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Assessment of kidney function : clinical indications for measured GFR

Assessment of kidney function : clinical indications for measured GFR

Title: Assessment of kidney function : clinical indications for measured GFR
Author: Ebert, Natalie
Bevc, Sebastjan
Bökenkamp, Arend
Gaillard, Francois
Hornum, Mads
Jager, Kitty J.
Mariat, Christophe
Eriksen, Bjørn Odvar
Palsson, Runolfur   orcid.org/0000-0001-6763-1702
Rule, Andrew D.
... 3 more authors Show all authors
Date: 2021-08-01
Language: English
Scope: 10
Department: Faculty of Medicine
Office of Division of Clinical Services I
Series: Clinical Kidney Journal; 14(8)
ISSN: 2048-8505
DOI: 10.1093/ckj/sfab042
Subject: biomarker; chronic kidney disease; clinical indications; creatinine; cystatin C; kidney function; measured glomerular filtration rate; Nephrology; Transplantation
URI: https://hdl.handle.net/20.500.11815/3991

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Ebert , N , Bevc , S , Bökenkamp , A , Gaillard , F , Hornum , M , Jager , K J , Mariat , C , Eriksen , B O , Palsson , R , Rule , A D , van Londen , M , White , C & Schaeffner , E 2021 , ' Assessment of kidney function : clinical indications for measured GFR ' , Clinical Kidney Journal , vol. 14 , no. 8 , pp. 1861-1870 . https://doi.org/10.1093/ckj/sfab042


In the vast majority of cases, glomerular filtration rate (GFR) is estimated using serum creatinine, which is highly influenced by age, sex, muscle mass, body composition, severe chronic illness and many other factors. This often leads to misclassification of patients or potentially puts patients at risk for inappropriate clinical decisions. Possible solutions are the use of cystatin C as an alternative endogenous marker or performing direct measurement of GFR using an exogenous marker such as iohexol. The purpose of this review is to highlight clinical scenarios and conditions such as extreme body composition, Black race, disagreement between creatinine- and cystatin C-based estimated GFR (eGFR), drug dosing, liver cirrhosis, advanced chronic kidney disease and the transition to kidney replacement therapy, non-kidney solid organ transplant recipients and living kidney donors where creatinine-based GFR estimation may be invalid. In contrast to the majority of literature on measured GFR (mGFR), this review does not include aspects of mGFR for research or public health settings but aims to reach practicing clinicians and raise their understanding of the substantial limitations of creatinine. While including cystatin C as a renal biomarker in GFR estimating equations has been shown to increase the accuracy of the GFR estimate, there are also limitations to eGFR based on cystatin C alone or the combination of creatinine and cystatin C in the clinical scenarios described above that can be overcome by measuring GFR with an exogenous marker. We acknowledge that mGFR is not readily available in many centres but hope that this review will highlight and promote the expansion of kidney function diagnostics using standardized mGFR procedures as an important milestone towards more accurate and personalized medicine.


We acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Fund of Charite´– Universitätsmedizin Berlin. Publisher Copyright: © The Author(s) 2021.

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