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Kidney Week

Abstract: TH-OR67

GFR in the Era of Precision Medicine: The Importance of a Measured GFR in Onco-Nephrology

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Trevisani, Francesco, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
  • Pegoraro, Giulia, Biorek S.R.L., Milano, Lombardia, Italy
  • Pugno, Daniele, Biorek S.R.L., Milano, Lombardia, Italy
  • Quattrini, Giulia, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
  • Di marco, Federico, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
  • Cinque, Alessandra, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
  • Bettiga, Arianna, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
  • Capitanio, Umberto, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
  • Salonia, Andrea, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
  • Pizzagalli, Giorgio, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
  • Montorsi, Francesco, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
Background

An accurate assessment of renal function in nephrological patients (pts) is of paramount importance Unfortunately, the most used method to measure GFR is represented by the estimated GFR(eGFR) which harbours a significant error in comparison to gold standards(mGFR). Aim of this study was to determine the extent of the error of eGFR compared to the mGFR in onco-nephrological pts.

Methods

A total consecutive cohort of 200 pts was collected to compare the eGFR formulas(MDRD,CKD-EPI 2012) with mGFR method(Iohexol Plasma Clearance).Cohort composition: 116 oncological pts(cases) and 84 functional diseases pts(controls) matched for baseline variables.The agreement between eGFR and mGFR was evaluated using bias, precision, accuracy, and total deviation index. The differences between cohorts were evaluated with Fisher’s exact test and Chi-squared test and Wilcoxon rank sum test for continuous variables.

Results

Clinical data are reported in Table 1. The two matched cohorts displayed no statistical differences in term of clinical variables and agreement parameters(TDI, CCC and P30). Surprisingly, both groups harboured a non negligible errors in each CKD class with a huge discrepancy between the eGFR formulas and the gold standard method (Figure 1, 2), suggesting the great relevance of mGFR in the clinical decision making algorithm, both with two and one kidney.

Conclusion

The error in the classification of CKD stages using eGFR by formulas was too common in case and controls, with a poor agreement with mGFR in all CKD classes. The use of mGFR should be mandatory to obtain a tailored management in onco-nephrology.

Figure on the left represent the percentages of pts with four different intervals of error. Figure on the right represent the classification of pts in CKD stages by eGFR. True positive represent subjects that were correctly classified from eGFR and false positive represent the cases that were not classified in the corresponding class. Table shows the clinical data of the population divided in two cohorts: functional and oncological pts.