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Estimated pediatric glomerular filtration rate presentation improves the detection rate of kidney impairment in children

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Abstract

Background

Accurate interpretation of everyday laboratory work is crucial for the early detection of impaired kidney function. Bedside estimation of glomerular filtration rate (eGFR) in children is based on serum creatinine standardized for body mass, most commonly using the revised Schwartz equation using height. This study evaluates how data presentation affects the correct assessment of children’s kidney function.

Methods

In this survey-based study, 121 physicians treating children routinely in a tertiary hospital answered 11 clinical questions requiring assessment of kidney function based on serum creatinine with general (adult) or pediatric normal serum creatinine ranges, or by presented eGFR. The demographic data of the participants were collected.

Results

Presenting eGFR values rather than the customary presentation of serum creatinine and anthropometric parameters more than quadrupled the number of physicians who accurately estimated pediatric kidney function; 38.8% of physicians correctly assessed kidney function when presented with eGFR values but misinterpreted it when equivalent creatinine values were presented (p < 0.001). Seniority, specialty, and self-reported frequency of pediatric kidney function assessment did not affect the interpretation.

Conclusions

Presenting physicians with calculated eGFR can dramatically improve the ability of the medical team to assess kidney function correctly in children.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

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Data Availability

The data that support the findings of this study are available on request from the corresponding author.

References

  1. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637. https://doi.org/10.1681/ASN.2008030287

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mian AN, Schwartz GJ (2017) Measurement and estimation of glomerular filtration rate in children. Adv Chronic Kidney Dis 24:348–356. https://doi.org/10.1053/j.ackd.2017.09.011

    Article  PubMed  PubMed Central  Google Scholar 

  3. Abukwaik WM, Baracco R, Jain A, Gregory M, Valentini RP, Kapur G (2022) Clinical profile of children incidentally found to have advanced kidney failure. Pediatr Nephrol 37:1097–1103. https://doi.org/10.1007/s00467-021-05293-4

    Article  PubMed  Google Scholar 

  4. Pottel H (2017) Measuring and estimating glomerular filtration rate in children. Pediatr Nephrol 32:249–263. https://doi.org/10.1007/s00467-016-3373-x

    Article  PubMed  Google Scholar 

  5. Schwartz GJ, Work DF (2009) Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol 4:1832–1843. https://doi.org/10.2215/CJN.01640309

    Article  PubMed  Google Scholar 

  6. De Broe ME, Gharbi MB, Zamd M, Elseviers M (2017) Why overestimate or underestimate chronic kidney disease when correct estimation is possible? Nephrol Dial Transplant 32:ii136–ii141. https://doi.org/10.1093/ndt/gfw267

    Article  CAS  PubMed  Google Scholar 

  7. Rahn KH, Heidenreich S, Brückner D (1999) How to assess glomerular function and damage in humans. J Hypertens 17:309–317. https://doi.org/10.1097/00004872-199917030-00002

    Article  CAS  PubMed  Google Scholar 

  8. Stevens LA, Levey AS (2009) Measured GFR as a confirmatory test for estimated GFR. J Am Soc Nephrol 20:2305–2313. https://doi.org/10.1681/ASN.2009020171

    Article  PubMed  Google Scholar 

  9. Simon J, Amde M, Poggio ED (2011) Interpreting the estimated glomerular filtration rate in primary care: benefits and pitfalls. Cleve Clin J Med 78:189–195. https://doi.org/10.3949/ccjm.78a.10057

    Article  PubMed  Google Scholar 

  10. Lyle AN, Pokuah F, Dietzen DJ, Wong ECC, Pyle-Eilola AL, Fuqua JS, Woodworth A, Jones PM, Akinbami LJ, Garibaldi LR, Vesper HW. (2022) Current State of Pediatric Reference Intervals and the Importance of Correctly Describing the Biochemistry of Child Development: A Review. JAMA Pediatr 176:699–714. https://doi.org/10.1001/jamapediatrics.2022.0794

    Article  PubMed  PubMed Central  Google Scholar 

  11. van Dam MJCM, Pottel H, Vreugdenhil ACE (2022) Creatinine-based GFR-estimating equations in children with overweight and obesity. Pediatr Nephrol 37:2393–2403. https://doi.org/10.1007/s00467-021-05396-y

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pottel H, Hoste L, Delanaye P (2015) Abnormal glomerular filtration rate in children, adolescents and young adults starts below 75 mL/min/1.73 m2. Pediatr Nephrol 30:821–828. https://doi.org/10.1007/s00467-014-3002-5

    Article  PubMed  Google Scholar 

  13. Pierce CB, Muñoz A, Ng DK, Warady BA, Furth SL, Schwartz GJ (2021) Age- and sex-dependent clinical equations to estimate glomerular filtration rates in children and young adults with chronic kidney disease. Kidney Int 99:948–956. https://doi.org/10.1016/j.kint.2020.10.047

    Article  CAS  PubMed  Google Scholar 

  14. Pottel H, Björk J, Delanaye P, Nyman U (2022) Evaluation of the creatinine-based chronic kidney disease in children (under 25 years) equation in healthy children and adolescents. Pediatr Nephrol 37:2213–2216. https://doi.org/10.1007/s00467-022-05429-0

    Article  PubMed  Google Scholar 

  15. Nyman U, Björk J, Berg U, Bökenkamp A, Dubourg L, Goffin K, Grubb A, Hansson M, Larsson A, Littmann K, Åsling-Monemi K, Pottel H, Delanaye P (2022) The Modified CKiD Study Estimated GFR Equations for Children and Young Adults Under 25 Years of Age: Performance in a European Multicenter Cohort. Am J Kidney Dis 80:807–810. https://doi.org/10.1053/j.ajkd.2022.02.018

    Article  CAS  PubMed  Google Scholar 

  16. Pottel H, Vrydags N, Mahieu B, Vandewynckele E, Croes K, Martens F (2008) Establishing age/sex related serum creatinine reference intervals from hospital laboratory data based on different statistical methods. Clin Chim Acta 396:49–55. https://doi.org/10.1016/j.cca.2008.06.017

    Article  CAS  PubMed  Google Scholar 

  17. Pottel H, Mottaghy FM, Zaman Z, Martens F (2010) On the relationship between glomerular filtration rate and serum creatinine in children. Pediatr Nephrol 25:927–934. https://doi.org/10.1007/s00467-009-1389-1

    Article  PubMed  Google Scholar 

  18. Ceriotti F, Boyd JC, Klein G, Henny J, Queraltó J, Kairisto V, Panteghini M; IFCC Committee on Reference Intervals and Decision Limits (C-RIDL) (2008) Reference intervals for serum creatinine concentrations: Assessment of available data for global application. Clin Chem 54:559–566. https://doi.org/10.1373/clinchem.2007.099648

    Article  PubMed  Google Scholar 

  19. Hughes H, Kahl L (2018) In: The Harriet Lane handbook: a manual for pediatric house officers, 21st edn. Elsevier, Philadelphia, PA, p 712

    Google Scholar 

  20. Kliegman R (2020) In: Nelson textbook of pediatrics, 21st edn. Elsevier, Philadelphia, PA

    Google Scholar 

  21. Pottel H, Hoste L, Dubourg L, Ebert N, Schaeffner E, Eriksen BO, Melsom T, Lamb EJ, Rule AD, Turner ST, Glassock RJ, De Souza V, Selistre L, Mariat C, Martens F, Delanaye P (2016) An estimated glomerular filtration rate equation for the full age spectrum. Nephrol Dial Transplant 31:798–806. https://doi.org/10.1093/ndt/gfv454

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pottel H, Björk J, Courbebaisse M, Couzi L, Ebert N, Eriksen BO, Dalton RN, Dubourg L, Gaillard F, Garrouste C, Grubb A, Jacquemont L, Hansson M, Kamar N, Lamb EJ, Legendre C, Littmann K, Mariat C, Melsom T, Rostaing L, Rule AD, Schaeffner E, Sundin PO, Turner S, Bökenkamp A, Berg U, Åsling-Monemi K, Selistre L, Åkesson A, Larsson A, Nyman U, Delanaye P (2021) Development and validation of a modified full age spectrum creatinine-based equation to estimate glomerular filtration rate. Ann Intern Med 174:183–191. https://doi.org/10.7326/M20-4366

    Article  PubMed  Google Scholar 

  23. Stevens PE, Levin A (2013) Evaluation and management of chronic kidney disease: synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline. Ann Intern Med 158:825–830. https://doi.org/10.7326/0003-4819-158-11-201306040-00007

    Article  PubMed  Google Scholar 

  24. Harada R, Ishikura K, Shinozuka S, Mikami N, Hamada R, Hataya H, Morikawa Y, Omori T, Takahashi H, Hamasaki Y, Kaneko T, Iijima K, Honda M (2018) Ensuring safe drug administration to pediatric patients with renal dysfunction: a multicenter study. Clin Exp Nephrol 22:938–946. https://doi.org/10.1007/s10157-018-1537-7

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Prof. Ora Paltiel for her bright insights and helpful comments regarding the study design and structure of the questionnaires. This study was carried out as part of Mr. Egger’s MD thesis at the Faculty of Medicine at the Hebrew University of Jerusalem.

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Author notes

  1. Aviad Schnapp, Yonatan Egger, Naomi Issler and Oded Volovelsky have contributed equally.

Authors and Affiliations

  1. Department of Pediatrics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Aviad Schnapp & Oded Volovelsky

  2. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Aviad Schnapp, Yonatan Egger, Naomi Issler & Oded Volovelsky

  3. Division of Nephrology and Hypertension, Nationwide Children’s Hospital, Columbus, OH, USA

    O. N. Ray Bignall II

  4. The Ohio State University College of Medicine, Columbus, OH, USA

    O. N. Ray Bignall II

  5. Pediatric Nephrology Unit and Research Lab, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Naomi Issler & Oded Volovelsky

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  1. Aviad Schnapp
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Correspondence to Aviad Schnapp.

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This observational study has been approved by the institutional research ethics committee.

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Schnapp, A., Egger, Y., Bignall, O.N.R. et al. Estimated pediatric glomerular filtration rate presentation improves the detection rate of kidney impairment in children. Pediatr Nephrol 38, 3091–3097 (2023). https://doi.org/10.1007/s00467-023-05934-w

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  • DOI: https://doi.org/10.1007/s00467-023-05934-w

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