How the latest evidence from clinical research informs patient care

✍ Scribed by Kanae Ishihara; Brett W. Stephens; Donald A Molony

• Publisher: Wiley (John Wiley & Sons)
• Year: 2010
• Tongue: English
• Weight: 116 KB
• Volume: 39
• Category: Article
• ISSN: 0090-2934
• DOI: 10.1002/dat.20454

✦ Synopsis

Analysis: In 2009, there were 6,388 living kidney donations in the U.S. 1 Data compiled over the past several decades support the view that the overall survival and risk of end stage renal disease is no different in screened donors after donation than that observed in the general population. 2 While many centers use standardized criteria for donor evaluation, the basic measure of kidney function, glomerular fi ltration rate (GFR), and its subsequent evaluation in the patient after single kidney donation, remain areas of controversy. 3 Although most will agree that creatinine-based estimates of GFR are potentially inaccurate, they remain the most commonly employed method for determining GFR.

In this study, Tan and colleagues compare measurements of GFR in 64 patients after kidney donation to evaluate the estimation of GFR (eGFR) by measurement of a creatinine clearance, by the Modifi cation of Diet in Renal Disease (MDRD) equation, and the CKD-EPI equation compared to the "Gold-standard" of a GFR measured by iothalamate clearance. Poor correlation to the iothalamate value was found with all methods to estimate GFR, particularly amongst older kidney donors, resulting in substantial misclassifi cation of individuals as having chronic kidney disease when in truth they did not have substantial CKD.

Validity and threats to validity: The study population consisted of donors representing a wide variety of ages (21-70 yrs), with a good inclusion of women (47%) and differing ethnicities. Time from donation to the measurement of GFR for this study also varied broadly from 5 to 86 months. All of these characteristics are important