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Kinetic Estimation of GFR Improves Prediction of Dialysis and Recovery after Kidney Transplantation.

Pianta TJ, Endre ZH, Pickering JW, Buckley NA, Peake PW - PLoS ONE (2015)

Bottom Line: The utility of KeGFR(sCr) for DGF prediction was compared with, sCr, plasma cystatin C (pCysC), and KeGFR(pCysC) similarly derived from pCysC concentrations.Integrated discrimination improvement analysis showed that the KeGFR(sCr) improved a validated clinical prediction model at 4h, 8h, and 12h, increasing the AUC from 0.68 (0.52-0.83) to 0.88 (0.78-0.99) at 12h (p = 0.01).KeGFR(pCysC) also improved DGF prediction.

View Article: PubMed Central - PubMed

Affiliation: Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Melbourne Medical School, University of Melbourne, Melbourne, Australia.

ABSTRACT

Background: The early prediction of delayed graft function (DGF) would facilitate patient management after kidney transplantation.

Methods: In a single-centre retrospective analysis, we investigated kinetic estimated GFR under non-steady-state conditions, KeGFR, in prediction of DGF. KeGFR(sCr) was calculated at 4h, 8h and 12h in 56 recipients of deceased donor kidneys from initial serum creatinine (sCr) concentrations, estimated creatinine production rate, volume of distribution, and the difference between consecutive sCr values. The utility of KeGFR(sCr) for DGF prediction was compared with, sCr, plasma cystatin C (pCysC), and KeGFR(pCysC) similarly derived from pCysC concentrations.

Results: At 4h, the KeGFR(sCr) area under the receiver operator characteristic curve (AUC) for DGF prediction was 0.69 (95% CI: 0.56-0.83), while sCr was not useful (AUC 0.56, (CI: 0.41-0.72). Integrated discrimination improvement analysis showed that the KeGFR(sCr) improved a validated clinical prediction model at 4h, 8h, and 12h, increasing the AUC from 0.68 (0.52-0.83) to 0.88 (0.78-0.99) at 12h (p = 0.01). KeGFR(pCysC) also improved DGF prediction. In contrast, sCr provided no improvement at any time point.

Conclusions: Calculation of KeGFR from sCr facilitates early prediction of DGF within 4 hours of renal transplantation.

No MeSH data available.


Related in: MedlinePlus

KeGFR prediction of DGF compared with unadjusted eGFR and sCr.A: estimated kinetic GFR using serum creatinine (KeGFRsCr) compared with serum creatinine (sCr) and unadjusted estimate of GFR using sCr (eGFRsCr). Figures show area under receiver operator characteristic curve (AUC) and 95% confidence intervals for prediction of DGF at 4h (n = 56), 8h (n = 52) and 12h (n = 52). Asterisk (*) denotes p < 0.05 for the comparison with the AUC for sCr at the same time.
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pone.0125669.g003: KeGFR prediction of DGF compared with unadjusted eGFR and sCr.A: estimated kinetic GFR using serum creatinine (KeGFRsCr) compared with serum creatinine (sCr) and unadjusted estimate of GFR using sCr (eGFRsCr). Figures show area under receiver operator characteristic curve (AUC) and 95% confidence intervals for prediction of DGF at 4h (n = 56), 8h (n = 52) and 12h (n = 52). Asterisk (*) denotes p < 0.05 for the comparison with the AUC for sCr at the same time.

Mentions: sCr, pCysC, eGFRsCr, eGFRpCysC, KeGFRsCr, and KeGFRpCysC for each patient are presented in Fig 1; the latter four are compared in Fig 2. AUCs for prediction of DGF are presented in Fig 3.


Kinetic Estimation of GFR Improves Prediction of Dialysis and Recovery after Kidney Transplantation.

Pianta TJ, Endre ZH, Pickering JW, Buckley NA, Peake PW - PLoS ONE (2015)

KeGFR prediction of DGF compared with unadjusted eGFR and sCr.A: estimated kinetic GFR using serum creatinine (KeGFRsCr) compared with serum creatinine (sCr) and unadjusted estimate of GFR using sCr (eGFRsCr). Figures show area under receiver operator characteristic curve (AUC) and 95% confidence intervals for prediction of DGF at 4h (n = 56), 8h (n = 52) and 12h (n = 52). Asterisk (*) denotes p < 0.05 for the comparison with the AUC for sCr at the same time.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4418565&req=5

pone.0125669.g003: KeGFR prediction of DGF compared with unadjusted eGFR and sCr.A: estimated kinetic GFR using serum creatinine (KeGFRsCr) compared with serum creatinine (sCr) and unadjusted estimate of GFR using sCr (eGFRsCr). Figures show area under receiver operator characteristic curve (AUC) and 95% confidence intervals for prediction of DGF at 4h (n = 56), 8h (n = 52) and 12h (n = 52). Asterisk (*) denotes p < 0.05 for the comparison with the AUC for sCr at the same time.
Mentions: sCr, pCysC, eGFRsCr, eGFRpCysC, KeGFRsCr, and KeGFRpCysC for each patient are presented in Fig 1; the latter four are compared in Fig 2. AUCs for prediction of DGF are presented in Fig 3.

Bottom Line: The utility of KeGFR(sCr) for DGF prediction was compared with, sCr, plasma cystatin C (pCysC), and KeGFR(pCysC) similarly derived from pCysC concentrations.Integrated discrimination improvement analysis showed that the KeGFR(sCr) improved a validated clinical prediction model at 4h, 8h, and 12h, increasing the AUC from 0.68 (0.52-0.83) to 0.88 (0.78-0.99) at 12h (p = 0.01).KeGFR(pCysC) also improved DGF prediction.

View Article: PubMed Central - PubMed

Affiliation: Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Melbourne Medical School, University of Melbourne, Melbourne, Australia.

ABSTRACT

Background: The early prediction of delayed graft function (DGF) would facilitate patient management after kidney transplantation.

Methods: In a single-centre retrospective analysis, we investigated kinetic estimated GFR under non-steady-state conditions, KeGFR, in prediction of DGF. KeGFR(sCr) was calculated at 4h, 8h and 12h in 56 recipients of deceased donor kidneys from initial serum creatinine (sCr) concentrations, estimated creatinine production rate, volume of distribution, and the difference between consecutive sCr values. The utility of KeGFR(sCr) for DGF prediction was compared with, sCr, plasma cystatin C (pCysC), and KeGFR(pCysC) similarly derived from pCysC concentrations.

Results: At 4h, the KeGFR(sCr) area under the receiver operator characteristic curve (AUC) for DGF prediction was 0.69 (95% CI: 0.56-0.83), while sCr was not useful (AUC 0.56, (CI: 0.41-0.72). Integrated discrimination improvement analysis showed that the KeGFR(sCr) improved a validated clinical prediction model at 4h, 8h, and 12h, increasing the AUC from 0.68 (0.52-0.83) to 0.88 (0.78-0.99) at 12h (p = 0.01). KeGFR(pCysC) also improved DGF prediction. In contrast, sCr provided no improvement at any time point.

Conclusions: Calculation of KeGFR from sCr facilitates early prediction of DGF within 4 hours of renal transplantation.

No MeSH data available.


Related in: MedlinePlus