Estimating the glomerular filtration rate in pregnancy: The evaluation of the Nanra and CKD-EPI serum creatinine-based equations

Abstract

Aim

To compare the performance of the Nanra and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimating glomerular filtration rate in pregnancy against the 24 h urine creatinine clearance.

Methods

Pregnant women had 24 h urine collections with simultaneous serum creatinine levels. Measured 24 h urine creatinine clearance was compared to two equations: Nanra and CKD-EPI. Level of concordance was measured, with an a priori bias acceptance of ±15 ml/min/1.73 m².

Results

A total of 53 synchronous urine and serum creatinine samples were analysed. The Nanra equation had a bias of −13.4 ml/min/1.73 m² while the CKD-EPI equation had bias of 14.2 ml/min/1.73 m². Both equations showed a high degree of proportional error and had poor agreement with 24 h urine creatinine clearance.

Conclusions

None of the equations were shown to reliably measure the estimated glomerular filtration rate in pregnant women. A valid serum creatinine-based estimated glomerular filtration rate equation in pregnancy is yet to be established.

Keywords

Glomerular filtration rate pregnancy serum creatinine creatinine clearance Nanra CKD-EPI

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References

Hladunewich

Melamad

Bramham

Pregnancy across the spectrum of chronic kidney disease. Kidney Int 2016; 89: 995–1007.

Zhang

, et al. A sytematic review and meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy. Clin J Am Soc Nephrol 2015; 10: 1964–1978.

Jones

Hayslett

JP.

Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med 1996; 335: 226–232.

Maynard

Thadhani

Pregnancy and the kidney. J Am Soc Nephrol 2009; 20: 14–22.

Smith

, et al. Assessment of glomerular filtration rate during pregnancy using the MDRD formula. BJOG 2008; 115: 109–112.

Ahmed

, et al. A comparison of prediction equations for estimating glomerular filtration rate in pregnancy. Hypertens Pregnancy 2009; 28: 243–255.

Harel

McArthur

Hladunewich

, et al. Serum creatinine levels before, during, and after pregnancy. JAMA 2019; 321: 205–207. doi:10.1001/jama.2018.17948

Alper

, et al. Estimation of glomerular filtration rate in preeclamptic patients. Am J Perinatol 2007; 24: 569–574.

Johnson

, et al. Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: new developments and revised recommendations. Med J Aust 2012; 197: 224–225.

10.

Smith

Moran

Davison

JM.

EPI-CKD is a poor predictor of GFR in pregnancy. Arch Dis Child Fetal Neonatal Ed 2011; 96: Fa99–Fa99.

11.

Alper

, et al. Performance of estimated glomerular filtration rate prediction equations in preeclamptic patients. Am J Perinatol 2011; 28: 425–430.

12.

Mourad

, et al. Measurement of glomerular filtration rate in renal transplant recipients: a comparison of methods. Nephrology 2002; 7: 77–82.

13.

Côté

A-M

Firoz

Mattman

, et al. The 24-hour urine collection: gold standard or historical practice? Am J Obstet Gynecol 2008; 199: 625.e1–625.e6.

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