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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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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
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author 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
author_facet 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
author_sort Raynaud, Marc
collection PubMed
description 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.
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spelling pubmed-102314442023-06-01 Race-free estimated glomerular filtration rate equation in kidney transplant recipients: development and validation study 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 BMJ Research 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. BMJ Publishing Group Ltd. 2023-05-31 /pmc/articles/PMC10231444/ /pubmed/37257905 http://dx.doi.org/10.1136/bmj-2022-073654 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Research
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
Race-free estimated glomerular filtration rate equation in kidney transplant recipients: development and validation study
title Race-free estimated glomerular filtration rate equation in kidney transplant recipients: development and validation study
title_full Race-free estimated glomerular filtration rate equation in kidney transplant recipients: development and validation study
title_fullStr Race-free estimated glomerular filtration rate equation in kidney transplant recipients: development and validation study
title_full_unstemmed Race-free estimated glomerular filtration rate equation in kidney transplant recipients: development and validation study
title_short Race-free estimated glomerular filtration rate equation in kidney transplant recipients: development and validation study
title_sort race-free estimated glomerular filtration rate equation in kidney transplant recipients: development and validation study
topic Research
url 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
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