Improving the urine spot protein/creatinine ratio by the estimated creatinine excretion to predict proteinuria in pediatric kidney transplant recipients

Background Since the daily creatinine excretion rate (CER) is directly affected by muscle mass, which varies with age, gender, and body weight, using the spot protein/creatinine ratio (Spot P/Cr) follow‐up of proteinuria may not always be accurate. Estimated creatinine excretion rate (eCER) can be c...

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Published in:Pediatric transplantation 2021-11, Vol.25 (7), p.e14142-n/a
Main Authors: Incir, Said, Tasdemir, Mehmet, Kocak, Burak, Yelken, Berna, Arpali, Emre, Akyollu, Basak, Palaoglu, Kerim Erhan, Baygul, Arzu, Bilge, Ilmay, Turkmen, Aydin
Format: Article
Language:English
Subjects:
accuracy
Bias
Biomarkers - urine
Body weight
Child
Children
Creatinine
Creatinine - urine
creatinine excretion rate
Excretion
Female
Humans
Kidney Function Tests
Kidney Transplantation
Kidney transplants
Male
Pediatrics
Population studies
Postoperative Complications - diagnosis
protein excretion rate
Proteins
Proteinuria
Proteinuria - diagnosis
protein‐to‐creatinine ratio
Statistical analysis
Urine
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container_issue 7
container_start_page e14142
container_title Pediatric transplantation
container_volume 25
creator Incir, Said
Tasdemir, Mehmet
Kocak, Burak
Yelken, Berna
Arpali, Emre
Akyollu, Basak
Palaoglu, Kerim Erhan
Baygul, Arzu
Bilge, Ilmay
Turkmen, Aydin
description Background Since the daily creatinine excretion rate (CER) is directly affected by muscle mass, which varies with age, gender, and body weight, using the spot protein/creatinine ratio (Spot P/Cr) follow‐up of proteinuria may not always be accurate. Estimated creatinine excretion rate (eCER) can be calculated from spot urine samples with formulas derived from anthropometric factors. Multiplying Spot P/Cr by eCER gives the estimated protein excretion rate (ePER). We aimed to determine the most applicable equation for predicting daily CER and examine whether ePER values acquired from different equations can anticipate measured 24 h urine protein (m24 h UP) better than Spot P/Cr in pediatric kidney transplant recipients. Methods This study enrolled 23 children with kidney transplantation. To estimate m24 h UP, we calculated eCER and ePER values with three formulas adapted to children (Cockcroft‐Gault, Ghazali‐Barratt, and Hellerstein). To evaluate the accuracy of the methods, Passing‐Bablok and Bland‐Altman analysis were used. Results A statistically significant correlation was found between m24 h UP and Spot P/Cr (p 
doi_str_mv 10.1111/petr.14142
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Estimated creatinine excretion rate (eCER) can be calculated from spot urine samples with formulas derived from anthropometric factors. Multiplying Spot P/Cr by eCER gives the estimated protein excretion rate (ePER). We aimed to determine the most applicable equation for predicting daily CER and examine whether ePER values acquired from different equations can anticipate measured 24 h urine protein (m24 h UP) better than Spot P/Cr in pediatric kidney transplant recipients. Methods This study enrolled 23 children with kidney transplantation. To estimate m24 h UP, we calculated eCER and ePER values with three formulas adapted to children (Cockcroft‐Gault, Ghazali‐Barratt, and Hellerstein). To evaluate the accuracy of the methods, Passing‐Bablok and Bland‐Altman analysis were used. Results A statistically significant correlation was found between m24 h UP and Spot P/Cr (p &lt; .001, r = 0.850), and the correlation was enhanced by multiplying the Spot P/Cr by the eCER equations. The average bias of the ePER formulas adjusted by the Cockcroft‐Gault, Ghazali‐Barratt, and Hellerstein equations were −0.067, 0.031, and 0.064 g/day, respectively, whereas the average bias of Spot P/Cr was −0.270 g/day obtained by the Bland‐Altman graphics. Conclusion Using equations to estimate eCER may improve the accuracy and reduce the spot urine samples’ bias in pediatric kidney transplantation recipients. Further studies in larger populations are needed for ePER reporting to be ready for clinical practice.</description><identifier>ISSN: 1397-3142</identifier><identifier>EISSN: 1399-3046</identifier><identifier>DOI: 10.1111/petr.14142</identifier><identifier>PMID: 34523202</identifier><language>eng</language><publisher>Denmark: Wiley Subscription Services, Inc</publisher><subject>accuracy ; Bias ; Biomarkers - urine ; Body weight ; Child ; Children ; Creatinine ; Creatinine - urine ; creatinine excretion rate ; Excretion ; Female ; Humans ; Kidney Function Tests ; Kidney Transplantation ; Kidney transplants ; Male ; Pediatrics ; Population studies ; Postoperative Complications - diagnosis ; protein excretion rate ; Proteins ; Proteinuria ; Proteinuria - diagnosis ; protein‐to‐creatinine ratio ; Statistical analysis ; Urine</subject><ispartof>Pediatric transplantation, 2021-11, Vol.25 (7), p.e14142-n/a</ispartof><rights>2021 Wiley Periodicals LLC</rights><rights>2021 Wiley Periodicals LLC.</rights><rights>2021 John Wiley &amp; Sons A/S. Published by John Wiley &amp; Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3162-1151322b0ed37ee23fabf5208cba3056dd084addbc42217d8befab0ed99032a53</cites><orcidid>0000-0002-4852-989X ; 0000-0001-6172-2398 ; 0000-0001-9706-9378 ; 0000-0003-0392-6709 ; 0000-0003-3664-8469 ; 0000-0002-5579-6339 ; 0000-0002-0312-2447 ; 0000-0002-0597-7350 ; 0000-0003-2244-9629 ; 0000-0002-7700-7388</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34523202$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Incir, Said</creatorcontrib><creatorcontrib>Tasdemir, Mehmet</creatorcontrib><creatorcontrib>Kocak, Burak</creatorcontrib><creatorcontrib>Yelken, Berna</creatorcontrib><creatorcontrib>Arpali, Emre</creatorcontrib><creatorcontrib>Akyollu, Basak</creatorcontrib><creatorcontrib>Palaoglu, Kerim Erhan</creatorcontrib><creatorcontrib>Baygul, Arzu</creatorcontrib><creatorcontrib>Bilge, Ilmay</creatorcontrib><creatorcontrib>Turkmen, Aydin</creatorcontrib><title>Improving the urine spot protein/creatinine ratio by the estimated creatinine excretion to predict proteinuria in pediatric kidney transplant recipients</title><title>Pediatric transplantation</title><addtitle>Pediatr Transplant</addtitle><description>Background Since the daily creatinine excretion rate (CER) is directly affected by muscle mass, which varies with age, gender, and body weight, using the spot protein/creatinine ratio (Spot P/Cr) follow‐up of proteinuria may not always be accurate. Estimated creatinine excretion rate (eCER) can be calculated from spot urine samples with formulas derived from anthropometric factors. Multiplying Spot P/Cr by eCER gives the estimated protein excretion rate (ePER). We aimed to determine the most applicable equation for predicting daily CER and examine whether ePER values acquired from different equations can anticipate measured 24 h urine protein (m24 h UP) better than Spot P/Cr in pediatric kidney transplant recipients. Methods This study enrolled 23 children with kidney transplantation. To estimate m24 h UP, we calculated eCER and ePER values with three formulas adapted to children (Cockcroft‐Gault, Ghazali‐Barratt, and Hellerstein). To evaluate the accuracy of the methods, Passing‐Bablok and Bland‐Altman analysis were used. Results A statistically significant correlation was found between m24 h UP and Spot P/Cr (p &lt; .001, r = 0.850), and the correlation was enhanced by multiplying the Spot P/Cr by the eCER equations. The average bias of the ePER formulas adjusted by the Cockcroft‐Gault, Ghazali‐Barratt, and Hellerstein equations were −0.067, 0.031, and 0.064 g/day, respectively, whereas the average bias of Spot P/Cr was −0.270 g/day obtained by the Bland‐Altman graphics. Conclusion Using equations to estimate eCER may improve the accuracy and reduce the spot urine samples’ bias in pediatric kidney transplantation recipients. 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Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Incir, Said</au><au>Tasdemir, Mehmet</au><au>Kocak, Burak</au><au>Yelken, Berna</au><au>Arpali, Emre</au><au>Akyollu, Basak</au><au>Palaoglu, Kerim Erhan</au><au>Baygul, Arzu</au><au>Bilge, Ilmay</au><au>Turkmen, Aydin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improving the urine spot protein/creatinine ratio by the estimated creatinine excretion to predict proteinuria in pediatric kidney transplant recipients</atitle><jtitle>Pediatric transplantation</jtitle><addtitle>Pediatr Transplant</addtitle><date>2021-11</date><risdate>2021</risdate><volume>25</volume><issue>7</issue><spage>e14142</spage><epage>n/a</epage><pages>e14142-n/a</pages><issn>1397-3142</issn><eissn>1399-3046</eissn><abstract>Background Since the daily creatinine excretion rate (CER) is directly affected by muscle mass, which varies with age, gender, and body weight, using the spot protein/creatinine ratio (Spot P/Cr) follow‐up of proteinuria may not always be accurate. Estimated creatinine excretion rate (eCER) can be calculated from spot urine samples with formulas derived from anthropometric factors. Multiplying Spot P/Cr by eCER gives the estimated protein excretion rate (ePER). We aimed to determine the most applicable equation for predicting daily CER and examine whether ePER values acquired from different equations can anticipate measured 24 h urine protein (m24 h UP) better than Spot P/Cr in pediatric kidney transplant recipients. Methods This study enrolled 23 children with kidney transplantation. To estimate m24 h UP, we calculated eCER and ePER values with three formulas adapted to children (Cockcroft‐Gault, Ghazali‐Barratt, and Hellerstein). To evaluate the accuracy of the methods, Passing‐Bablok and Bland‐Altman analysis were used. Results A statistically significant correlation was found between m24 h UP and Spot P/Cr (p &lt; .001, r = 0.850), and the correlation was enhanced by multiplying the Spot P/Cr by the eCER equations. The average bias of the ePER formulas adjusted by the Cockcroft‐Gault, Ghazali‐Barratt, and Hellerstein equations were −0.067, 0.031, and 0.064 g/day, respectively, whereas the average bias of Spot P/Cr was −0.270 g/day obtained by the Bland‐Altman graphics. Conclusion Using equations to estimate eCER may improve the accuracy and reduce the spot urine samples’ bias in pediatric kidney transplantation recipients. Further studies in larger populations are needed for ePER reporting to be ready for clinical practice.</abstract><cop>Denmark</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34523202</pmid><doi>10.1111/petr.14142</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-4852-989X</orcidid><orcidid>https://orcid.org/0000-0001-6172-2398</orcidid><orcidid>https://orcid.org/0000-0001-9706-9378</orcidid><orcidid>https://orcid.org/0000-0003-0392-6709</orcidid><orcidid>https://orcid.org/0000-0003-3664-8469</orcidid><orcidid>https://orcid.org/0000-0002-5579-6339</orcidid><orcidid>https://orcid.org/0000-0002-0312-2447</orcidid><orcidid>https://orcid.org/0000-0002-0597-7350</orcidid><orcidid>https://orcid.org/0000-0003-2244-9629</orcidid><orcidid>https://orcid.org/0000-0002-7700-7388</orcidid></addata></record>
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source Wiley-Blackwell Read & Publish Collection
subjects accuracy
Bias
Biomarkers - urine
Body weight
Child
Children
Creatinine
Creatinine - urine
creatinine excretion rate
Excretion
Female
Humans
Kidney Function Tests
Kidney Transplantation
Kidney transplants
Male
Pediatrics
Population studies
Postoperative Complications - diagnosis
protein excretion rate
Proteins
Proteinuria
Proteinuria - diagnosis
protein‐to‐creatinine ratio
Statistical analysis
Urine
title Improving the urine spot protein/creatinine ratio by the estimated creatinine excretion to predict proteinuria in pediatric kidney transplant recipients
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