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

PLoS One. 2015 May 4;10(5):e0125669. doi: 10.1371/journal.pone.0125669. eCollection 2015.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers
  • Creatinine / blood
  • Cystatin C / blood
  • Delayed Graft Function*
  • Disease Management
  • Female
  • Glomerular Filtration Rate*
  • Humans
  • Kidney / physiopathology
  • Kidney Function Tests
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Renal Dialysis*
  • Retrospective Studies
  • Risk Assessment

Substances

  • Biomarkers
  • Cystatin C
  • Creatinine

Associated data

  • Dryad/10.5061/dryad.F1T8M

Grant support

The research was in part funded by the National Health and Medical Research Council (NHMRC, Australia) project grant 1011772 www.nhmrc.gov.au. Stipend support for TJP was provided by the Jacquot Research Entry Scholarship and a University of New South Wales Australian Postgraduate Award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.