Chronic Kidney Disease Research Center (CKDRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.
Iran J Kidney Dis. 2023 Jan;1(1):54-60.
The accurate assessment of the pre-donation glomerular filtration rate (GFR) is a crucial step in donor selection. We conducted a prospective cross-sectional study to identify the best equation to estimate GFR and the necessity of a radio-nuclear scan in GFR evaluation.
In this study, 154 potential donors were enrolled, and GFR equations (the MDRD study, the CKD-EPI study, and the full age spectrum [FAS]), and creatinine clearance were compared with measured GFR (mGFR) by the radio-nuclear method.
The study results indicate that Potential donors had an mGFR of 95.56 ± 15.57 mL/min per 1.73 m2. Though body surface area (BSA) adjusted full age spectrum (FAS) and CKD-EPI equations were most correlated with mGFR, the correlation coefficients were weak (ICC: 0.3 and 0.32, respectively). Misclassification at the cut-off of 80 cc/min/ 1.73 m2 was about 42% for both equations. Besides, 16.8% of donors with eGFR more than 80 cc/min/ 1.73 m2 had a difference in split renal function, and 57.1% of participants had a > 2% probability of having an mGFR < 90 mL/min per 1.73 m2.
If the nuclear scan is easily available, we suggest measuring GFR by 99mTc -DTPA scan as the preferred method. Otherwise, our data suggest utilizing mGFR in patients with high body mass index, size asymmetry in CT-scan, eGFR less than 90 mL/min per 1.73 m2 with FAS and/or CKD-EPI equation as these factors deviated the estimated GFR, and also in those with inaccurate creatinine clearance measurements or with posttest probability of having mGFR less than 90 mL/min per 1.73 m2 more than 2%. DOI: 10.52547/ijkd.7271.
准确评估供体的肾小球滤过率（GFR）是选择供体的关键步骤。我们进行了一项前瞻性的横断面研究，旨在确定最佳的方程来估计 GFR，并确定放射性核素扫描在 GFR 评估中的必要性。
本研究共纳入 154 名潜在供体，比较了 GFR 方程（MDRD 研究、CKD-EPI 研究和全年龄谱[FAS]）和肌酐清除率与放射性核素法测量的 GFR（mGFR）的关系。
研究结果表明，潜在供体的 mGFR 为 95.56±15.57ml/min/1.73m2。尽管体表面积（BSA）校正后的全年龄谱（FAS）和 CKD-EPI 方程与 mGFR 相关性最强，但相关系数较弱（ICC：0.3 和 0.32）。两种方程的截断值为 80cc/min/1.73m2 时的分类错误率约为 42%。此外，16.8%的 eGFR 大于 80cc/min/1.73m2 的供体存在分肾功能差异，57.1%的参与者 mGFR<90ml/min/1.73m2 的概率>2%。
如果核扫描易于获得，我们建议使用 99mTc-DTPA 扫描测量 GFR，作为首选方法。否则，我们的数据表明，在肥胖指数较高的患者、CT 扫描中存在大小不对称的患者、eGFR 低于 90ml/min/1.73m2 的患者、使用 FAS 和/或 CKD-EPI 方程的患者中，以及在那些肌酐清除率测量不准确或 posttest mGFR<90ml/min/1.73m2 的可能性大于 2%的患者中，使用 mGFR。DOI：10.52547/ijkd.7271.
