Renal Function Assessment Gap in Clinical Practice: An Awkward Truth
Introduction: An accurate assessment of renal function is needed in the majority of clinical settings. Unfortunately, the most used estimated glomerular filtration rate (eGFR) formulas are affected by significant errors in comparison to gold standards methods of measured GFR (mGFR). Objective: The o...
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Karger Publishers
2020-01-01
|
| Series: | Kidney & Blood Pressure Research |
| Subjects: | |
| Online Access: | https://www.karger.com/Article/FullText/504649 |
| _version_ | 1828851397799444480 |
|---|---|
| author | Francesco Trevisani Federico Di Marco Umberto Capitanio Alessandro Larcher Arianna Bettiga Flaviano Dosio Michele Ghidini Gianluca Del Conte Riccardo Vago Alessandra Cinque Luigi Gianolli Andrea Salonia Alberto Briganti Sergio Luis-Lima Natalia Negrín-Mena Francesco Montorsi Esteban Porrini |
| author_facet | Francesco Trevisani Federico Di Marco Umberto Capitanio Alessandro Larcher Arianna Bettiga Flaviano Dosio Michele Ghidini Gianluca Del Conte Riccardo Vago Alessandra Cinque Luigi Gianolli Andrea Salonia Alberto Briganti Sergio Luis-Lima Natalia Negrín-Mena Francesco Montorsi Esteban Porrini |
| author_sort | Francesco Trevisani |
| collection | DOAJ |
| description | Introduction: An accurate assessment of renal function is needed in the majority of clinical settings. Unfortunately, the most used estimated glomerular filtration rate (eGFR) formulas are affected by significant errors in comparison to gold standards methods of measured GFR (mGFR). Objective: The objective of the study is to determine the extent of the error of eGFR formulas compared to the mGFR in different specific clinical settings. Methods: A total retrospectively consecutive cohort of 1,320 patients (pts) enrolled in 2 different European Hospitals (Center 1: 470 pts; Center 2: 850 pts) was collected in order to compare the most common eGFR formulas used by physicians with the most widespread mGFR methods in daily clinical practice (Iohexol Plasma Clearance -Center 1 [mGFR-iox] and Renal Scintigraphy -Center 2 [mGFR-scnt]). The study cohort was composed by urological, oncological, and nephrological pts. The agreement between eGFR and mGFR was evaluated using bias (as median of difference), precision (as interquartile range of difference) accuracy (as P30), and total deviation index. Results: The most accurate eGFR formula in the comparison with gold standard method (Iohexol plasma clearance) in Center 1 was represented by s-creatinine and cystatin C combined Chronic Kidney Disease-Epidemiology Collaboration-cr-cy, even though the P30 is reduced (84%) under the threshold of 60 mL/min/1.73 m2. Similar results were found in Center 2, with a wider discrepancy between mGFR-scnt and eGFR formulas due to the minor accuracy of the nuclear tool in respect to the mGFR-iox. Conclusions: The loss of accuracy observed for the formulas at lower values of GFR suggests the mandatory use of gold standards methods as Iohexol Plasma Clearance to assess the correct status of renal function for critical cases. The center 2 showed lower levels of agreement between mGFR and eGFR suggesting that the errors are partially accounted for the Renal Scintigraphy technique too. In particular, we suggest the use of mGFR-iox in oncological urological and nephrological pts with an eGFR lower than 60 mL/min/1.73 m2. |
| first_indexed | 2024-12-12T23:31:49Z |
| format | Article |
| id | doaj.art-c8755614213443ad86e911ab764b6fa7 |
| institution | Directory Open Access Journal |
| issn | 1420-4096 1423-0143 |
| language | English |
| last_indexed | 2024-12-12T23:31:49Z |
| publishDate | 2020-01-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Kidney & Blood Pressure Research |
| spelling | doaj.art-c8755614213443ad86e911ab764b6fa72022-12-22T00:07:46ZengKarger PublishersKidney & Blood Pressure Research1420-40961423-01432020-01-0111410.1159/000504649504649Renal Function Assessment Gap in Clinical Practice: An Awkward TruthFrancesco TrevisaniFederico Di MarcoUmberto CapitanioAlessandro LarcherArianna BettigaFlaviano DosioMichele GhidiniGianluca Del ConteRiccardo VagoAlessandra CinqueLuigi GianolliAndrea SaloniaAlberto BrigantiSergio Luis-LimaNatalia Negrín-MenaFrancesco MontorsiEsteban PorriniIntroduction: An accurate assessment of renal function is needed in the majority of clinical settings. Unfortunately, the most used estimated glomerular filtration rate (eGFR) formulas are affected by significant errors in comparison to gold standards methods of measured GFR (mGFR). Objective: The objective of the study is to determine the extent of the error of eGFR formulas compared to the mGFR in different specific clinical settings. Methods: A total retrospectively consecutive cohort of 1,320 patients (pts) enrolled in 2 different European Hospitals (Center 1: 470 pts; Center 2: 850 pts) was collected in order to compare the most common eGFR formulas used by physicians with the most widespread mGFR methods in daily clinical practice (Iohexol Plasma Clearance -Center 1 [mGFR-iox] and Renal Scintigraphy -Center 2 [mGFR-scnt]). The study cohort was composed by urological, oncological, and nephrological pts. The agreement between eGFR and mGFR was evaluated using bias (as median of difference), precision (as interquartile range of difference) accuracy (as P30), and total deviation index. Results: The most accurate eGFR formula in the comparison with gold standard method (Iohexol plasma clearance) in Center 1 was represented by s-creatinine and cystatin C combined Chronic Kidney Disease-Epidemiology Collaboration-cr-cy, even though the P30 is reduced (84%) under the threshold of 60 mL/min/1.73 m2. Similar results were found in Center 2, with a wider discrepancy between mGFR-scnt and eGFR formulas due to the minor accuracy of the nuclear tool in respect to the mGFR-iox. Conclusions: The loss of accuracy observed for the formulas at lower values of GFR suggests the mandatory use of gold standards methods as Iohexol Plasma Clearance to assess the correct status of renal function for critical cases. The center 2 showed lower levels of agreement between mGFR and eGFR suggesting that the errors are partially accounted for the Renal Scintigraphy technique too. In particular, we suggest the use of mGFR-iox in oncological urological and nephrological pts with an eGFR lower than 60 mL/min/1.73 m2.https://www.karger.com/Article/FullText/504649renal functionserum creatininecystatin cglomerular filtration raterenal measurement techniquesestimated glomerular filtration ratemeasured glomerular filtration rate |
| spellingShingle | Francesco Trevisani Federico Di Marco Umberto Capitanio Alessandro Larcher Arianna Bettiga Flaviano Dosio Michele Ghidini Gianluca Del Conte Riccardo Vago Alessandra Cinque Luigi Gianolli Andrea Salonia Alberto Briganti Sergio Luis-Lima Natalia Negrín-Mena Francesco Montorsi Esteban Porrini Renal Function Assessment Gap in Clinical Practice: An Awkward Truth Kidney & Blood Pressure Research renal function serum creatinine cystatin c glomerular filtration rate renal measurement techniques estimated glomerular filtration rate measured glomerular filtration rate |
| title | Renal Function Assessment Gap in Clinical Practice: An Awkward Truth |
| title_full | Renal Function Assessment Gap in Clinical Practice: An Awkward Truth |
| title_fullStr | Renal Function Assessment Gap in Clinical Practice: An Awkward Truth |
| title_full_unstemmed | Renal Function Assessment Gap in Clinical Practice: An Awkward Truth |
| title_short | Renal Function Assessment Gap in Clinical Practice: An Awkward Truth |
| title_sort | renal function assessment gap in clinical practice an awkward truth |
| topic | renal function serum creatinine cystatin c glomerular filtration rate renal measurement techniques estimated glomerular filtration rate measured glomerular filtration rate |
| url | https://www.karger.com/Article/FullText/504649 |
| work_keys_str_mv | AT francescotrevisani renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT federicodimarco renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT umbertocapitanio renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT alessandrolarcher renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT ariannabettiga renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT flavianodosio renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT micheleghidini renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT gianlucadelconte renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT riccardovago renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT alessandracinque renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT luigigianolli renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT andreasalonia renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT albertobriganti renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT sergioluislima renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT natalianegrinmena renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT francescomontorsi renalfunctionassessmentgapinclinicalpracticeanawkwardtruth AT estebanporrini renalfunctionassessmentgapinclinicalpracticeanawkwardtruth |