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Race-free estimated glomerular filtration rate equation in kidney transplant recipients: development and validation study

OBJECTIVE: To compare the performance of a newly developed race-free kidney recipient specific glomerular filtration rate (GFR) equation with the three current main equations for measuring GFR in kidney transplant recipients. DESIGN: Development and validation study SETTING: 17 cohorts in Europe, th...

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Detalles Bibliográficos
Autores principales: Raynaud, Marc, Al-Awadhi, Solaf, Juric, Ivana, Divard, Gillian, Lombardi, Yannis, Basic-Jukic, Nikolina, Aubert, Olivier, Dubourg, Laurence, Masson, Ingrid, Mariat, Christophe, Prié, Dominique, Pernin, Vincent, Le Quintrec, Moglie, Larson, Timothy S, Stegall, Mark D, Bikbov, Boris, Ruggenenti, Piero, Mesnard, Laurent, Ibrahim, Hassan N, Nielsen, Marie Bodilsen, Matas, Arthur J, Nankivell, Brian J, Benjamens, Stan, Pol, Robert A, Bakker, Stephan J L, Jouven, Xavier, Legendre, Christophe, Kamar, Nassim, Smith, Byron H, Wadei, Hani M, Durrbach, Antoine, Vincenti, Flavio, Remuzzi, Giuseppe, Lefaucheur, Carmen, Bentall, Andrew J, Loupy, Alexandre
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231444/
https://www.ncbi.nlm.nih.gov/pubmed/37257905
http://dx.doi.org/10.1136/bmj-2022-073654
Descripción
Sumario:OBJECTIVE: To compare the performance of a newly developed race-free kidney recipient specific glomerular filtration rate (GFR) equation with the three current main equations for measuring GFR in kidney transplant recipients. DESIGN: Development and validation study SETTING: 17 cohorts in Europe, the United States, and Australia (14 transplant centres, three clinical trials). PARTICIPANTS: 15 489 adults (3622 in development cohort (Necker, Saint Louis, and Toulouse hospitals, France), 11 867 in multiple external validation cohorts) who received kidney transplants between 1 January 2000 and 1 January 2021. MAIN OUTCOME MEASURE: The main outcome measure was GFR, measured according to local practice. Performance of the GFR equations was assessed using P(30) (proportion of estimated GFR (eGFR) within 30% of measured GFR (mGFR)) and correct classification (agreement between eGFR and mGFR according to GFR stages). The race-free equation, based on creatinine level, age, and sex, was developed using additive and multiplicative linear regressions, and its performance was compared with the three current main GFR equations: Modification of Diet in Renal Disease (MDRD) equation, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 equation, and race-free CKD-EPI 2021 equation. RESULTS: The study included 15 489 participants, with 50 464 mGFR and eGFR values. The mean GFR was 53.18 mL/min/1.73m(2) (SD 17.23) in the development cohort and 55.90 mL/min/1.73m(2) (19.69) in the external validation cohorts. Among the current GFR equations, the race-free CKD-EPI 2021 equation showed the lowest performance compared with the MDRD and CKD-EPI 2009 equations. When race was included in the kidney recipient specific GFR equation, performance did not increase. The race-free kidney recipient specific GFR equation showed significantly improved performance compared with the race-free CKD-EPI 2021 equation and performed well in the external validation cohorts (P(30) ranging from 73.0% to 91.3%). The race-free kidney recipient specific GFR equation performed well in several subpopulations of kidney transplant recipients stratified by race (P(30) 73.0-91.3%), sex (72.7-91.4%), age (70.3-92.0%), body mass index (64.5-100%), donor type (58.5-92.9%), donor age (68.3-94.3%), treatment (78.5-85.2%), creatinine level (72.8-91.3%), GFR measurement method (73.0-91.3%), and timing of GFR measurement post-transplant (72.9-95.5%). An online application was developed that estimates GFR based on recipient’s creatinine level, age, and sex (https://transplant-prediction-system.shinyapps.io/eGFR_equation_KTX/). CONCLUSION: A new race-free kidney recipient specific GFR equation was developed and validated using multiple, large, international cohorts of kidney transplant recipients. The equation showed high accuracy and outperformed the race-free CKD-EPI 2021 equation that was developed in individuals with native kidneys. TRIAL REGISTRATION: ClinicalTrials.gov NCT05229939.