Division of Nephrology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Division of Nephrology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Transplant Proc. 2022 Mar;54(2):254-259. doi: 10.1016/j.transproceed.2021.12.023. Epub 2022 Feb 3.
Evaluation of donor renal function as glomerular filtration rate (GFR) is a crucial part of pretransplant workup. Most guidelines recommend measured GFR (mGFR) using exogenous markers with creatinine clearance (CrCl) as an alternative. However, exogenous markers are difficult to obtain and perform, and CrCl may overestimate GFR.
We explore the use of CrCl and combined urea and creatinine clearance as an alternative for GFR assessment.
A retrospective study involving 81 kidney donors from 2007 to 2020, with mGFR collected by chromium 51-labeled ethylenediaminetetraacetic acid (Cr-EDTA) and CrCl and combined urea and creatinine clearance. We analyzed the performance of CrCl and combined urea and creatinine clearance against Cr-EDTA. Adequacy of urine volume was taken into consideration.
A total of 81 candidates with a mean age of 44.80 ± 10.77 years were enrolled. Mean mGFR from Cr-EDTA was 123.66 ± 26.91 mL/min/1.73 m, and combined urea and creatinine clearance and CrCl were 122.13 ± 47.07 and 133.40 ± 36.32 mL/min/1.73 m, respectively. CrCl overestimated Cr-EDTA. Though combined urea and creatinine clearance had minimal bias, it had a lower correlation coefficient (0.25 vs 0.43), lower precision (49.51 vs 38.10), and slightly lower accuracy within 30% of Cr-EDTA (74.07% vs 76.54%).
Combined urea and creatinine clearance did not improve the performance of CrCl. Nevertheless, it can potentially be used as first-line GFR assessment, followed by mGFR in selected donors, to ascertain threshold of safe kidney donation. A stringent urine collection method is essential to ensure accurate measurement.
作为移植前评估的重要部分，评估供体的肾功能（肾小球滤过率[GFR]）。大多数指南建议使用外源性标志物测量 GFR（mGFR），并以肌酐清除率（CrCl）作为替代。然而，外源性标志物获取和操作困难，CrCl 可能高估 GFR。
我们探讨使用 CrCl 和联合尿素和肌酐清除率作为 GFR 评估的替代方法。
这是一项回顾性研究，纳入了 2007 年至 2020 年间的 81 例肾脏供者，使用铬 51-标记的乙二胺四乙酸（Cr-EDTA）和 CrCl 及联合尿素和肌酐清除率收集 mGFR。我们分析了 CrCl 和联合尿素和肌酐清除率与 Cr-EDTA 的相关性。考虑到尿量是否充足。
共纳入 81 例候选者，平均年龄为 44.80±10.77 岁。Cr-EDTA 测定的平均 mGFR 为 123.66±26.91mL/min/1.73m，联合尿素和肌酐清除率和 CrCl 分别为 122.13±47.07 和 133.40±36.32mL/min/1.73m。CrCl 高估了 Cr-EDTA。尽管联合尿素和肌酐清除率的偏差最小，但它的相关系数（0.25 对 0.43）较低，精度（49.51 对 38.10）较低，并且在 Cr-EDTA 的 30%范围内的准确性略低（74.07%对 76.54%）。
联合尿素和肌酐清除率并没有提高 CrCl 的性能。然而，它可以作为一线 GFR 评估方法，在选定的供者中使用 mGFR，以确定安全肾脏捐献的阈值。严格的尿液收集方法是确保准确测量的关键。
