Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Pre-donation renal function is an important determinant of future development of kidney disease in live kidney donors (LKD). In 2017, the Kidney Disease Improving Global Outcomes (KDIGO) Living Donor Work Group recommendations state that donors’ renal function can be determined using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) study equation using creatinine alone (eGFRcr), cystatin C alone (eGFRcys), or a combination of creatinine and cystatin C (eGFRcr-cys). Recent studies have shown that eGFRcr misclassifies LKD, especially at higher mGFR thresholds. There are, however, no studies assessing accuracy of eGFRcr-cys in LKD. The goal of our study was to compare accuracy of eGFRcr, eGFRcys, and eGFRcr-cys against mGFR at varying GFR strata.
*Methods: Renal function was assessed in 181 LKD candidates via mGFR using 125-I iothalamate clearance and CKD-EPI formula using serum creatinine and/or cystatin C. Iothalamate clearance was reported as an average of four independent measurements. Patients were stratified into three groups based on their mGFR, ≥70, ≥80, and ≥90 mL/min/1.73m2. Sensitivity, specificity, and accuracy analyses were performed for eGFRcr, eGFRcys, and eGFRcr-cys within each mGFR strata. Statistical analyses were performed using SAS.
*Results: Median age was 46±12 years and body surface area (BSA) 1.88 ±0.23m2 in donors, 72% were female, and 86% were white. Median mGFR was 99.4ml/min/1.73m2 (range 66-140), eGFRcr 96 ml/min/1.73m2 (range 61-131), eGFRcys 99.4ml/min/1.73m2 (range 58-145), and eGFRcr-cys 97.9ml/min/1.73m2 (range 62-132). Table 1 below shows the sensitivity, specificity, and accuracy of eGFR comparing different eGFR formulas to mGFR. Specificity of eGFR was higher in the mGFR≥90 group. While accuracy was similar across all three strata, it was highest in the mGFR≥70 group. There was a range of 27-34% misclassification of mGFR based on eGFR.
*Conclusions: Addition of cystatin C alone or in combination with serum creatinine does not improve performance in appropriately classifying potential donors at the tested thresholds.
To cite this abstract in AMA style:Lu Y, Naik A, Woodside K, Sung R, Doshi R, Parasuraman R, Norman S, Doshi M. Utility of Estimated Glomerular Filtration Rate in Living Kidney Donor Candidates [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/utility-of-estimated-glomerular-filtration-rate-in-living-kidney-donor-candidates/. Accessed March 4, 2021.
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