Estimated Glomerular Filtration Rate in Renal Transplantation: The Nephrologist in the Mist

Background. Formulas do not estimate renal function with acceptable precision and accuracy. Methods. We compared 51 creatinine-based and/or cystatin c-based formulas with a gold standard (iohexol plasma clearance) in 193 renal transplant recipients using concordance correlation coefficient, total deviation index, coverage probability and the error in chronic kidney disease (CKD) stage classification. Results. No formula showed a concordance correlation coefficient greater than 0.90 (average for creatinine-based formulas: similar to 0.70 and for cystatin c-based formulas: similar to 0.85). A wide total deviation index was observed: approximately 70% (creatinine-based) and approximately 50% (cystatin c-based), indicating that 90% of the estimations showed bounds of error of +/- 70% or +/- 50%, respectively, compared with the gold standard. No formula included 90% of the estimations within a coverage probability of +/- 10%. Half the CKD stages classified by creatinine-based formulas were incorrect, mainly due to overestimation of renal function. One of 3 CKD stages diagnosed by cystatin c-based formulas was incorrect, with both overestimation and underestimation. Overall, the formulas showed very low precision and accuracy and a high degree of error in reflecting real renal function. Conclusions. In conclusion, formulas do not properly reflect renal function in kidney transplantation, which makes their use in clinical practice unreliable. Moreover, their use in clinical trials should be avoided.