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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

Clinical model enhancement by measured and calculated variables at 12h.A: serum creatinine (sCr), B: estimated GFR using sCr (KeGFRsCr) C: plasma Cystatin C (pCysC), D: estimated GFR using pCysC (KeGFRpCysC).
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pone.0125669.g004: Clinical model enhancement by measured and calculated variables at 12h.A: serum creatinine (sCr), B: estimated GFR using sCr (KeGFRsCr) C: plasma Cystatin C (pCysC), D: estimated GFR using pCysC (KeGFRpCysC).

Mentions: Incorporation of KeGFRsCr independently improved prediction of DGF at 4h [average increase in calculated risk of DGF (IDI-DGF): 0.03 (95% CI: 1 x 10–6 to 0.11)] and non-DGF [IDI-non-DGF: 0.02 (95% CI: 3 x 10–5 to 0.08)] (Table 2) with the AUC for the new model increasing from 0.72 to 0.77 (95% CI: 0.63–0.89). Enhancement of the clinical model with KeGFRsCr was also seen at 8h and 12h (Table 2, Fig 4).


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)

Clinical model enhancement by measured and calculated variables at 12h.A: serum creatinine (sCr), B: estimated GFR using sCr (KeGFRsCr) C: plasma Cystatin C (pCysC), D: estimated GFR using pCysC (KeGFRpCysC).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4418565&req=5

pone.0125669.g004: Clinical model enhancement by measured and calculated variables at 12h.A: serum creatinine (sCr), B: estimated GFR using sCr (KeGFRsCr) C: plasma Cystatin C (pCysC), D: estimated GFR using pCysC (KeGFRpCysC).
Mentions: Incorporation of KeGFRsCr independently improved prediction of DGF at 4h [average increase in calculated risk of DGF (IDI-DGF): 0.03 (95% CI: 1 x 10–6 to 0.11)] and non-DGF [IDI-non-DGF: 0.02 (95% CI: 3 x 10–5 to 0.08)] (Table 2) with the AUC for the new model increasing from 0.72 to 0.77 (95% CI: 0.63–0.89). Enhancement of the clinical model with KeGFRsCr was also seen at 8h and 12h (Table 2, Fig 4).

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