Kidney Week

Abstract: SA-PO0930

D-Amino Acids-Based Estimation of Glomerular Filtration Rate Is Possible Using the Same Formula in Both Children and Adults

Session Information

• Pathology: Updates and Insights
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pathology and Lab Medicine

• 1800 Pathology and Lab Medicine

Authors

• Fukae, Shota, The University of Osaka Graduate School of Medicine, Suita, Japan

Shota Fukae, MD

• Kimura, Tomonori, The University of Osaka Graduate School of Medicine, Suita, Japan

Tomonori Kimura, MD, PhD

• Matsumura, Soichi, The University of Osaka Graduate School of Medicine, Suita, Japan

Soichi Matsumura, MD

• Kawamura, Masataka, The University of Osaka Graduate School of Medicine, Suita, Japan

Masataka Kawamura, MD, PhD

• Nakazawa, Shigeaki, The University of Osaka Graduate School of Medicine, Suita, Japan

Shigeaki Nakazawa, MD

• Kakuta, Yoichi, The University of Osaka Graduate School of Medicine, Suita, Japan

Yoichi Kakuta, MD, PhD

• Sakai, Shinsuke, The University of Osaka Graduate School of Medicine, Suita, Japan

Shinsuke Sakai, MD

• Mizui, Masayuki, The University of Osaka Graduate School of Medicine, Suita, Japan

Masayuki Mizui, MD, PhD

• Takahara, Shiro, Kansai Medical Clinic for Renal Transplantation, Toyonaka, Japan

Shiro Takahara, MD, PhD

• Isaka, Yoshitaka, The University of Osaka Graduate School of Medicine, Suita, Japan

Yoshitaka Isaka, MD, PhD

• Nonomura, Norio, The University of Osaka Graduate School of Medicine, Suita, Japan

Norio Nonomura, MD, PhD

Background

Estimating glomerular filtration rate (GFR) is challenging due to its dependence on age and body composition, especially in pediatric and elderly populations. Recently, D-Ser and D-Asn, rare amino acid enantiomers, have been identified as GFR biomarkers relatively unaffected by body composition. We investigated whether GFR estimation using these D-amino acids is applicable across a wide age range.

Methods

We analyzed data from two cross-sectional observational cohorts: 366 living kidney transplant donors and recipients, and 27 pediatric patients. Using a dataset of 244 adult patients, we developed GFR estimation formulae based on blood levels of D-Ser and D-Asn using linear regression analyses. We validated the formulas’ performance in 122 adults and 27 children.

Results

The D-amino acid-based equation was 60.4 x D-Ser^-0.450 x D-Asn^-0.304 x 0.916 (if female). For D-amino acid-based equations, age was unnecessary. The performance of the established equations was equivalent to that of creatinine-based equations: bias, 9.1 [8.0-11.2], precision, 11.1 [8.8-14.2], and accuracy (P₃₀), 0.82 [0.73-0.89]. Strikingly, in the pediatric cohort, D-amino acid-based eGFR correlated well with conventional pediatric eGFR.

Conclusion

The performance of D-amino acids-based eGFR is compatible with the conventional eGFR. This approach shows minimal age and sex influence, making it broadly applicable from pediatric to geriatric populations and allowing the extrapolation of adult evidence to children.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025z8d5dm49