Hyperfiltration Affects Accuracy of Creatinine eGFR Measurement

Background and objectives Surrogate markers such as creatinine, cystatin C (CysC), and beta trace protein (BTP) have been used to estimate GFR (eGFR). The accuracy of eGFR may be altered with hyperfiltration and differences in filtration fraction (FF). It is hypothesized that the accuracy of creatinine for eGFR may be affected by hyperfiltration and different effective renal plasma flow (ERPF). Design, setting, participants, & measurements A total of 127 pediatric patients with various renal diseases underwent simultaneous measurements of GFR using Cr-51-EDTA renal scan and ERPF (I-131-hippurate clearance) to calculate the FF (FF = GFR/ERPF). The eGFRs were calculated using the commonly used Schwartz (creatinine), Filler (CysC), and Benlamri (BTP) formulas. Agreement of the eGFRs with the measured isotope GFRs was assessed by Bland-Altman plots. Correlation analysis was performed using non-parametric tests to compare FF with eGFR - GFR. Results The 127 children at a median age (with 25th percentile, 75th percentile) of 11.9 (8.5, 14.9) years had a mean Cr-51 EDTA-GFR of 100.6 +/- 32.1 ml/min per 1.73 m(2) and a median I-131-hippurate clearance (ERPF) of 588 (398,739) ml/min per 1.73 m(2). Mean FF was 17.7 +/- 4.5% with no correlation between the FF and the error (eGFR - GFR) for CysC and BTP eGFR, whereas there was a significant negative correlation between the error for Schwartz eGFR and FF. Conclusions There is a significant negative correlation between the error for the Schwartz eGFR and the FF. CysC and BTP are not affected by differences in FF. Clin J Am Soc Nephrol 6: 274-280, 2011. doi: 10.2215/CJN.02760310