Estimated glomerular filtration rate as an end point in kidney transplant trial: where do we stand?

C. Mariat; Nicolas Maillard; Manolie Phayphet; L. Thibaudin; Silvy Laporte; É. Alamartine; F. Berthoux

doi:10.1093/ndt/gfm708

August 17, 2007Nephrology Dialysis Transplantation

Estimated glomerular filtration rate as an end point in kidney transplant trial: where do we stand?

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Key Points

To evaluate whether mathematical equations estimating glomerular filtration rate can reliably replace direct measurement methods as primary endpoints in kidney transplant clinical trials.
Reviewed literature evaluating the bias, precision, limits of agreement, and accuracy of four major prediction equations: Cockcroft-Gault, Walser, Nankivell, and MDRD.
Assessed equation performance against direct reference clearance standards (inulin, 125I-iothalamate, 99mTc-DTPA, and iohexol) across multiple renal transplant cohorts.
Limits of agreement exceeded 35 ml/min/1.73 m² across all four equations, and at least 64% of estimated values differed from measured GFR by more than ±10%.
Accuracy within 30% of true GFR reached only 69% to 77% for MDRD and 59% for Cockcroft-Gault, causing chronic kidney disease stage misclassification in more than one-third of transplant recipients.

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Implication

Literature review reveals poor agreement between estimated and measured glomerular filtration rate in kidney transplant recipients, suggesting clinical trials require direct clearance measurements.

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Mariat et al. (2007) studied this question.

synapsesocial.com/papers/6a978a852b1871755431c189 https://doi.org/10.1093/ndt/gfm708

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Estimated glomerular filtration rate as an end point in kidney transplant trial: where do we stand?

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Cite This Study

Estimated glomerular filtration rate as an end point in kidney transplant trial: where do we stand?

Key Points

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Implication

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