-HP, Hôpital Necker-Enfants Malades, Renal Transplantation Department, Paris Descartes University, Paris, France.
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Legendre
AP-HP, Hôpital Européen Georges Pompidou, Physiology Department, Paris Descartes University, and INSERM, Unit 1151, Paris, France.
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Courbebaisse
D000328:Adult; D015415:Biomarkers / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006305:Health Status Indicators; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
D015415:Biomarkers
clinical research/practice; donors and donation: donor evaluation; donors and donation: living; glomerular filtration rate (GFR); internet; kidney transplantation/nephrology