The ratio of measured to estimated glomerular filtration rate may be a marker of early mortality and dialysis requirement

Abstract Background It has been suggested that, in patients with CKD stage 5, measured GFR (mGFR), defined as the mean of urea and creatinine clearance, as measured by a 24-h urine collection, is a better measure of renal function than estimated GFR (eGFR), based on the CKD-EPI formula. This could b...

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Autores principales:	James G. Heaf, Rafal Yahya, Morten Dahl
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Uraemia Glomerular filtration rate dialysis Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/cb567d1c0a334a218f617a3e02fe8f38
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spelling	oai:doaj.org-article:cb567d1c0a334a218f617a3e02fe8f382021-11-08T11:18:08ZThe ratio of measured to estimated glomerular filtration rate may be a marker of early mortality and dialysis requirement10.1186/s12882-021-02561-11471-2369https://doaj.org/article/cb567d1c0a334a218f617a3e02fe8f382021-11-01T00:00:00Zhttps://doi.org/10.1186/s12882-021-02561-1https://doaj.org/toc/1471-2369Abstract Background It has been suggested that, in patients with CKD stage 5, measured GFR (mGFR), defined as the mean of urea and creatinine clearance, as measured by a 24-h urine collection, is a better measure of renal function than estimated GFR (eGFR), based on the CKD-EPI formula. This could be due to reduced muscle mass in this group. Its use is recommended in the ERBP guidelines. Unplanned dialysis initiation (DI) is associated with increased morbidity, mortality, and reduced modality choice and is generally considered undesirable. We hypothesized that the ratio mGFR/eGFR (M/E) aids prediction of death and DI. Methods All 24-h measurements of urea and creatinine excretion were extracted from the clinical biochemistry databases in Zealand. Data concerning renal diagnosis, comorbidity, biochemistry, medical treatment, mortality and date of DI, were extracted from patient notes, the National Patient Registry and the Danish Nephrology Registry. Patients were included if their eGFR was < 30 ml/min/1.73m2. The last available value for each patient was included. Follow-up was 12 months. Results One thousand two hundred sixty-five patients were included. M/E was median 0.91 ± 0.43. It was highly correlated to previous determinations. It was negatively correlated to eGFR, comorbidity, high age and female sex. It was positively related to albumin and negatively to C-reactive protein. M/E was higher in patients treated with ACE inhibitors and diuretics but no other treatment groups. On a multivariate analysis, M/E was negatively correlated with mortality and combined mortality/DI, but not DI. A post hoc analysis showed a negative correlation to DI at 3 months. For patients with an eGFR 10–15 ml/min/1.73m2, combined mortality and DI at 3 months was for low M/E (< 0.75) 36%, medium (0.75–1.25) 20%, high (> 1.25) 8%. A low M/E predicted increased need for unplanned DI. A supplementary analysis in 519 patients where body surface area values were available, allowing BSA-corrected M/E to be analyzed, revealed similar results. Conclusion A low mGFR/eGFR ratio is associated with comorbidity, malnutrition, and inflammation. It is a marker of early DI, mortality, and unplanned dialysis initiation, independently of eGFR, age and comorbidity. Particular attention paid to patients with a low M/E may lower the incidence of unplanned dialysis requirement.James G. HeafRafal YahyaMorten DahlBMCarticleUraemiaGlomerular filtration ratedialysisDiseases of the genitourinary system. UrologyRC870-923ENBMC Nephrology, Vol 22, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Uraemia Glomerular filtration rate dialysis Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Uraemia Glomerular filtration rate dialysis Diseases of the genitourinary system. Urology RC870-923 James G. Heaf Rafal Yahya Morten Dahl The ratio of measured to estimated glomerular filtration rate may be a marker of early mortality and dialysis requirement
description	Abstract Background It has been suggested that, in patients with CKD stage 5, measured GFR (mGFR), defined as the mean of urea and creatinine clearance, as measured by a 24-h urine collection, is a better measure of renal function than estimated GFR (eGFR), based on the CKD-EPI formula. This could be due to reduced muscle mass in this group. Its use is recommended in the ERBP guidelines. Unplanned dialysis initiation (DI) is associated with increased morbidity, mortality, and reduced modality choice and is generally considered undesirable. We hypothesized that the ratio mGFR/eGFR (M/E) aids prediction of death and DI. Methods All 24-h measurements of urea and creatinine excretion were extracted from the clinical biochemistry databases in Zealand. Data concerning renal diagnosis, comorbidity, biochemistry, medical treatment, mortality and date of DI, were extracted from patient notes, the National Patient Registry and the Danish Nephrology Registry. Patients were included if their eGFR was < 30 ml/min/1.73m2. The last available value for each patient was included. Follow-up was 12 months. Results One thousand two hundred sixty-five patients were included. M/E was median 0.91 ± 0.43. It was highly correlated to previous determinations. It was negatively correlated to eGFR, comorbidity, high age and female sex. It was positively related to albumin and negatively to C-reactive protein. M/E was higher in patients treated with ACE inhibitors and diuretics but no other treatment groups. On a multivariate analysis, M/E was negatively correlated with mortality and combined mortality/DI, but not DI. A post hoc analysis showed a negative correlation to DI at 3 months. For patients with an eGFR 10–15 ml/min/1.73m2, combined mortality and DI at 3 months was for low M/E (< 0.75) 36%, medium (0.75–1.25) 20%, high (> 1.25) 8%. A low M/E predicted increased need for unplanned DI. A supplementary analysis in 519 patients where body surface area values were available, allowing BSA-corrected M/E to be analyzed, revealed similar results. Conclusion A low mGFR/eGFR ratio is associated with comorbidity, malnutrition, and inflammation. It is a marker of early DI, mortality, and unplanned dialysis initiation, independently of eGFR, age and comorbidity. Particular attention paid to patients with a low M/E may lower the incidence of unplanned dialysis requirement.
format	article
author	James G. Heaf Rafal Yahya Morten Dahl
author_facet	James G. Heaf Rafal Yahya Morten Dahl
author_sort	James G. Heaf
title	The ratio of measured to estimated glomerular filtration rate may be a marker of early mortality and dialysis requirement
title_short	The ratio of measured to estimated glomerular filtration rate may be a marker of early mortality and dialysis requirement
title_full	The ratio of measured to estimated glomerular filtration rate may be a marker of early mortality and dialysis requirement
title_fullStr	The ratio of measured to estimated glomerular filtration rate may be a marker of early mortality and dialysis requirement
title_full_unstemmed	The ratio of measured to estimated glomerular filtration rate may be a marker of early mortality and dialysis requirement
title_sort	ratio of measured to estimated glomerular filtration rate may be a marker of early mortality and dialysis requirement
publisher	BMC
publishDate	2021
url	https://doaj.org/article/cb567d1c0a334a218f617a3e02fe8f38
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The ratio of measured to estimated glomerular filtration rate may be a marker of early mortality and dialysis requirement

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