©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Longitudinal assessment of measured and estimated glomerular filtration-rate in autosomal dominant polycystic kidney disease: Real practice experience
Juan M Fernandez, José C Rodriguez-Pérez, M Mercedes Lorenzo-Medina, Fancisco Rodriguez-Esparragon, Juan C Quevedo-Reina, Carmen R Hernandez-Socorro
Juan M Fernandez, Medical Manager Southern Europe, Baxter Healthcare Ltd., Madrid 28830, Spain
Juan M Fernandez, Escuela de Doctorado, Universidad De Las Palmas De Gran Canaria, Las Palmas 35001, Canary Islands, Spain
José C Rodriguez-Pérez, Department of Research, Universidad Fernando Pessoa Canarias, Las Palmas 35450, Canary Islands, Spain
M Mercedes Lorenzo-Medina, Department of Clinical Chemistry, Hospital Universitario De Gran Canaria Doctor Negrín, Las Palmas 35010, Canary Islands, Spain
Fancisco Rodriguez-Esparragon, Department of Research, Hospital Universitario De Gran Canaria Doctor Negrín, Las Palmas 35010, Canary Islands, Spain
Juan C Quevedo-Reina, Department of Nephrology, Hospital Universitario De Gran Canaria Doctor Negrín, Las Palmas 35010, Canary Islands, Spain
Carmen R Hernandez-Socorro, Department of Radiology, Hospital Universitario De Gran Canaria Doctor Negrín, Las Palmas 35010, Canary Islands, Spain
Author contributions: Fernandez JM and Rodriguez-Pérez JC participated in the conception and design of the study and were involved in the acquisition, analysis and interpretation of data and process of writing; Lorenzo-Medina MM, Quevedo-Reina JC, and Hernandez-Socorro CR accessed and verified the study data; Rodriguez-Esparragon F analysis and writing; all authors contributed to the preparation and critical review of the manuscript, and approved the final manuscript.
Institutional review board statement: The study protocol received approval from the Ethics Committee of the HUGCDN (Protocol VO 05-2017; Review Board approval, No. 170071; May 2017).
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study. Nevertheless, prior to participation and inclusion in the prospective database, written informed consent was obtained from all patients.
Conflict-of-interest statement: None of the authors have any conflict of interest to declare. Neither honoraria nor payments were made for authorship of this article. All authors declare no proprietary interest.
Data sharing statement: The data underlying this article will be shared on reasonable request to the corresponding author.
Corresponding author: Juan M Fernandez, MD, Medical Manager Southern Europe, Baxter Healthcare Ltd., Parque Empresarial San Fernando-Edificio Londres, Madrid 28830, Spain.
docjuanfernandez@gmail.com
Received: July 11, 2024
Revised: December 7, 2024
Accepted: December 27, 2024
Published online: March 25, 2025
Processing time: 192 Days and 10 Hours
BACKGROUND
Equations for estimation glomerular filtration rate (eGFR) have been associated with poor clinical performance and their clinical accuracy and reliability have been called into question.
AIM
To assess the longitudinal changes in measured glomerular filtration rate (mGFR) in patients with autosomal dominant polycystic kidney disease (ADPKD).
METHODS
Analysis of an ambispective data base conducted on consecutive patients diagnosed with ADPKD. The mGFR was assessed by iohexol clearance; while eGFR was calculated by three different formulas: (1) The chronic kidney disease epidemiology collaboration (CKD-EPI); (2) Modification of diet in renal disease (MDRD); and (3) The 24-hour urine creatinine clearance (CrCl). The primary end-points were the mean change in mGFR between the baseline and final visit, as well as the comparison of the mean change in mGFR with the change estimated by the different formulas.
RESULTS
Thirty-seven patients were included in the study. As compared to baseline, month-6 mGFR was significantly decrease by -4.4 mL/minute ± 10.3 mL/minute (P = 0.0132). However, the CKD-EPI, MDRD, and CrCl formulas underestimated this change by 48.3%, 89.0%, and 45.8% respectively, though none of these differences reached statistical significance (P = 0.3647; P = 0.0505; and P = 0.736, respectively). The discrepancies between measured and estimated glomerular filtration rate values, as evaluated by CKD-EPI (r = 0.29, P = 0.086); MDRD (r = 0.19, P = 0.272); and CrCl (r = 0.09, P = 0.683), were not correlated with baseline mGFR values.
CONCLUSION
This study indicated that eGFR inaccurately reflects the decline in mGFR and cannot reliably track changes over time. This poses significant challenges for clinical decision-making, particularly in treatment strategies.
Core Tip: This analysis of an ambispective data base aimed to evaluate the longitudinal changes in measured glomerular filtration rate (mGFR) and the estimation glomerular filtration rate (eGFR). Glomerular filtration rate (GFR) in patients with autosomal dominant polycystic kidney disease (ADPKD) and their relationship between baseline eGFR and final mGFR. The three formulas for estimating GFR were notably imprecise and unreliable, especially for tracking changes in GFR in individuals with ADPKD. The change in mGFR was underestimated by 48.3%, 89.0%, and 45.8% by the chronic kidney disease epidemiology collaboration, modification of diet in renal disease, and the 24-hour urine creatinine clearance formulas, respectively, although none of these underestimations were statistically significant. These results could significantly influence clinical decision-making, particularly regarding treatment selection.
