TY - JOUR
T1 - A Model for Glomerular Filtration Rate Assessment in Liver Disease (GRAIL) in the Presence of Renal Dysfunction
AU - Asrani, Sumeet K.
AU - Jennings, Linda W.
AU - Trotter, James F.
AU - Levitsky, Josh
AU - Nadim, Mitra K.
AU - Kim, W. R.
AU - Gonzalez, Stevan A.
AU - Fischbach, Bernard
AU - Bahirwani, Ranjeeta
AU - Emmett, Michael
AU - Klintmalm, Goran
N1 - Funding Information:
Received March 13, 2018; accepted September 3, 2018. Additional Supporting Information may be found at onlinelibrary.wiley.com/doi/10.1002/hep.30321/suppinfo. National data reported here have been supplied by the Minneapolis Medical Research Foundation as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. Supported by the Baylor Foundation Grant. © 2018 by the American Association for the Study of Liver Diseases. View this article online at wileyonlinelibrary.com. DOI 10.1002/hep.30321
Publisher Copyright:
© 2018 by the American Association for the Study of Liver Diseases.
PY - 2019/3
Y1 - 2019/3
N2 - Estimation of glomerular filtration rate (eGFR) in patients with liver disease is suboptimal in the presence of renal dysfunction. We developed a model for GFR assessment in liver disease (GRAIL) before and after liver transplantation (LT). GRAIL was derived using objective variables (creatinine, blood urea nitrogen, age, gender, race, and albumin) to estimate GFR based on timing of measurement relative to LT and degree of renal dysfunction (www.bswh.md/grail). The measured GFR (mGFR) by iothalamate clearance (n = 12,122, 1985-2015) at protocol time points before/after LT was used as reference. GRAIL was compared with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD-4, MDRD-6) equations for mGFR < 30 mL/min/1.73 m 2 . Prediction of development of chronic kidney disease (mGFR < 20 mL/min/1.73 m 2 , initiation of chronic dialysis) and listing or receipt of kidney transplantation within 5 years was examined in internal cohort (n = 785) and external validation (n = 68,217, 2001-2015). GRAIL had less bias and was more accurate and precise as compared with CKD-EPI, MDRD-4, and MDRD-6 at time points before/after LT for low GFR. For mGFR < 30 mL/min/1.73 m 2 , the median difference (eGFR–mGFR) was GRAIL: 5.24 (9.65) mL/min/1.73 m 2 as compared with CKD-EPI: 8.70 (18.24) mL/min/1.73 m 2 , MDRD-4: 8.82 (17.38) mL/min/1.73 m 2 , and MDRD-6: 6.53 (14.42) mL/min/1.73 m 2 . Before LT, GRAIL correctly classified 75% as having mGFR < 30 mL/min/1.73 m 2 versus 36.1% (CKD-EPI), 36.1% (MDRD-4), and 52.8% (MDRD-6) (P < 0.01). An eGFR < 30 mL/min/1.73 m 2 by GRAIL predicted development of CKD (26.9% versus 4.6% CKD-EPI, 5.9% MDRD-4, and 10.5% MDRD-6) in center data and needing kidney after LT (48.3% versus 22.0% CKD-EPI versus 23.1% MDRD-4 versus 48.3% MDRD-6, P < 0.01) in national data within 5 years after LT. Conclusion: GRAIL may serve as an alternative model to estimate GFR among patients with liver disease before and after LT at low GFR.
AB - Estimation of glomerular filtration rate (eGFR) in patients with liver disease is suboptimal in the presence of renal dysfunction. We developed a model for GFR assessment in liver disease (GRAIL) before and after liver transplantation (LT). GRAIL was derived using objective variables (creatinine, blood urea nitrogen, age, gender, race, and albumin) to estimate GFR based on timing of measurement relative to LT and degree of renal dysfunction (www.bswh.md/grail). The measured GFR (mGFR) by iothalamate clearance (n = 12,122, 1985-2015) at protocol time points before/after LT was used as reference. GRAIL was compared with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD-4, MDRD-6) equations for mGFR < 30 mL/min/1.73 m 2 . Prediction of development of chronic kidney disease (mGFR < 20 mL/min/1.73 m 2 , initiation of chronic dialysis) and listing or receipt of kidney transplantation within 5 years was examined in internal cohort (n = 785) and external validation (n = 68,217, 2001-2015). GRAIL had less bias and was more accurate and precise as compared with CKD-EPI, MDRD-4, and MDRD-6 at time points before/after LT for low GFR. For mGFR < 30 mL/min/1.73 m 2 , the median difference (eGFR–mGFR) was GRAIL: 5.24 (9.65) mL/min/1.73 m 2 as compared with CKD-EPI: 8.70 (18.24) mL/min/1.73 m 2 , MDRD-4: 8.82 (17.38) mL/min/1.73 m 2 , and MDRD-6: 6.53 (14.42) mL/min/1.73 m 2 . Before LT, GRAIL correctly classified 75% as having mGFR < 30 mL/min/1.73 m 2 versus 36.1% (CKD-EPI), 36.1% (MDRD-4), and 52.8% (MDRD-6) (P < 0.01). An eGFR < 30 mL/min/1.73 m 2 by GRAIL predicted development of CKD (26.9% versus 4.6% CKD-EPI, 5.9% MDRD-4, and 10.5% MDRD-6) in center data and needing kidney after LT (48.3% versus 22.0% CKD-EPI versus 23.1% MDRD-4 versus 48.3% MDRD-6, P < 0.01) in national data within 5 years after LT. Conclusion: GRAIL may serve as an alternative model to estimate GFR among patients with liver disease before and after LT at low GFR.
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U2 - 10.1002/hep.30321
DO - 10.1002/hep.30321
M3 - Article
C2 - 30338870
AN - SCOPUS:85061933247
SN - 0270-9139
VL - 69
SP - 1219
EP - 1230
JO - Hepatology
JF - Hepatology
IS - 3
ER -