scholarly journals Transplant Clinician Opinions on Use of Race in the Estimation of Glomerular Filtration Rate

2021 ◽  
Vol 16 (10) ◽  
pp. 1552-1559 ◽  
Author(s):  
Mona D. Doshi ◽  
Neeraj Singh ◽  
Benjamin E. Hippen ◽  
Kenneth J. Woodside ◽  
Prince Mohan ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Cystatin C ◽  
Health Care Disparities ◽  
The United States ◽  
Living Donors ◽  
Serum Cystatin C ◽  
Content Type ◽  
Adult Kidney ◽  
Black Patients ◽  
Measured Gfr

Background and objectivesCurrent race-based eGFR calculators assign a higher eGFR value to Black patients, which could affect the care of kidney transplant candidates and potential living donors.Design, setting, participants, & measurementsWe conducted a survey of staff at adult kidney transplant centers in the United States (December 17, 2020 to February 28, 2021) to assess opinions on use of race-based eGFR equations for waitlisting and living donor candidate evaluation, availability of serum cystatin C testing and measured GFR, and related practices.ResultsRespondents represented 57% (124 of 218) of adult kidney transplant programs, and the responding centers conducted 70% of recent kidney transplant volume. Most (93%) programs use serum creatinine–based eGFR for listing candidates. However, only 6% of respondents felt that current race-based eGFR calculators are appropriate, with desire for change grounded in concerns for promotion of health care disparities by current equations and inaccuracies in reporting of race. Most respondents (70%) believed that elimination of race would allow more preemptive waitlisting for Black patients, but a majority (79%) also raised concerns that such an approach could incur harms. More than one third of the responding programs lacked or were unsure of availability of testing for cystatin C or measured GFR. At this time, 40% of represented centers did not plan to remove race from eGFR calculators, 46% were planning to remove, and 15% had already done so. There was substantial variability in eGFR reporting and listing of multiracial patients with some Black ancestry. There was no difference in GFR acceptance thresholds for Black versus non-Black living donors.ConclusionsThis national survey highlights a broad consensus that extant approaches to GFR estimation are unsatisfactory, but it also identified a range of current opinions.

Serum cystatin C as an index of renal function in kidney transplant patients

2004 ◽  
Vol 36 (1) ◽  
pp. 99-101 ◽  
Author(s):  
S.H Akbas ◽  
A Yavuz ◽  
M Tuncer ◽  
C Ruhi ◽  
A Gurkan ◽  
...  
Keyword(s):  
Renal Function ◽  
Kidney Transplant ◽  
Cystatin C ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Transplant Patients ◽  
Kidney Transplant Patients

scholarly journals OLDER ADULT KIDNEY TRANSPLANT RECIPIENTS: THE LIVED EXPERIENCE OF ADAPTATION AND INTEGRATION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S141-S141
Author(s):  
Laura L Kimberly ◽  
Denise Burnette ◽  
Ellen Lukens ◽  
Bruce Gelb
Keyword(s):  
Lived Experience ◽  
Kidney Transplant ◽  
Older Adult ◽  
Sense Of Self ◽  
Life Time ◽  
The United States ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Conceptual Approach ◽  
Adult Kidney

Abstract As the prevalence of end-stage renal disease increases in the United States, a growing number of adults aged 65 and over are receiving kidney transplants. While older adult recipients tend to fare well from a clinical standpoint, far less is known about their psychosocial wellbeing following transplantation. This study seeks to better understand the lived experience of older adult kidney transplant recipients, focusing on the ‘liminal’ period of adaptation following organ transplantation that has been reported elsewhere in the literature. Applying the hermeneutic phenomenology of philosopher Paul Ricoeur, the study explores the lived experience of 10 deceased donor kidney transplant recipients aged 65 and over. Guided by Ricoeur’s conceptual approach to identity as constituted through two forms, idem and ipse, preliminary findings suggest that despite expressing some distress around the ‘strangeness’ of integrating part of another into oneself (disruption of the idem sense of self), participants also constructed powerful narratives of resilience and coping that were rooted in the continuity of a deeply held ipse sense of identity over the life course. In particular, participants emphasized their ability to overcome adversity as an anchor of their ipse sense of self that enabled them to navigate the idem corporeal changes of transplantation. Moreover, they described kidney transplantation as a form of liberation, ultimately restoring their idem sense of self that had been profoundly disrupted by ‘machine life’ (time spent on dialysis). These findings will have significant implications for ensuring the provision of optimal support to older adult kidney transplant recipients.

scholarly journals Comparison of Chronic Kidney Disease Epidemiology Collaboration Equations with Other Accepted Equations for Estimation of Glomerular Filtration Rate in Indian Chronic Kidney Disease Patients

2017 ◽  
Vol 16 (2) ◽  
pp. 238-244
Author(s):  
Kumaresan Ramanathan ◽  
Giri Padmanabhan
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Cystatin C ◽  
Filtration Rate ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Disease Epidemiology ◽  
Measured Gfr

Background and Aim: In routine clinical practice, the estimation of glomerular filtration rate (GFR) based on serum creatinine has been followed. However, the reliability of creatinine in estimation of GFR is biased and imprecise, leading to the misdiagnosis of chronic kidney disease (CKD). The serum cystatin C is an alternative marker for estimating GFR. Hence, we aimed to compare the newly proposed Chronic Kidney Disease Epidemiology Collaboration Equations (CKD-EPI) with four approved equations based on both creatinine and cystatin C with reference to Tc-99m-diethylenetriamine pentaacetate (Tc-99m-DTPA) considered as a standard.Materials and Methods:Two hundred and one patients were enrolled in the study from a private nephrology outpatient clinic(OPD), Tiruchirappalli, India. The serum creatinine and cystatin C were measured along with routine biochemistry tests. The measurement of GFR was done by Tc-99m-DTPA gates method. The estimated GFR (eGFR) were calculated using serum cystatin C and creatinine based formulae along with the new CKD-EPI formulae. All eGFR estimations were compared with the measured GFR by gates method.Results: The average measured GFR of end stage, severe, moderate, mild renal disease and normal patient groups were 10.17±2.47, 22.58±4.40, 39.05±7.06, 69.62±24.64 and 118.06±29.23 respectively. When comparing the diagnostic accuracy for predicting GFR using well established formulae, the cystatin C based formulae have shown to be highly accurate in all stages of CKD than creatinine based formulae. Among cystatin C based formulae, CKD-EPI Cystatin C had relatively better diagnostic accuracy for predicting GFR in all stages of CKD.Conclusion: CKD-EPI Cystatin C formula has unbiased and more accurate to predict GFR in all stages of CKD.Bangladesh Journal of Medical Science Vol.16(2) 2017 p.238-244

scholarly journals Overweight, Obesity, and Elevated Serum Cystatin C Levels in Adults in the United States

2008 ◽  
Vol 121 (4) ◽  
pp. 341-348 ◽  
Author(s):  
Paul Muntner ◽  
Jonathan Winston ◽  
Jaime Uribarri ◽  
Devin Mann ◽  
Caroline S. Fox
Keyword(s):  
United States ◽  
Cystatin C ◽  
Elevated Serum ◽  
The United States ◽  
Serum Cystatin C ◽  
Serum Cystatin

scholarly journals Serum Cystatin C as a Predictor of Acute Kidney Transplant Rejection

2015 ◽  
Vol 57 (3) ◽  
pp. 188-192
Author(s):  
Fadhil B. Shamkhi ◽  
◽  
Ala Sh. Ali ◽  
Hedef D. El-Yassin ◽  
◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Cystatin C ◽  
Transplant Rejection ◽  
Serum Cystatin C ◽  
Serum Cystatin

Effect of Clinical Variables and Immunosuppression on Serum Cystatin C and Beta-Trace Protein in Kidney Transplant Recipients

2009 ◽  
Vol 54 (5) ◽  
pp. 922-930 ◽  
Author(s):  
Christine A. White ◽  
Ayub Akbari ◽  
Steve Doucette ◽  
Dean Fergusson ◽  
Tim Ramsay ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Cystatin C ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Clinical Variables

scholarly journals Estimating Renal Function in the Elderly Malaysian Patients Attending Medical Outpatient Clinic: A Comparison between Creatinine Based and Cystatin-C Based Equations

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Maisarah Jalalonmuhali ◽  
Salma Mohamed Abouzriba Elagel ◽  
Maw Pin Tan ◽  
Soo Kun Lim ◽  
Kok Peng Ng
Keyword(s):  
Serum Creatinine ◽  
Cystatin C ◽  
Outpatient Clinic ◽  
The Elderly ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Serum Cystatin C ◽  
Cross Sectional ◽  
Serum Cystatin ◽  
Measured Gfr

Background. To assess the performance of different GFR estimating equations, test the diagnostic value of serum cystatin-C, and compare the applicability of cystatin-C based equation with serum creatinine based equation for estimating GFR (eGFR) in comparison with measured GFR in the elderly Malaysian patients.Methods. A cross-sectional study recruiting volunteered patients 65 years and older attending medical outpatient clinic. 51 chromium EDTA (51Cr-EDTA) was used as measured GFR. The predictive capabilities of Cockcroft-Gault equation corrected for body surface area (CGBSA), four-variable Modification of Diet in Renal Disease (4-MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations using serum creatinine (CKD-EPIcr) as well as serum cystatin-C (CKD-EPIcys) were calculated.Results. A total of 40 patients, 77.5% male, with mean measured GFR41.2±18.9 ml/min/1.73 m2were enrolled. Mean bias was the smallest for 4-MDRD; meanwhile, CKD-EPIcr had the highest precision and accuracy with lower limit of agreement among other equations. CKD-EPIcys equation did not show any improvement in GFR estimation in comparison to CKD-EPIcr and MDRD.Conclusion. The CKD-EPIcr formula appears to be more accurate and correlates better with measured GFR in this cohort of elderly patients.

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