Comparison of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD) Study Equations and A Formula Based on Cystatin-C and Serum Creatinine for the Estimation of Glomerular Filtration Rate in Patients with Multiple Myeloma; Is It Time to Change From MDRD to CKD-EPI Equation?

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5091-5091
Author(s):  
Meletios Athanasios Dimopoulos ◽  
Efstathios Kastritis ◽  
Eirini Katodritou ◽  
Anastasia Pouli ◽  
Eurydiki Michalis ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Filtration Rate ◽  
Newly Diagnosed ◽  
Mdrd Equation ◽  
Ckd Stage ◽  
Stage 1

Abstract Abstract 5091 Renal impairment (RI) is a frequent complication in multiple myeloma (MM). The IMWG has recommended the use of the MDRD formula for the estimation of glomerular filtration rate (GFR) in MM patients with stabilized serum creatinine (sCr) and the classification of these patients in the 5 stages of RI, according to the KDIGO classification (Dimopoulos et al, JCO 2010;28:4976–84). Because MDRD equation has limitations, especially in the normal or near-normal GFR range, other prediction equations based on serum cystatin-C (cys-C), a very sensitive GFR surrogate marker, have been suggested for use in patients with CKD. Furthermore, the CKD-EPI has proposed a new formula for the estimation of GFR, which is based on age, race and sCr, and it seems to be more accurate than the MDRD equation in the estimation of GFR in CKD and in kidney transplant patients (Levey et al, Ann Intern Med 2009;150:604–12). The aim of this study was to evaluate the renal function of newly diagnosed patients with symptomatic MM using the MDRD, the CKD-EPI equations and an equation based on Cys-C/age/sCr (Stevens et al, Am J Kidney Dis 2008;51:395–406) and explore their prognostic value on survival. We studied 204 newly-diagnosed, previously untreated, symptomatic MM patients. The median age was 69 years (range: 36–94 years); 62% of patients were >65 years of age, 57% were males and 16% had sCr ≥2 mg/dl. Serum Cys-C was measured using a latex particle-enhanced nephelometric immunoassay (Dade Behring, Liederbach, Germany). Serum Cys-C was increased in MM patients compared to 52 age- and gender-matched controls [median: 1.07 mg/l vs. 0.72 mg/l, p<0.0001]. The median values for eGFR calculated by the MDRD, the Cys-C/age/sCr and the CKD-EPI equations were 63.95 ml/min/1.73m2, 68.08 ml/min/1.73m2 and 56.5 ml/min/1.73 m2, respectively (p<0.01 for all comparisons between equations). Patients were divided in the 5 CKD stages of KDIGO classification, according to eGFR (stage 1: eGFR >90 ml/min/1.73 m2; stage 2: 60–89 ml/min/1.73m2; stage 3: 30–59 ml/min/1.73 m2; stage 4: 15–29 ml/min/1.73 m2; stage 5: <15 ml/min/1.73 m2 or on dialysis). For each studied equation, the number of patients with RI stage 3–5 (i.e. eGFR <60 ml/min/1.732) was 43% for MDRD vs. 42% for Cys-C/age/sCr vs. 53% for CKD-EPI (p<0.001; see also the table). Concordance for CKD stage allocation for the three equations of estimating eGFR was 68% for MDRD vs. CKD-EPI, 68% for MDRD vs. Cys-C/age/creatinine and 61% for CKD-EPI vs. Cys-C/age/sCr (see also the table). A significant correlation was found between ISS stage and MDRD, Cys/age/creatinine and CKD-EPI calculated eGFR (p<0.001 for all). The median survival for all patients was 49 months. Overall survival was significantly shorter for patients with CKD stage 3, 4 or 5, calculated by the different studied equations, compared to those with CKD stage 1 or 2 (p<0.01 for all equations). Thus, we pooled patients with CKD stages 1 and 2 and CKD stages 3–5 for survival analysis. By using the eGFR of 60 ml/min/1.73 m2 as a cut-off, patients with eGFR <60 ml/min/1.73 m2, assessed by each of the 3 studied equations, had a significantly shorter median overall survival: 24 months vs. 98 months (χ2=9.8, p=0.002) for MDRD equation, 27 months vs. 98 months (χ2=12.8, p<0.001) for Cys-C/age/sCr equation and 38 months vs. not reached (χ2=13.3, p<0.001) for CKD-EPI equation. When we adjusted for ISS stage, the allocation to RI of stage 3–5, using the CKD-EPI equation, was significantly associated with survival (p=0.041); this was not observed for the allocation to stage 3–5 RI using the other formulas (p=0.357 for MDRD equation and p=0.235 for Cys-C/age/sCr equation). Our data suggest that CKD-EPI equation for the estimation of GFR detects more MM patients with stage 3–5 RI than MDRD or Cys-C/age/sCr equations. Furthermore, CKD-EPI was the only equation that could predict for overall survival adjusted for ISS stage. The confirmation of these data may lead to the broader use of CKD-EPI formula for the evaluation of RI in patients with MM, as it has been suggested for patients with several renal disorders.Table.Evaluation of Renal Function Stage by Different EquationsCKD stageMDRD equationEquation based on Cys-C/age/sCrCKD-EPI equationp-value147 (23%)51 (25%)30 (15%)270 (34%)68 (33%)66 (32%)Friedman-test354 (26%)54 (26%)68 (33%)p<0.001422 (11%)23 (11%)23 (11)511 (5%)8 (4%)17 (8%) Disclosures: No relevant conflicts of interest to declare.

Tubular Damage Is Present In Patients With MGUS and Asymptomatic Multiple Myeloma Even In The Absence Of Impaired Estimated Glomerular Filtration Rate; Alterations Of Neutrophil Gelatinase-Associated Lipocalin and Cystatin-C In Myeloma Patients Post IMiD- and Bortezomib-Based Regimens

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3091-3091
Author(s):  
Evangelos Terpos ◽  
Dimitrios Christoulas ◽  
Efstathios Kastritis ◽  
Gerasimos-Petros Papassotiriou ◽  
Filia Apostolakou ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Function ◽  
Renal Damage ◽  
Urinary Ngal ◽  
Newly Diagnosed ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Ckd Stage ◽  
Frontline Therapy ◽  
Stage 1 ◽  
Neutrophil Gelatinase

Abstract Neutrophil gelatinase-associated lipocalin (NGAL) is a 25 kDa protein, which is produced by the injured tubule epithelium. In contrast to serum creatinine (sCr), NGAL is specifically induced in the damaged nephron and then released into blood and urine; thus it is considered as an early marker of renal tubular injury. Our group has recently shown that urinary and serum NGAL were elevated in the vast majority (90% and 70%, respectively) of newly diagnosed patients with multiple myeloma (MM), while serum cystatin-C (CysC), an accurate marker of GFR, was elevated in 70% of them. However, there is no information for the value of these markers in patients with MGUS, asymptomatic MM (AMM), as well as in symptomatic MM post treatment. Thus, we measured urinary and serum NGAL and serum CysC in 40 patients with MGUS (23M/17F, median age 72 years), 36 with AMM (16M/20F, 60 years) and 120 healthy controls. Furthermore, we measured serum NGAL and CysC in 39 newly diagnosed symptomatic MM patients (24M/15F, 70 years) before and after frontline therapy with novel agents. Serum and urinary NGAL was measured using an ELISA method (BioPorto Diagnostics A/S, Gentofte, Denmark), while CysC was measured using a latex particle-enhanced nephelometric immunoassay (Dade Behring-Siemens Healthcare Diagnostics, Liederbach, Germany). The estimated GFR (eGFR) was calculated using the CKD-EPI equation. Patients were divided into the 5 CKD stages of the KDIGO classification, according to eGFR (stage 1: eGFR >90 ml/min/1.73m2; stage 2: 60-89 ml/min/1.73m2; stage 3: 30-59 ml/min/1.73m2; stage 4: 15-29 ml/min/1.73m2; stage 5: <15 ml/min/1.73m2or on dialysis). Only two (5%) patients with MGUS and two (5.5%) with AMM had sCr above the upper normal limit, but none had sCr >2 mg/dl. Regarding eGFR, 34 (85%) patients with MGUS and 31 (86%) with AMM had CKD stage 1/2, while 6 (15%) MGUS and 5 (14%) AMM patients had CKD stage 3. Urinary NGAL was elevated in patients with MGUS (median: 14 ng/ml, range 0.5-31 ng/ml) and AMM (22.3 ng/ml, 0.9-78 ng/ml) compared to controls (5.3 ng/ml, 0.7-9.8 ng/ml, p<0.001 for both comparisons). Similarly, serum NGAL was elevated in patients with MGUS (106 ng/ml, 74.9-205.5 ng/ml) and AMM (94.2 ng/ml, 29.5-306.4 ng/ml) compared to controls (63ng/ml, 37-106 ng/ml; p<0.01). There was no difference between MGUS and controls or MGUS and AMM regarding CysC serum values, indicating that traditional indices of renal function could not detect early renal damage. However, 22 (55%) patients with MGUS and 24 (66%) with AMM had higher urinary NGAL values than the higher value of the controls. Similarly, 9 (22.5%) MGUS and 11 (30%) AMM patients had higher levels of serum NGAL than the higher value in the control group. Twelve (31%) patients with symptomatic MM had sCr >2 mg/dl, while 41% had CKD stages 1/2, 28% had CKD stage 3 and 31% CKD stages 4/5. As expected, patients with symptomatic MM had elevated serum NGAL and CysC (p<0.001). NGAL strongly correlated with CysC (r=0.675, p<0.001) and CKD stage (mean±SD values for stages 1/2, stage 3 and stages 4/5 were: 97±57 ng/ml, 144±79 ng/ml and 205±124 ng/ml, respectively; ANOVA p=0.014). CysC also correlated with CKD stage (0.96±0.29 mg/l, 1.54±0.32 mg/l and 2.51±1.00 mg/l respectively, ANOVA p<0.001). Seven patients received bortezomib-based regimens and 32 patients received IMiD-based regimens as frontline therapy: 9 patients achieved sCR, 13 VGPR, 12 PR, while 3 had stable disease and 2 progressed. Among patients with eGFR <50 ml/min at baseline (n=22), 4/4 who received bortezomib-based regimens and 5/18 who received IMiD-based regimens achieved at least minor renal response. After 4 cycles of therapy, serum NGAL increased in patients who received IMiD-based therapy compared to baseline (255±264 ng/ml vs. 147±104ng/ml, p=0.021), but not in patients who received bortezomib (119±68 ng/ml vs. 159±111 ng/ml p=0.520), regardless of myeloma response to treatment. We conclude that the high levels of urinary and serum NGAL in MGUS and AMM indicate the presence of subclinical renal damage in these patients early in the course of their disease, when other markers of renal function, such as sCr or even the more sensitive CysC indicate that renal function is preserved. Thus, NGAL may be useful as an early marker that predicts the development of renal damage and the progression of the disease in these patients. NGAL seems also to increase in patients with renal impairment who receive IMiD-based regimens. Disclosures: No relevant conflicts of interest to declare.

Pathogenesis and Assessment of Renal Function in Patients With Liver Cirrhosis

Folia Medica ◽  
2012 ◽  
Vol 54 (4) ◽  
pp. 5-13 ◽  
Author(s):  
Bilyana H. Teneva
Keyword(s):  
Renal Function ◽  
Liver Cirrhosis ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Serum Markers ◽  
Meld Score ◽  
Kidney Damage ◽  
Early Assessment

Abstract In liver cirrhosis patients awaiting liver transplantation, it is prognostically equally important to assess the renal function before and after transplantation. This is evidenced by the inclusion of serum creatinine in the Model for End-Stage Liver Disease (MELD) score. Most of the causes of renal failure in liver cirrhosis are functional, the acute kidney damage including prerenal azotemia, acute tubular necrosis and hepatorenal syndrome. A major index of the renal function, the glomerular filtration rate (GFR) is determined in a specific way in patients with liver cirrhosis. Clinically, serum creatinine is considered the best indicator of kidney function, although it is rather unreliable when it comes to early assessment of renal dysfunction. Most of the patients with liver cirrhosis have several concomitant conditions, which are the reason for the false low creatinine levels, even in the presence of moderate to severe kidney damage. This also holds for the creatinine clearance and creatinine-based estimation equations for assessment of the glomerular filtration rate (the Cockroft-Gault and MDRD formulas), which overestimate the real glomerular filtration. Clearance of exogenous markers is considered a gold standard, but the methods for their determination are rather costly and hard to apply. Alternative serum markers (e.g., cystatin C) have been used, but they should be better studied in cases of liver cirrhosis assessment.

scholarly journals Isatuximab plus carfilzomib and dexamethasone versus carfilzomib and dexamethasone in relapsed multiple myeloma patients with renal impairment: IKEMA subgroup analysis

Haematologica ◽  
2021 ◽  
Author(s):  
Marcelo Capra ◽  
Thomas Martin ◽  
Philippe Moreau ◽  
Ross Baker ◽  
Ludek Pour ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Renal Impairment ◽  
Glomerular Filtration ◽  
Subgroup Analysis ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Phase 3 ◽  
New Therapies

Renal impairment (RI) is common in patients with multiple myeloma (MM) and new therapies that can improve renal function are needed. The Phase 3 IKEMA study (NCT03275285) investigated isatuximab (Isa) with carfilzomib and dexamethasone (Kd) vs Kd in relapsed MM. This subgroup analysis examined results from patients with RI, defined as estimated glomerular filtration rate

scholarly journals Effect of Atorvastatin and Losartan on Glomerular Filtration Rate in Patients With Mild to Moderate Chronic Kidney Disease

KYAMC Journal ◽  
2019 ◽  
Vol 10 (1) ◽  
pp. 43-47
Author(s):  
Md Moniruzzaman Khan ◽  
Zesmin Fauzia Dewan ◽  
AKM Shahidur Rahman ◽  
Bakhtiare Md Shoeb Nomany ◽  
Ahmed Salam Mir ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Kidney Diseases ◽  
Cell Damage ◽  
Renoprotective Effect ◽  
Ckd Stage

Background: Atorvastatin, a member of HMG CO-A reductase inhibitors, has been shown to have renoprotective effect in patients with Chronic Kidney Disease (CKD). Statins are supposed to decrease the oxidized lipid particles, suppress the activity of inflammatory mediators and prevent vascular thrombosis and thus could minimize renal cell damage. Losartan, an antihypertensive drug also diminishes proteinuria in patients with chronic kidney diseases or diabetes mellitus. Therefore the effect of concurrent use of atorvastatin and losartan on Glomerular Filtration Rate (GFR) could be a matter of interest from both Pharmacological and Clinical perspective. Objective: To assess the renoprotective effect of atorvastatin and losartan in patients with chronic kidney disease treated at Bangabandhu Sheikh Mujib Medical University (BSMMU). Materials and Method: Total forty four (44) patients suffering from CKD (stage one to stage three) were enrolled into two groups. Patients in Group A, received atorvastatin (10 mg) and losartan (50 mg) once daily for eight weeks. Patients in Group B, received losartan but not atorvastatin for the same duration. Serum creatinine level was measured at the commencement and also after eight weeks to calculate estimated glomerular filtration rate (eGFR) in individual patients with MDRD (Modification of Diet in Renal Disease) study equation. Results: There was significant (P < 0.001) reduction of Serum Creatinine and significant (P < 0.001) increase in e GFR in the patients, treated with atorvastatin and losartan. Conclusion: Concurrent administration of atorvastatin and losartan increased glomerular filtration rate (GFR) significantly in patients with chronic kidney disease. KYAMC Journal Vol. 10, No.-1, April 2019, Page 43-47

Treatment of Patients with Multiple Myeloma Complicated by Renal Failure with Bortezomib - Based Regimens.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2739-2739 ◽  
Author(s):  
Maria Roussou ◽  
Efstathios Kastritis ◽  
Athanasios Anagnostopoulos ◽  
Erasmia Psimenou ◽  
Irini Grapsa ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Renal Function ◽  
Serum Creatinine ◽  
Median Time ◽  
Objective Response ◽  
Elevated Serum ◽  
Management Problem ◽  
Newly Diagnosed ◽  
Kinetics Of

Abstract Introduction: Renal failure is a common feature of multiple myeloma and a major management problem. There is limited data regarding the reversibility of renal failure, the kinetics of serum creatinine and the safety of novel agents, such as bortezomib, when administered to newly diagnosed or relapsed/refractory patients with renal failure. The purpose of our analysis was to assess the frequency of renal failure improvement and kinetics of serum creatinine in patients who received bortezomib-based regimens. Patients and methods: We evaluated 20 consecutive patients with newly diagnosed (n=7) or relapsed/refractory (n=13) multiple myeloma and renal failure, defined as a serum creatinine ≥ 2mg/dl. Patients’ median age was 66 years (range 43–88 years). Median serum creatinine was 3.8 mg/dl (range 2–11.9 mg/dl) and median creatinine clearance was 15.3 ml/min (range 6.4–33.3). Other features included hemoglobin <10gr/dl in 12 patients, platelets <100 × 109/l in 3 patients and elevated serum LDH in 9 patients. All patients received bortezomib plus dexamethasone alone or in combination with other agents, such as thalidomide, doxorubicin or melphalan. Reversibility of renal failure was defined as a sustained decrease of serum creatinine to <1.5 mg/dl and renal response was defined as ≥50% decrease of serum creatinine from its peak value. Results: Reversal of renal failure was documented in 35% of all patients and the median time to reversal was 23 days. Moreover, 9 patients (45%) had 50% decrease in serum creatinine and the median time to decrease was 34 days. Some decrease of creatinine was documented in 88% of patients. Among four patients who were on renal dialysis, 2 became independent of this procedure after the second and the third cycle of treatment. The objective response rate was 61% and the median progression free survival for responders was 12 months. Toxicities were similar to those seen in myeloma patients without renal failure who were treated with bortezomib-based regimens. Grade 3–4 neutropenia and thrombocytopenia were seen in 28% and 22% of patients respectively. One patient died of infection and bortezomib had to be discontinued in 4 patients due to grade III neurotoxicity. Conclusions: When bortezomib-based regimens are administered to myeloma patients with renal impairment their toxicity and efficacy are similar to those observed in patients with normal renal function. Moreover, these regimens are associated with rapid improvement of renal function in most patients and with reversal of renal failure in one-third of them.

Improvement In Renal Function In Newly Diagnosed Myeloma Improves Survival, but Still Remains Inferior to Those with Normal Renal Function

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2970-2970 ◽  
Author(s):  
Shaji Kumar ◽  
Angela Dispenzieri ◽  
Martha Lacy ◽  
Suzanne R. Hayman ◽  
Francis Buadi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Renal Function ◽  
Renal Insufficiency ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Research Funding ◽  
Negative Impact ◽  
Newly Diagnosed ◽  
Number Of Patients ◽  
The Impact

Abstract Abstract 2970 Background: Over a quarter of patients (pts) with symptomatic multiple myeloma (MM) have some degree of renal insufficiency at the time of diagnosis. Multiple studies show that presence of renal failure is strong predictor of inferior overall survival in MM. With effective therapy, renal function improves in a considerable number of patients. It is not clear if the return of renal function to normal levels will improve their outcome to that expected for patients without renal dysfunction. Methods: We evaluated 1478 patients with newly diagnosed myeloma seen at Mayo Clinic within 90 days of diagnosis, between January 1999 and January 2009. We examined these patients for improvement in renal function and identified the lowest serum creatinine obtained during the disease course. The outcomes were analyzed with respect to the renal function improvements. Results: The median age at diagnosis was 64 years (range; 22–93) and 50% were male. The median estimated follow up for the entire cohort was 53 months, with 781 patients alive at the time of analysis with a median follow of 3 years. The serum creatinine was over 1.5 mg/dL at diagnosis in 333 (22.5%) pts and over 2.5 mg/dL in 148 (10%) pts. The median overall survival for the 333 patients was 37 mos (95% CI; 28, 40) compared to 56 mos (95% CI; 51, 63) for those < 1.5 mg/dL; P < 0.001. Among the 333 pts with baseline Cr > 1.5 mg/dl, any improvement in Cr was seen in 263 (79%) including an improvement of at least 0.5 mg/dL in 208 (62%) pts. Among the 263 pts with any improvement, the median time to lowest Cr was 4 months (range; 1–13). The median survival of the group of patients with Cr <= 1.5 mg/dl, over 1.5 mg/dL at diagnosis but improved to <= 1.5 mg/dL, or remained >1.5 mg/dL were 56., 40 and 27 mos respectively; P < 0.001, Figure). We then examined the impact of renal function improvement in the group of patients where the baseline Cr was >2.5 mg/dL. The median OS for the 42 (out of 148 pts with Cr > 2.5 at diagnosis) who had improved to <=1.5 mg/dL was 40 mos compared to 56 mos for those with a Cr <= 1.5 mg/dL at diagnosis and 27.4 mos for the 106 pts whose Cr did not decrease to <= 1.5 mg/dL; P < 0.001. Conclusion: The results of this study point toward improved outcome among patients with renal dysfunction in whom renal function improves. However, it shows that this improvement in renal function does not necessarily improve survival to that observed for the patients with a comparable level of serum creatinine at diagnosis. While early treatment of asymptomatic myeloma has been shown to have little impact on overall survival, a strategy of waiting for serious features of target organ damage to appear before initiation of treatment may have a negative impact on survival in some patients, especially patients with high light chain production who have a higher predilection for renal insufficiency. Disclosures: Kumar: Celgene: Consultancy, Research Funding; Millennium: Research Funding; Merck: Consultancy, Research Funding; Novartis: Research Funding; Genzyme: Consultancy, Research Funding; Cephalon: Research Funding. Off Label Use: Lenalidomide for treatment of newly diagnosed myeloma. Dispenzieri:Celgene: Honoraria, Research Funding; Binding Site: Honoraria. Lacy:Celgene: Research Funding.

scholarly journals Assessing glomerular filtration rate in patients with severe heart failure: comparison between creatinine-based formulas

2012 ◽  
Vol 130 (5) ◽  
pp. 289-293 ◽  
Author(s):  
Alexandre Libório ◽  
Russian Uchoa ◽  
João Neto ◽  
Juan Valdivia ◽  
Elizabeth De Francesco Daher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Severe Heart Failure ◽  
Creatinine Concentration ◽  
Cross Sectional ◽  
Gfr Estimation

CONTEXT AND OBJECTIVE: Severe heart failure is highly associated with chronic kidney disease (CKD). Serum creatinine is a poor indicator of renal function and glomerular filtration rate (GFR) estimation is an accessible method for assessing renal function. The most popular formulas for GFR estimation are the Cockcroft-Gault (CG), the four-variable Simplified Modification of Diet in Renal Disease (sMDRD) and the recently introduced CKD-Epidemiology Collaboration (CKD-EPI). The objective of the study was to analyze the correlation between these three equations for estimating GFR in patients with severe heart failure. DESIGN AND SETTING: Cross-sectional observational study at a university reference center. METHODS: GFR was estimated in patients with severe heart failure who were awaiting heart transplantation, using the CG, sMDRD and CKD-EPI formulas. These estimates were analyzed using Pearson's correlation and Bland-Altman analysis. RESULTS: This study included 157 patients, of whom 32 (20.3%) were female. Normal serum creatinine concentration was observed in 21.6%. The mean GFR according to CG, sMDRD and CKD-EPI was 70.1 ± 29.5, 70.7 ± 37.5 and 73.7 ± 30.1 ml/min/1.73 m²; P > 0.05. Pearson's coefficient demonstrated good correlations between all the formulas, as did Bland-Altman. However, the patients presented GFR < 60 ml/min more frequently with the sMDRD formula (54.1% versus 40.2% for CG and 43.2% for CKD-EPI; P = 0.02). CONCLUSION: Despite the good correlation and agreement between the three methods, the sMDRD formula classified more patients as presenting GFR less than 60 ml/min.

scholarly journals P0223AGING CHANGES OF RENAL FUNCTION AND EVALUATION OF DIFFERENT GLOMERULAR FILTRATION RATE ESTIMATION EQUATIONS IN HEALTH PEOPLE IN BEIJING

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Lengnan Xu ◽  
Yonghui Mao ◽  
Aiqun Chen ◽  
Ban Zhao
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Age Groups ◽  
The Elderly ◽  
The Body ◽  
True Value ◽  
Age Related

Abstract Background and Aims The kidney is an important organ that removes metabolites and certain wastes and poisons from the body, and retains water and other useful substances through reabsorption. Its aging and function decline have a significant impact on the human health.Rather than simply depending on serum creatinine, glomerular filtration rate (GFR) assessment equation should be given priority in evaluating renal function. Different evaluated GFR (eGFR) equations sometimes have great differences in assessing the true value of GFR, especially for the elderly. The purpose of this study was to analyze the aging changes of renal function in normal people in Beijing and to compare the significance of different eGFR equations in evaluating renal function in Chinese population. Method The age, sex and serum creatinine were recorded in the population who underwent routine physical examination in our hospital from January 2012 to December 2014. Kidney function was assessed by CKD-EPI, MDRD, MDRDc, FAS and BIS equations, respectively. Results A total of 46 713 persons were enrolled in this study, of whom 27 249 (58.33%) were males. They were followed up for 3 years, ranging in age from 16 to 100 years. Both men and women showed age-related change in serum creatinine: serum creatinine and its standard deviation gradually increases parallel with age, indicating that the range of serum creatinine changes in the elderly was larger. Whether male or female, there were differences in eGFR change between different age groups (male: Χ2=141.28, P=0.000; female: Χ2=97.55, P=0.000). For male, eGFR decreased more in the elderly, and it was more common for young people to keep the eGFR constant or increase. However, in female, eGFR remained unchanged in most old people, and increased or decreased in the majority of the young. For all age groups, the ICC was very consistent among the equations, 0.849 for males and 0.817 for females. The whole population was divided into three groups according to serum creatinine &lt; 1mg/dL, &gt; 1mg/dL and &lt; 1.5mg/dL, &gt; 1.5mg/dL. The CKD-EPI equation gave higher stages of CKD than other equations. There was no clear age-related change trend in the 3-year average eGFR change rate of all age groups. For the elderly over 70 years of age, the MDRD and MDRDc equations had higher GFR evaluation results than the other three equations. The BIS equation had the lowest results of all equations. The ICC was very consistent among the equations, 0.966 for males and 0.957 for females. Conclusion we believed that the annual change of GFR varied from person to person and had little to do with age. GFR needed to be calculated more accurately in order to formulate corresponding medical strategies. Those eGFR equations the above-mentioned can be used to evaluate renal function, but the results were very different for different populations and serum creatinine levels. The use of different eGFR equations may lead to large differences in drug dose adjustment and the risk of serious adverse reactions. For the elderly in China, which equation was more suitable was inconclusive and further research was urgently needed.

scholarly journals Estimation of Glomerular Filtration Rate From Serum Cystatin C and Creatinine in Patients with Thyroid Dysfunction

2012 ◽  
Vol 31 (2) ◽  
pp. 88-93
Author(s):  
Velibor Čabarkapa ◽  
Romana Mijović ◽  
Zoran Stošić ◽  
Nikola Ćurić ◽  
Radmila Žeravica ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Thyroid Dysfunction ◽  
Newly Diagnosed ◽  
Serum Concentrations ◽  
Serum Cystatin C ◽  
Serum Cystatin

Estimation of Glomerular Filtration Rate From Serum Cystatin C and Creatinine in Patients with Thyroid DysfunctionGiven that thyroid function influences serum cystatin C and creatinine levels, the question arises as to whether it is possible to accurately estimate glomerular filtration rate (GFR) in patients with thyroid dysfunction. The objective of the study was to determine serum cystatin C and creatinine levels and estimate GFR in patients with thyroid dysfunction. The study included 32 cases with newly diagnosed hyperthyroidism and 27 cases with newly diagnosed hypothyroidism, as well as 20 healthy controls matched for sex and age with the cases. Serum concentrations of thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4), creatinine and cystatin C were measured in all study subjects. GFR was estimated using the Modification of Diet in Renal Disease (MDRD), the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and cystatin C-based equations. Serum cystatin C levels were significantly higher in hyperthyroid subjects compared to controls (1.32±0.31 vs. 0.89±0.15; p<0.01). Serum creatinine levels were significantly lower in hyperthyroid subjects compared to controls (60.6±10.2 vs. 76.4±8.6; p<0.01), and significantly higher in hypothyroid subjects compared to controls (94.5±13.2 vs. 76.4±8.6; p<0.01). GFR estimated with the MDRD equations was significantly higher in hyperthyroid subjects compared to hypothyroid subjects (101.6±20.7 vs. 64.1±11.6 mL/min/1.73m2; p<0.01). GFR estimated with the equation based on serum cystatin C was significantly lower in hyperthyroid subjects compared to hypothyroid subjects (59.2±22.1 vs. 92.1±16.0 mL/min/1.73m2; p<0.01). Although serum cystatin C is regarded a reliable marker of GFR and more sensitive than serum creatinine, it has limitations in patients with thyroid dysfunction, due to significant changes in its serum concentrations regardless of renal function. In patients with thyroid dysfunction GFR should therefore be estimated using the equations based on serum creatinine.

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