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Background <p>Accurate estimation of glomerular filtration rate (eGFR) is essential for managing pediatric chronic kidney disease (CKD). While multiple eGFR equations are used clinically, their reliability in adolescents transitioning to adulthood with pediatric-onset CKD remains uncertain. This study aimed to evaluate the accuracy of 10 eGFR equations against measured GFR (mGFR) values in South Korean adolescents and young adults with CKD using data from the KoreaN Cohort Study for Outcomes in Patients With Pediatric Chronic Kidney Disease (KNOW-PedCKD) cohort.</p> Methods <p>Patients aged ≥ 15 years who underwent mGFR testing were included in the KNOW-PedCKD study. mGFR was determined using plasma clearance of <sup>51</sup>Cr-EDTA or <sup>99m</sup>Tc-DTPA. Ten eGFR equations (U25<sub>Cr</sub>, U25<sub>CysC</sub>, U25<sub>Cr-CysC</sub>, Schwartz<sub>Cr</sub>, CKiD<sub>Cr-CysC</sub>, FAS<sub>Cr</sub>-Age, FAS<sub>Cr</sub>-Ht, FAS<sub>CysC</sub>, CKD-EPI<sub>Cr</sub>, and CKD-EPI<sub>Cr-CysC</sub>) were compared with concurrent mGFR values. Performance was assessed using bias, precision, and accuracy expressed as the percentage of eGFR estimates within 10% [P10] and 30% [P30] of the mGFR.</p> Results <p>The analysis encompassed 187 mGFR measurements from 82 patients (median age 18.4 years, interquartile range (IQR) 16.5–20.8; 75.9% male). Median mGFR was 42.3 (19.3–70.5) mL/min/1.73 m<sup>2</sup>. Overall, the U25<sub>Cr-CysC</sub> showed the most balanced performance, with low bias (1.9 mL/min/1.73 m<sup>2</sup>), high precision (SD 10.5), and accuracy values of 32.6% for P10 and 67.4% for P30. FAS<sub>Cr</sub>-Ht equation exhibited the highest accuracy (77.0%) and the lowest bias (-0.44), with slightly lower precision (SD 12.5). Both equations performed constantly across adolescents and young adult subgroups. In contrast, CKD-EPI<sub>Cr</sub> equation consistently overestimated GFR with the highest bias and lowest accuracy. None of the evaluated equations achieved accuracy of 80–90% within 30% of mGFR, which are generally considered acceptable. However, after exclusion of measurements corresponding to CKD stage 5, the FAS<sub>Cr</sub>-Ht and Schwartz<sub>Cr</sub> equations achieved P30 accuracies of 84.6% and 84.0%, respectively.</p> Conclusions <p>The eGFR equations covering children — particularly U25<sub>Cr-CysC</sub> and FAS<sub>Cr</sub>-Ht equations — provide more reliably estimates of GFR than adult equations in Korean adolescents and young adults with CKD. These findings support the use of age-spanning formulas during transitional care to improve clinical accuracy and continuity.</p>

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Comparison of estimated and measured GFR in pediatric CKD patients transitioning from adolescence to adulthood: results from KNOW-PedCKD

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月2日

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  • Seon Hee Lim,
  • Eujin Park,
  • Kyung Hee Han,
  • Ji Yeon Song,
  • Seong Heon Kim,
  • Naye Choi,
  • Heeyeon Cho,
  • Jeong Yeon Kim,
  • Jae Il Shin,
  • Keum Hwa Lee,
  • Min Hyun Cho,
  • Min Ji Park,
  • Hee Sun Baek,
  • Joo Hoon Lee,
  • Jiwon Jung,
  • Eun Mi Yang,
  • Ji Hyun Kim,
  • Il-Soo Ha,
  • Hee Gyung Kang,
  • Yo Han Ahn

摘要

Background

Accurate estimation of glomerular filtration rate (eGFR) is essential for managing pediatric chronic kidney disease (CKD). While multiple eGFR equations are used clinically, their reliability in adolescents transitioning to adulthood with pediatric-onset CKD remains uncertain. This study aimed to evaluate the accuracy of 10 eGFR equations against measured GFR (mGFR) values in South Korean adolescents and young adults with CKD using data from the KoreaN Cohort Study for Outcomes in Patients With Pediatric Chronic Kidney Disease (KNOW-PedCKD) cohort.

Methods

Patients aged ≥ 15 years who underwent mGFR testing were included in the KNOW-PedCKD study. mGFR was determined using plasma clearance of 51Cr-EDTA or 99mTc-DTPA. Ten eGFR equations (U25Cr, U25CysC, U25Cr-CysC, SchwartzCr, CKiDCr-CysC, FASCr-Age, FASCr-Ht, FASCysC, CKD-EPICr, and CKD-EPICr-CysC) were compared with concurrent mGFR values. Performance was assessed using bias, precision, and accuracy expressed as the percentage of eGFR estimates within 10% [P10] and 30% [P30] of the mGFR.

Results

The analysis encompassed 187 mGFR measurements from 82 patients (median age 18.4 years, interquartile range (IQR) 16.5–20.8; 75.9% male). Median mGFR was 42.3 (19.3–70.5) mL/min/1.73 m2. Overall, the U25Cr-CysC showed the most balanced performance, with low bias (1.9 mL/min/1.73 m2), high precision (SD 10.5), and accuracy values of 32.6% for P10 and 67.4% for P30. FASCr-Ht equation exhibited the highest accuracy (77.0%) and the lowest bias (-0.44), with slightly lower precision (SD 12.5). Both equations performed constantly across adolescents and young adult subgroups. In contrast, CKD-EPICr equation consistently overestimated GFR with the highest bias and lowest accuracy. None of the evaluated equations achieved accuracy of 80–90% within 30% of mGFR, which are generally considered acceptable. However, after exclusion of measurements corresponding to CKD stage 5, the FASCr-Ht and SchwartzCr equations achieved P30 accuracies of 84.6% and 84.0%, respectively.

Conclusions

The eGFR equations covering children — particularly U25Cr-CysC and FASCr-Ht equations — provide more reliably estimates of GFR than adult equations in Korean adolescents and young adults with CKD. These findings support the use of age-spanning formulas during transitional care to improve clinical accuracy and continuity.