Variations in Creatinine Generation Among Patients With Glomerular Disease: Evidence From the NEPTUNE and CureGN Studies
Notice bibliographique
Résumé
Rationale & Objective Estimation of glomerular filtration rate (GFR) assumes that creatinine generation (crG) is relatively stable. This study identified factors associated with crG variability and its impact on serum creatinine changes ( Δ Scr) among patients with glomerular disease. Study Design An observational cohort study. Setting & Participants Nephrotic Syndrome Study Network and Cure Glomerulonephropathy adult and pediatric participants with at least one crG measurement. Predictors Potential predictors of crG levels included age, sex, disease diagnosis, weight status, estimated GFR (eGFR), urine protein, steroid use, and nonsteroid immunosuppressant use. crG change ( Δ crG) was then used as an exposure to assess impacts on Δ Scr. Outcomes crG levels and Δ Scr. Analytical Approach The intraclass correlation coefficient illustrated crG variability within individuals. Multivariable linear mixed models identified factors associated with crG levels. Among those with 2+crG measurements, multivariable linear mixed models estimated the association between Δ crG and Δ Scr. Results Among 4,626 crG measurements from 1,081 participants, there was only moderate correlation between measurements within individuals (intraclass correlation coefficient=0.517, 95% CI, 0.482-0.548) overall. For pediatric participants, factors significantly associated with crG included age, sex, weight status, and urine protein. Among adults, significant factors were age, sex, disease diagnosis, weight status, eGFR, steroid use, and nonsteroid immunosuppressant use. Limitations The 24-hour urine collections may have collection error, measured GFR was unavailable, and edema status was unavailable. Conclusions crG was highly dynamic within individuals over time and varied with glomerular disease activity and treatments. The impact of Δ crG on Δ Scr —and subsequently on estimation of kidney function—is potentially large. Accounting for these changes or development of alternative kidney function measures are needed among glomerular disease patients. Plain Language Summary Creatinine generation is often assumed to be stable when using creatinine to estimate kidney function and track kidney function over time, but it can vary with chronic disease. This study showed high variability in creatinine generation within individuals with glomerular disease. Besides age, sex, and weight, important factors that can impact creatinine generation include urine protein in children and kidney function, disease diagnosis, steroid use, and nonsteroid immunosuppressant use in adults. Changes in creatinine generation may also impact changes in the serum creatinine, which would influence estimates of kidney function, but this relationship needs to be studied further. In the meantime, accounting for factors affecting creatinine generation or using alternative estimates of kidney function in patients with glomerular diseases is needed.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».