Details

Autor(en) / Beteiligte

• Spithoven, Edwin M., MD
• Meijer, Esther, MD, PhD
• Boertien, Wendy E., MD
• Sinkeler, Steef J., MD
• Tent, Hilde, MD, PhD
• de Jong, Paul E., MD, PhD
• Navis, Gerjan, MD, PhD
• Gansevoort, Ron T., MD, PhD

Titel

Tubular Secretion of Creatinine in Autosomal Dominant Polycystic Kidney Disease: Consequences for Cross-sectional and Longitudinal Performance of Kidney Function Estimating Equations

Ist Teil von

• American journal of kidney diseases, 2013-09, Vol.62 (3), p.531-540

Ort / Verlag

New York, NY: Elsevier Inc

Erscheinungsjahr

2013

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Autosomal dominant polycystic kidney disease (ADPKD) is characterized by renal tubular cell proliferation and dedifferentiation, which may influence tubular secretion of creatinine (CCr[TS]). Study Design Diagnostic test study. Setting & Participants We therefore investigated CCr(TS) in patients with ADPKD and controls and studied consequences for the performance of glomerular filtration rate (GFR) estimating equations. Index & Reference Tests In patients with ADPKD and healthy controls, we measured GFR as125 I-iothalamate clearance while simultaneously determining creatinine clearance. Other Measurements 24-hour urinary albumin excretion. Results In 121 patients with ADPKD (56% men; mean age, 40 ± 11 [SD] years) and 215 controls (48% men; mean age, 53 ± 10 years), measured GFR (mGFR) was 78 ± 30 and 98 ± 17 mL/min/1.73 m2 , respectively, and CCr(TS) was 15.9 ± 10.8 and 10.9 ± 10.6 mL/min/1.73 m2 , respectively ( P < 0.001). The higher CCr(TS) in patients with ADPKD remained significant after adjustment for covariates and appeared to be dependent on mGFR. Correlation and accuracy between mGFR and CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) estimated GFR (eGFR) were 0.95 and 99%, respectively; between mGFR and MDRD (Modification of Diet in Renal Disease) Study eGFR, they were 0.93 and 97%, respectively. Values for bias, precision, and accuracy were similar or slightly better than in controls. In addition, change in mGFR during 3 years of follow-up in 45 patients with ADPKD correlated well with change in eGFR. Limitations Cross-sectional, single center. Conclusions CCr(TS) in patients with ADPKD is higher than that in controls, but this effect is limited and observed at only high-normal mGFR. Consequently, the CKD-EPI and MDRD Study equations perform relatively well in estimating GFR and change in GFR in patients with ADPKD.