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Application of GFR estimating equations to children with normal, near-normal, or discordant GFR

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Abstract

Background

The objective was to determine the extent that eGFR formulas correspond to measured plasma iohexol clearance (iGFR) in children with normal or near normal kidney function, particularly how different eGFR formulas yield discordant results.

Methods

iGFR from 2 (iGFR-2pt) and 4 (iGFR-4pt) time points along with creatinine and/or cystatin C-based eGFR were measured in children with mild CKD, stages 1–2. eGFR was calculated using 6 equations: 3 under 25 (U25) formulas from the Chronic Kidney Disease in Children (CKiD) study, the full age-combined cystatin C (cysC) and creatinine spectrum (FAS-combined), the European Kidney Function Consortium (EKFC-creatinine) equation, and the Chronic Kidney Disease Epidemiology Collaboration (CKD-epi) cysC-based equation.

Results

Twenty-nine children were included, of which 22 had discordant creatinine vs. cystatin C-based eGFR by ≥ 15mL/min/1.73 m2. Overall, the FAS-combined had the least bias, while the U25 most accurately identified children with an eGFR < 90 mL/min/1.73 m2. When Cr-eGFR was ≥ 15 mL/min higher than CysC-eGFR, the U25 creatinine eGFR was closest to iGFR-4pt. When CysC eGFR was higher, the U25-combined was closest to iGFR-4pt.

Conclusion

The formulas that most closely approximated the measured GFR varied depending on the pattern of discordant eGFR results. Based on the results, we recommend using the CKiD U25-combined formula to screen for children with a low GFR. Either the CKiD U25-combined or FAS-combined would be recommended for changes in eGFR longitudinally. However, because all formulas were discordant from the iGFR-4pt in over a third of participants, further refinement of pediatric eGFR formulas is needed at the normal/near-normal range.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, Indiana University, Indianapolis, USA

    Andrew L. Schwaderer

  2. Department of Pediatrics, Division of Nephrology, University of Rochester Medical Center, Room 4-8105, 601 Elmwood Avenue, Box 777, Rochester, NY, 14642, USA

    Paula Maier & George J. Schwartz

  3. Department of Pediatrics, Division of Nephrology, Emory University and Children’s Healthcare of Atlanta, Atlanta, USA

    Larry A. Greenbaum

  4. Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, and the Children’s Hospital of Philadelphia, Philadelphia, USA

    Susan L. Furth

Authors
  1. Andrew L. Schwaderer
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  2. Paula Maier
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  3. Larry A. Greenbaum
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  4. Susan L. Furth
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  5. George J. Schwartz
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Correspondence to George J. Schwartz.

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Schwaderer, A.L., Maier, P., Greenbaum, L.A. et al. Application of GFR estimating equations to children with normal, near-normal, or discordant GFR. Pediatr Nephrol 38, 4051–4059 (2023). https://doi.org/10.1007/s00467-023-06045-2

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  • DOI: https://doi.org/10.1007/s00467-023-06045-2

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