Estimated or Measured GFR in Living Kidney Donors Work-up?

F Gaillard; M Flamant; S Lemoine; S Baron; M-O Timsit; D Eladari; C Fournier; C Prot-Bertoye; J-P Bertocchio; E Vidal-Petiot; L Lamhaut; E Morelon; M-N Péraldi; F Vrtovsnik; G Friedlander; A Méjean; P Houillier; C Legendre; M Courbebaisse

doi:10.1111/ajt.13908

Estimated or Measured GFR in Living Kidney Donors Work-up?

Am J Transplant. 2016 Oct;16(10):3024-3032. doi: 10.1111/ajt.13908. Epub 2016 Jul 15.

Authors

F Gaillard¹, M Flamant², S Lemoine³, S Baron⁴, M-O Timsit⁵, D Eladari⁶, C Fournier¹, C Prot-Bertoye⁴, J-P Bertocchio⁴, E Vidal-Petiot², L Lamhaut⁷, E Morelon⁸, M-N Péraldi⁹, F Vrtovsnik¹⁰, G Friedlander¹¹, A Méjean⁵, P Houillier¹², C Legendre¹, M Courbebaisse¹¹

Affiliations

¹ AP-HP, Hôpital Necker-Enfants Malades, Renal Transplantation Department, Paris Descartes University, Paris, France.
² AP-HP, Hôpital Bichat, Department of Renal Physiology, DHU Fire and Paris Diderot University, Sorbonne Paris Cité, Paris, France.
³ Hospices civils de Lyon, Hôpital Edouard Herriot, Exploration fonctionnelle rénale Department and INSERM CARMEN 1060, University of Lyon, Lyon, France.
⁴ AP-HP, Hôpital Européen Georges Pompidou, Physiology Department, Paris Descartes University, Paris, France.
⁵ AP-HP, Hôpital Européen Georges Pompidou, Urology Department, Paris Descartes University, Paris, France.
⁶ AP-HP, Hôpital Européen Georges Pompidou, Physiology Department, Paris Descartes University, and INSERM, Unit 970, Paris, France.
⁷ AP-HP, Hôpital Necker-Enfants Malades, Anesthesia Department and Intensive Care Unit, Paris Descartes University, Paris, France.
⁸ Hospices civils de Lyon, Hôpital Edouard Herriot, Transplantation Department, INSERM U 851, University of Lyon, Centaure Network, Lyon, France.
⁹ AP-HP, Hôpital Saint-Louis, Department of Nephrology and Renal Transplantation, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
¹⁰ AP-HP, Hôpital Bichat, Department of Nephrology, DHU Fire and Paris Diderot University, Sorbonne Paris Cité, Paris, France.
¹¹ AP-HP, Hôpital Européen Georges Pompidou, Physiology Department, Paris Descartes University, and INSERM, Unit 1151, Paris, France.
¹² AP-HP, Hôpital Européen Georges Pompidou, Physiology Department, Paris Descartes University, INSERM, Unit umrs1138, and CNRS Unit erl8228, Paris, France.

PMID: 27273845
DOI: 10.1111/ajt.13908

Abstract

The value of estimated glomerular filtration rate (eGFR) in living kidney donors screening is unclear. A recently published web-based application derived from large cohorts, but not living donors, calculates the probability of a measured GFR (mGFR) lower than a determined threshold. Our objectives were to validate the clinical utility of this tool in a cohort of living donors and to test two other strategies based on chronic kidney disease epidemiology collaboration (CKD-EPI) and on MDRD-eGFR. GFR was measured using ⁵¹ Cr- ethylene-diamine tetraacetic acid urinary clearance in 311 potential living kidney donors (178 women, mean age 50 ± 11.6 years). The web-based tool was used to predict those with mGFR < 80 mL/min/1.73 m² . Inputs to the application were sex, age, ethnicity, and plasma creatinine. In our cohort, a web-based probability of mGFR <90 mL/min/1.73 m² higher than 2% had 100% sensitivity for detection of actual mGFR <80 mL/min/1.73 m² . The positive predictive value was 0.19. A CKD-EPI-eGFR threshold of 104 mL/min/1.73 m² and an MDRD-eGFR threshold of 100 mL/min/1.73 m² had 100% sensitivity to detect donors with actual mGFR <80 mL/min/1.73 m² . We obtained similar results in an external cohort of 354 living donors. We confirm the usefulness of the web-based application to identify potential donors who should benefit from GFR measurement.

Keywords: clinical research/practice; donors and donation: donor evaluation; donors and donation: living; glomerular filtration rate (GFR); internet; kidney transplantation/nephrology.

Publication types

Observational Study

MeSH terms

Adult
Biomarkers / analysis*
Female
Follow-Up Studies
Glomerular Filtration Rate*
Health Status Indicators
Humans
Kidney Failure, Chronic / surgery*
Kidney Transplantation*
Living Donors*
Male
Middle Aged
Prognosis
Retrospective Studies

Substances

Biomarkers