Comparison of different equations for estimating the glomerular filtration rate in pediatric kidney transplant recipients
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Issued Date
2025-01-01
Resource Type
ISSN
0931041X
eISSN
1432198X
Scopus ID
2-s2.0-105016760954
Journal Title
Pediatric Nephrology
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SCOPUS
Bibliographic Citation
Pediatric Nephrology (2025)
Suggested Citation
Sukboonthong P., Pooliam J., Jantongsree M., Sumboonnanonda A., Pattaragarn A., Supavekin S., Piyaphanee N., Lomjansook K., Thunsiribuddhichai Y., Tinnabut I., Khueankong N., Chaiyapak T. Comparison of different equations for estimating the glomerular filtration rate in pediatric kidney transplant recipients. Pediatric Nephrology (2025). doi:10.1007/s00467-025-06942-8 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/112327
Title
Comparison of different equations for estimating the glomerular filtration rate in pediatric kidney transplant recipients
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Corresponding Author(s)
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Abstract
Background: Accurate glomerular filtration rate estimation (eGFR) is essential for managing pediatric kidney transplant recipients. Given the physiology of pediatric patients receiving adult-donor kidneys, identifying the most appropriate plasma creatinine (PCr)-based formula—pediatric or adult-specific—is crucial. Methods: This cross-sectional study included pediatric kidney transplant recipients (age 1–18 years) who received adult-donor kidneys. We compared agreement thresholds of various pediatric and adult PCr-based GFR equations with CKiD 2012 combined PCr‒cystatin C (PCr-CystC) equation via intraclass correlation coefficients (ICCs), concordance correlation coefficients (CCCs), total deviation index (TDI), P30 performance metric (P30), Bland–Altman plots, and receiver-operating characteristic (ROC) analysis. Correlation between CKiD under 25 (U25) PCr–CystC and reference CKiD 2012 equation was also evaluated. Results: One hundred twenty samples were collected from 23 recipients (mean age = 14.2 ± 3.4 years) and donors (mean age = 31.7 ± 10.0 years). Schwartz–Lyon equation demonstrated the highest performance with the reference (ICC = 0.913, CCC = 0.911, TDI = 14.0 mL/min/1.73 m<sup>2</sup>, P30 = 99.2%). U25 (ICC = 0.922, CCC = 0.882, P30 = 93.3%), full age spectrum (FAS)-height (ICC = 0.897, CCC = 0.877, P30 = 96.7%), and Bedside Schwartz equations (ICC = 0.850, CCC = 0.819, P30 = 89.2%) showed comparable performance. Bland–Altman plots revealed proportional bias (p < 0.05), leading to ROC analysis, which identified eGFR < 70 mL/min/1.73 m<sup>2</sup> for Schwartz–Lyon, U25, and FAS-height, and < 60 mL/min/1.73 m<sup>2</sup> for Bedside Schwartz as optimal agreement thresholds, beyond which each equation showed increased bias. Subgroup analyses also showed better performance in patients aged 10–18 years. Additionally, U25 PCr-CystC equation showed excellent agreement with the reference (ICC = 0.993, CCC = 0.990, P30 = 100%). Conclusions: Schwartz–Lyon equation demonstrated the highest performance among PCr-based equations with the reference in pediatric kidney transplant recipients, particularly when eGFR was < 70 mL/min/1.73 m<sup>2</sup> and in patients aged 10–18 years. U25 PCr-CystC equation showed best overall agreement with the reference and should be preferred where CystC measurement is feasible.