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Kidney Week

Abstract: SA-PO118

GFR in the Era of Precision Medicine: The Relevance of a Measured GFR in the Onco-Nephrology Universe and Solitary Kidney

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Trevisani, Francesco, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
  • Franchini, Melania, Azienda Ospedaliera Universitaria Federico II, Napoli, Campania, Italy
  • Quattrini, Giulia, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
  • Cinque, Alessandra, Biorek s.r.l., 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
  • Locatelli, Massimo, 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

A reliable assessment of renal function in onconephrology (ON) is fundamental. The most used tool to measure GFR is the estimated GFR (eGFR) which harbors a significant error compared to gold standards (mGFR). Aim of this study was to determine the extent of the error of eGFR compared to mGFR in ON and solitary kidney (SK) patients (pts).

Methods

A consecutive cohort of 403 ON pts was collected to compare the most used eGFR formulas (MDRD, CKD-EPI SCr 2012, CKD-EPI 2021 SCr, CKD-EPI Cys 2012, CKD-EPI Cys 2021, CKD-EPI Cys/SCr, Cockroft-Gault) with mGFR (Iohexol Plasma Clearance). Among them, 126 pts were SK for radical nephrectomy. We performed statistical analyses on the overall population and a sub-analysis in SK pts. True positives and False positives were classified in CKD stages. Comparisons between groups were performed using Wilcoxon ranks sum test for numerical variables and Pearson’s Chi square test for categorical ones.

Results

Clinical data: overall median age was 67 years, median BMI 24.8, Male: 74.9%, F: 25.1%, Diabetes: 10.9%, Hypertension: 53.8%, CKD stage I: 3.7%, II: 25.5%, IIIA: 28%, IIIB: 27.5%, IV: 13.4%, V: 1.74%, mean Creatinine: 1,46 mg/dl, cystatin: 1,23. Both overall population (Figure 1) and SK cohort (Figure 2) harbored a non-negligible errors in each CKD class with a huge discrepancy between eGFR and mGFR, suggesting the great relevance of mGFR in the decision making algorithm.

Conclusion

The error in the classification of CKD stages using eGFR by formulas was too common, with a poor agreement with mGFR in all CKD classes. The use of mGFR should be mandatory to obtain a tailored management in ON, especially in SK.