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See detailCon: Should we abandon the use of the MDRD equation in favour of the CKD-EPI equation?
DELANAYE, Pierre ULg; Pottel, Hans; Botev, Rossini

in Nephrology Dialysis Transplantation (2013), 28(6), 1396-1403

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See detailMDRD Versus CKD_EPI equation to estimate glomerular filtration rate in kidney transplant recipients
masson, Ingrid; Flamant, Martin; Maillard, Nicolas et al

in Transplantation (2013), 95(10),

Background. The new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine-based equation was developed to address the systematic underestimation of the glomerular filtration rate (GFR) by ... [more ▼]

Background. The new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine-based equation was developed to address the systematic underestimation of the glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) Study equation in patients with a relatively well-preserved kidney function. The performance of the new equation for kidney transplant recipients is discussed. Methods. We analyzed the performances of the CKD-EPI equation in comparison with the MDRD Study equation in 825 stable kidney transplant recipients. Bias, precision, and accuracy within 30% of true GFR were determined. GFR was measured by urinary clearance of inulin (n=488) and plasma clearance of 51Cr-EDTA (n=337). Results. Mean measured GFR (mGFR) was 50T19 mL/min/1.73 m2. On the whole cohort, bias was significantly lower for MDRD Study equation compared with CKD-EPI creatinine. This superiority translates into a better accuracy (80% and 74% for the MDRD and CKD-EPI creatinine, respectively). The best performance of the MDRD Study equation is confirmed both in the subgroups of patients with mGFR G60 mL/min/1.73 m2 and between 60 and 90 mL/min/1.73 m2. For mGFR 990 mL/min/1.73 m2, there were no significant differences between the two equations in terms of performance. Conclusions. The CKD-EPI creatinine equation does not offer a better GFR prediction in renal transplant patients compared with the MDRD Study equation, even in the earlier CKD stages. [less ▲]

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See detailMDRD versus CKD-EPI equation to estimate glomerular filtration rate in kidney transplant recipients
Masson, Ingrid; Flamant, Martin; Maillard, Nicolas et al

in Transplantation (2013), 95(10), 1211-1217

Background. The new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine-based equation was developed to address the systematic underestimation of the glomerular filtration rate (GFR) by ... [more ▼]

Background. The new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine-based equation was developed to address the systematic underestimation of the glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) Study equation in patients with a relatively well-preserved kidney function. The performance of the new equation for kidney transplant recipients is discussed. Methods. We analyzed the performances of the CKD-EPI equation in comparison with the MDRD Study equation in 825 stable kidney transplant recipients. Bias, precision, and accuracy within 30% of true GFR were determined. GFR was measured by urinary clearance of inulin (n=488) and plasma clearance of 51Cr-EDTA (n=337). Results. Mean measured GFR (mGFR) was 50T19 mL/min/1.73 m2. On the whole cohort, bias was significantly lower for MDRD Study equation compared with CKD-EPI creatinine. This superiority translates into a better accuracy (80% and 74% for the MDRD and CKD-EPI creatinine, respectively). The best performance of the MDRD Study equation is confirmed both in the subgroups of patients with mGFR G60 mL/min/1.73 m2 and between 60 and 90 mL/min/1.73 m2. For mGFR 990 mL/min/1.73 m2, there were no significant differences between the two equations in terms of performance. Conclusions. The CKD-EPI creatinine equation does not offer a better GFR prediction in renal transplant patients compared with the MDRD Study equation, even in the earlier CKD stages. [less ▲]

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See detailMDRD VERSUS CKD-EPI EQUATIONS TO ESTIMATE GLOMERULAR FILTRATION RATE IN OBESE PATIENTS
BOUQUEGNEAU, Antoine ULg; CAVALIER, Etienne ULg; Krzesinski, Jean-Marie ULg et al

in Nephrology Dialysis Transplantation (2013, April 18), 28(supplément 1), 117-139

Introduction and Aims: Obesity is recognized as a risk factor both for the development and progression of chronic kidney disease (CKD). Estimating glomerular filtration rate (GFR) is thus especially ... [more ▼]

Introduction and Aims: Obesity is recognized as a risk factor both for the development and progression of chronic kidney disease (CKD). Estimating glomerular filtration rate (GFR) is thus especially important to follow these patients. We have tested the performances of two creatinine-based equations, namely the MDRD and CKD-EPI equations, in an obese population. Conclusions :Both in the global and subgroup analyses, the CKD-EPI equation did not outperform the MDRD study equation. The performances of both equations were worse in CKD patients. These two conclusions were still valid if indexed GFR was considered. [less ▲]

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See detailEnzymatic but not compensated Jaffe methods reach the desirable specifications of NKDEP at normal levels of creatinine. results of the French multicentric evaluation
Boutten, Anne; Bargnoux, Anne-Sophie; Carlier, Marie-Christine et al

in Clinica Chimica Acta (2013), 419

The French Society of Clinical Biochemistry conducted this study to compare the accuracy and performances of the best creatinine enzymatic assays and the compensated Jaffe methods from the same ... [more ▼]

The French Society of Clinical Biochemistry conducted this study to compare the accuracy and performances of the best creatinine enzymatic assays and the compensated Jaffe methods from the same manufacturers. Creatinine was measured in 3 serum pools with creatinine levels of 35.9±0.9 μmol/L, 74.4±1.4 μmol/L, and 97.9±1.7 μmol/L (IDMS determination). The performances of the assays (total error that includes the contribution of bias and imprecision) were evaluated using Monte-Carlo simulations and compared against desirable NKDEP criteria. The enzymatic assays always fell within the desirable total Error of 7.6%. By contrast, this requirement was never obtained for the compensated Jaffe methods at the critical level of 74.4±1.4 μmol/L. Only the compensated Jaffe creatinine on Olympus analyzer reached this specification at 35.9±0.9 and 97.9±1.7 μmol/L levels. This study demonstrates that, despite substantial improvement regarding traceability to the IDMS reference method and precision, compensated Jaffe creatinine methods, by contrast to enzymatic ones, do not reach the desirable specifications of NKDEP at normal levels of creatinine. [less ▲]

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See detailCreatinine - or cystatin C - based equations to estimate glomerular filtration in the general population: impact on the epidemiology of chronic kidney disease
DELANAYE, Pierre ULg; CAVALIER, Etienne ULg; Moranne, Olivier et al

in BMC Nephrology (2013), 14

Chronic kidney disease (CKD) is a major issue in public health. Its prevalence has been calculated using estimation of glomerular filtration rate (GFR) by the creatinine-based equations developed in the ... [more ▼]

Chronic kidney disease (CKD) is a major issue in public health. Its prevalence has been calculated using estimation of glomerular filtration rate (GFR) by the creatinine-based equations developed in the Modified Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) study. Recently, new equations based either on cystatin C (CKD-EPI Cys) or both cystatin and creatinine (CKD-EPI mix) have been proposed by the CKD-EPI consortium. The aim of this study was to measure the difference in the prevalence of stage 3 CKD, defined as an estimated GFR less than 60 mL/min/1.73 m2, in a population using these four equations. METHODS: CKD screening was performed in the Province of Liege, Belgium. On a voluntary basis, people aged over 50 years have been screened. GFR was estimated by the four equations. Stage 3 CKD was defined as a GFR less than 60 mL/min/1.73 m2. RESULTS: The population screened consisted of 4189 people (47% were men, mean age 63 +/- 7y). Their mean serum creatinine and plasma cystatin C levels were 0.88 +/- 0.21 mg/dL and 0.85 +/- 0.17 mg/L, respectively. The prevalence of CKD in this population using the MDRD, the CKD-EPI, the CKD-EPI Cys and the CKD-EPI mix equations was 13%, 9.8%, 4.7% and 5%, respectively. The prevalence of CKD was significantly higher with the creatinine-based (MDRD and the CKD-EPI) equations compared to the new cystatin C-based equations. CONCLUSIONS: Prevalence of CKD varies strongly depending on the method used to estimate GFR. Such discrepancies are of importance and must be confirmed and explained by additional studies, notably by studies using GFR measured with a reference method [less ▲]

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See detailParathormone and bone-specific alkaline phosphatase for the follow-up of bone turnover in hemodialysis patients : Is it so simple?
DELANAYE, Pierre ULg; DUBOIS, Bernard ULg; JOURET, François ULg et al

in Clinica Chimica Acta (2013), 417

Background: Chronic Kidney Disease (CKD) is associated with mineral and bone disorders (MBD). International guidelines suggest that levels of serum parathormone (PTH) or bone-specific alkaline phosphatase ... [more ▼]

Background: Chronic Kidney Disease (CKD) is associated with mineral and bone disorders (MBD). International guidelines suggest that levels of serum parathormone (PTH) or bone-specific alkaline phosphatase (b-ALP) can be used to evaluate MBD in dialysis patients. The evidence remains moderate and based on transversal studies. <br />Methods: We retrospectively investigated the variations of PTH (ΔPTH) and b-ALP (Δb-ALP) serum concentrations over a short (6-weeks) and a long (one-year) period in a monocentric hemodialysis population. The proportion of patients reaching the critical difference (CD) (50% for PTH and 25% for b-ALP) was calculated. <br />Results: Seventy-seven patientswere included. A significant correlation between PTHand b-ALP levelswas found at baseline (r=0.51). By contrast, no correlation was observed between ΔPTH and Δb-ALP over a 6-week interval (r=0.07). The CD for PTH and b-ALP was reached by 19 and 11 patients, respectively, with 2 patients showing consistent variations of both biomarkers. One year later, measurements were repeated in 48 survivors. <br />No correlation was found between ΔPTH and Δb-ALP (r=0.27). The CD for PTH or b-ALP was reached by 24 patients and 28 patients, respectively, with 6 patients (12.5%) showing opposite results for both biomarkers. <br />Conclusion: This study shows the lack of correlation between ΔPTH and Δb-ALP over time in patients under chronic hemodialysis. [less ▲]

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See detailPerformance of creatinine and cystatin C-based glomerular filtration rate estimating equations in a European HIV-positive cohort.
Gagneux-Brunon, Amandine; DELANAYE, Pierre ULg; Maillard, Nicolas et al

in AIDS (2013)

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See detailEnzymatic but not compensated Jaffe methods reach the desirable specifications of NKDEP at normal levels of creatinine. Results of the French multicentric evaluation
Boutten, A; Bargnoux, A.S.; Carlier, M.C. et al

in Clinica Chimica Acta (2013), 419

The French Society of Clinical Biochemistry conducted this study to compare the accuracy and performances of the best creatinine enzymatic assays and the compensated Jaffe methods from the same ... [more ▼]

The French Society of Clinical Biochemistry conducted this study to compare the accuracy and performances of the best creatinine enzymatic assays and the compensated Jaffe methods from the same manufacturers. Creatinine was measured in 3 serum pools with creatinine levels of 35.9 ± 0.9 μmol/L, 74.4 ± 1.4 μmol/L, and 97.9 ± 1.7 μmol/L (IDMS determination). The performances of the assays (total error that includes the contribution of bias and imprecision) were evaluated using Monte-Carlo simulations and compared against desirable NKDEP criteria. The enzymatic assays always fell within the desirable total Error of 7.6%. By contrast, this requirement was never obtained for the compensated Jaffe methods at the critical level of 74.4 ± 1.4 μmol/L. Only the compensated Jaffe creatinine on Olympus analyzer reached this specification at 35.9 ± 0.9 and 97.9 ± 1.7 μmol/L levels. This study demonstrates that, despite substantial improvement regarding traceability to the IDMS reference method and precision, compensated Jaffe creatinine methods, by contrast to enzymatic ones, do not reach the desirable specifications of NKDEP at normal levels of creatinine. [less ▲]

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See detailGFR Estimation Using Standardized Cystatin C in Kidney Transplant Recipients
Masson, Ingrid; Maillard, Nicolas; Tack, Ivan et al

in American Journal of Kidney Diseases (2013), 61(2), 279-284

Background: The utility of serum cystatin C (SCysC) as a filtration marker in kidney transplantation is uncertain. We took advantage of the recent validation of a reference calibrator for SCysC and of ... [more ▼]

Background: The utility of serum cystatin C (SCysC) as a filtration marker in kidney transplantation is uncertain. We took advantage of the recent validation of a reference calibrator for SCysC and of newly developed CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equations (2012) expressed for use with standardized SCysC level to reassess the performance of SCysC as a filtration marker in kidney transplant recipients. Study Design: Study of diagnostic test accuracy. Setting & Participants: 670 kidney transplant recipients from 3 centers undergoing glomerular filtration rate (GFR) measurements from December 2006 to November 2012. Index Test: Estimated GFR (eGFR) using the 2012 SCysC-based and serum creatinine (SCr)/SCysCbased CKD-EPI equations (eGFRcys and eGFRcr-cys, respectively) and the 2009 SCr-based CKD-EPI equation (eGFRcr), with SCysC and SCr measured at a single laboratory between April 2011 and June 2011. Reference Test: Measured GFR (mGFR) using urinary clearance of inulin. Results: Bias (the difference between mGFR and eGFR) was significantly smaller for eGFRcys and eGFRcr-cys versus eGFRcr ( 2.82 and 0.54 vs 4.4 mL/min/1.73 m2, respectively; P 0.001). Precision (standard deviation of the mean bias) also was better for eGFRcys and eGFRcr-cys versus eGFRcr (12 and 11 vs 13 mL/min/1.73 m2 [P 0.001 for both comparisons]). Accuracy (percentage of GFR estimates within 30% of mGFR) was greater for eGFRcys and eGFRcr-cys versus eGFRcr (81% and 86% vs 75%, respectively [P 0.004 and P 0.001]). Net reclassification index with respect to mGFR of 30 mL/min/1.73 m2 for eGFRcr-cys and eGFRcys versus eGFRcr was 18.8% [95% CI, 8.6%-28.9%] and 22.5% [95% CI, 10.2%-34.9%]. Limitations: Patients were exclusively of European descent; association with transplant outcome was not evaluated. Conclusions: Our data validate the use of both the newly developed SCysC-based and SCr/SCysC-based CKD-EPI equations (2012) in kidney transplant recipients. Both equations perform better than the SCr-based CKD-EPI equation (2009). [less ▲]

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See detailOstéomalacie hypophosphatémique hyperphosphaturique avec hypersécrétion de FGF-23
COLSON, Laurent ULg; Vander Rest, Catherine; Reginster, Jean-Yves ULg et al

in Lettre du Rhumatologue (La) (2012), 387

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See detailEffects of Large-Pore Hemofiltration in a Swine Model of Fulminant Hepatic Failure.
DETRY, Olivier ULg; JANSSEN, Nathalie ULg; CHERAMY-BIEN, Jean-Paul ULg et al

in Artificial Organs (2012), 36(11), 981-987

Among the different potential mechanisms that could lead to brain edema and intracranial hypertension in fulminant hepatic failure (FHF), the inflammatory hypothesis implies that systemic inflammation ... [more ▼]

Among the different potential mechanisms that could lead to brain edema and intracranial hypertension in fulminant hepatic failure (FHF), the inflammatory hypothesis implies that systemic inflammation might be in part responsible for an increase in cerebral blood flow (CBF) and brain water content. In this study, the authors used a validated ischemic FHF swine model to evaluate the effects of 80 kDa large-pore membrane hemofiltration (LPHF) on intracranial pressure (ICP) and CBF, in relation with the clearance of proinflammatory cytokines and blood liver tests, as primary end points. Fifteen pigs were randomized into one of three groups: SHAM, FHF, and FHF + LPHF. All experiments lasted 6 h. In the FHF groups, liver failure was induced by liver ischemia. After 2 h, the FHF + LPHF group underwent 4 h of a zero-balance continuous veno-venous hemofiltration using a 0.7-m(2) , large-pore (78 A) membrane with a cutoff of 80 kDa. ICP, CBF, mean arterial pressure, central venous pressure, and heart rate were continuously monitored and recorded. Arterial aspartate aminotransferase, total bilirubin, creatinine, international normalized ratio, glucose, lactate and serum cytokines interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha were measured at T0, T120, and T360. Over the 6 h following liver ischemia, the FHF group developed a significant increase in ICP. This ICP rise was not observed in the SHAM group and was attenuated in the FHF + LDHF group. However, the ICP levels were not different at T360 in the FHF + LDHF group compared to the FHF group. No significant effect of LPHF on liver tests or levels of proinflammatory cytokines could be demonstrated. In this model, 80 kDa LPHF was not efficient to control FHF intracranial hypertension and to decrease serum cytokine levels. [less ▲]

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See detailDemystifying ethnic/sex differences in kidney function: is the difference in (estimating) glomerular filtration rate or in serum creatinine concentration?
Pottel, Hans; Hoste, Liesbeth; DELANAYE, Pierre ULg et al

in Clinica Chimica Acta (2012), 413(19-20), 1612-17

BACKGROUND: The recent evaluation of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimating the glomerular filtration rate (GFR) in multiple ethnicities has raised the ... [more ▼]

BACKGROUND: The recent evaluation of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimating the glomerular filtration rate (GFR) in multiple ethnicities has raised the question on how well this equation performs for African-American and Asian subjects. There is no doubt that serum creatinine (Scr) concentration differs between ethnicities and sexes. We show that creatinine-based equations for white populations may be inaccurate for estimating GFR in other ethnic/gender groups, especially in populations from Asia. METHODS: This study presents a mathematical analysis of the CKD-EPI-equation complemented with a literature review of median and reference values for IDMS-standardized Scr-concentrations for multiple ethnicities. RESULTS: The study shows that at equal eGFR-CKD-EPI-values, the ratio of Scr between females and males equals 0.79 and between other ethnicities/sexes and white males is constant too. From this information, it is possible to calculate mean Scr-values that correspond very well with literature values directly obtained from Scr-distributions in healthy white males and females and in black males, but the discrepancy is larger for other populations. CONCLUSIONS: Our results confirm the criticism that has been raised for using the CKD-EPI-equation for these ethnicities. An alternative eGFR-model is proposed based on a population-normalized Scr that needs further validation. [less ▲]

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