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Article
Estimation of GFR in Patients With Cystic Fibrosis: A Cross-Sectional Study
Canadian Journal of Kidney Health and Disease
(2020)
Abstract
Background
Patients with cystic fibrosis (CF) have frequent infectious complications requiring nephrotoxic medications, necessitating monitoring of renal function. Although adult studies have suggested that cystatin C (CysC)-based estimated glomerular filtration rate (eGFR) may be preferable due to reduced muscle mass of patients with CF, pediatric patients remain understudied.
Objective
Our objective was to determine which eGFR formula is best for estimating glomerular filtration rate (GFR) in pediatric patients with CF.
Methods
A total of 17 patients with CF treated with nephrotoxic antibiotics were recruited from the Children's Hospital at London Health Sciences Centre, London, Ontario, Canada. 99Tc DTPA GFR (measured GFR [mGFR]) was measured with 4-point measurements starting at 120 minutes using a 2-compartmental model with Brøchner-Mortensen correction, with simultaneous measurement of creatinine, urea, and CysC. The eGFR was calculated using 16 known equations based on creatinine, urea, CysC, or combinations of these. Primary outcome measures were correlation with mGFR, and agreement within 10% for various eGFR equations.
Results
Mean mGFR was 136 ± 21 mL/min/1.73 m2. Mean creatinine, CysC, and urea were 38 ± 10 μmol/L, 0.72 ± 0.08 mg/L, and 3.9 ± 1.4 mmol/L, respectively. The 2014 Grubb CysC eGFR had the best correlation coefficient (r = 0.75, P = .0004); however, only 35% were within 10%. The new Schwartz formula with creatinine and urea had the best agreement within 10%, but a relatively low correlation coefficient (r = 0.63, P = .0065, 64% within 10%).
Conclusions
Our study suggests that none of the eGFR formulae work well in this small cohort of pediatric patients with CF with preserved body composition, possibly due to inflammation causing false elevations of CysC. Based on the small numbers, we cannot conclude which eGFR formula is best.
Keywords
99mTc DTPA clearance; GFR; creatinine; cystatin C; cystic fibrosis.
Disciplines
Publication Date
2020
Citation Information
Andrea Wallace, April Price, Erin Fleischer, Michael Khoury, et al.. "Estimation of GFR in Patients With Cystic Fibrosis: A Cross-Sectional Study" Canadian Journal of Kidney Health and Disease (2020) Available at: http://works.bepress.com/guido-filler/4/