ESPN 53rd Annual Meeting

ESPN 2021


 
Which formulas using to estimate GFR in adolescents and young adults?
LAURENCE DUBOURG DERAIN 1 SANDRINE LEMOINE 1 BRUNO RANCHIN 2 AURELIA BERTHOLET-THOMAS 2 ANNE-LAURE SELLIER LECLERC 2 LAURENCE CHARDON 3 JUSTINE BACCHETTA 4

1- NEPHROLOGIE, DIALYSE, HYPERTENSION ET EXPLORATION FONCTIONNELLE RENALE, GROUPEMENT HOSPITALIER EDOUARD HERRIOT, HOSPICES CIVILS DE LYON, FRANCE UNIVERSITE CLAUDE BERNARD LYON 1, LYON, FRANCE
2- CENTRE DE REFERENCE DES MALADIES RENALES ET PHOSPHOCALCIQUES RARES, BRON, FRANCE; UNIVERSITE CLAUDE BERNARD LYON 1, LYON, FRANCE
3- SERVICE DE BIOCHIMIE ET BIOLOGIE MOLECULAIRE GRAND EST, HOSPICES CIVILS DE LYON,LYON, FRANCE
4- CENTRE DE REFERENCE DES MALADIES RENALES ET PHOSPHOCALCIQUES RARES, BRON, FRANCE; UNIVERSITE CLAUDE BERNARD LYON 1, LYON, FRANCE
 
Introduction:

Estimating glomerular filtration rate (eGFR) in adolescents and during the pediatric-to-adult transition period is challenging since performance of specific pediatric or adult equations is poor. Some authors suggested to use the average of pediatric and adult creatinine-based eGFR in young adults whereas others proposed equations designed to cover the whole life span. The aim of this study is to evaluate the performance of these various methods of GFR estimation in adolescents and during the transition period, namely between 13 and 25 years.

Material and methods:

Measured GFR (mGFR) was assessed in 1861 adolescents and young adults at various CKD stages (mean age 16.0±0.1years) by a reference method (inulin or iohexol clearance); plasma creatinine (Pcr) was determined by an IDMS-standardized assay. Mean mGFR was 87.0±0.7mL/min/1.73m2 [range12-209]. The performance of Schwartz2009(1), Schwartz-Lyon(2), CKDEPI(3), average(Schwartz2009-CKDEPI)(4), EKFC(5), CKDEPI40(6), LMR18(7), CKiDU25ct and CKiDagedep(8) was studied according to age groups (13-16 n=949; 16-18 n=685; 18-25 years n=227). Equation performance was assessed using bias and accuracy (P30%). 

Results:

Mean absolute bias in all the groups for Schwartz2009, Schwartz-Lyon, CKD-EPI, average(Schwartz2009-CKDEPI), EKFC, CKDEPI40, LMR18, CKiDU25ct, and CKiDagedep equation was 3.0±0.6, -1.8±0.6, 32.2±0.5, 17.6±0.5, 4.5±0.4 0.8±0.4, 1.2±0.4, -0.3±0.6 and 6.6±0.7 ml/min/1.73m², respectively. P30% was 83.6, 86.8, 38.8, 64.8, 84.1, 85.8, 88.2, 89.8 and 84.5 %, respectively. For Schwartz2009, Schwartz-Lyon, EKFC, LMR18 and CKiDagedep P30% was >80% in all groups, except in girls 18-25 years who displayed lower P30% (71.2, 77.9, 70.2, 76.9 , 73.1%, respectively). CKDEPI40 and CKiDU25ct  were the only equations with a comparable performance in all groups (P30% > 82%).

Conclusions:

CKDEPI40 and CKiDU25ct have better performance all over the age groups. However the use of the whole age span CKDEPI40 could prevent the implausible increase in eGFR when switching from pediatric to adult equations.(1) Schwartz CJASN 2009 (2) Carla De Souza PLoS One 2012 (3) Levey AJKD 2010 (4) Ng Kidney Int 2018 (5) Pottel  Annals of Internal Medicine 2020 (6) Björk Kidney Int 2021 (7) Björk Scand J Clin Lab Invest 2020 (8)Pierce Kidney Int 2021