Estimation of GFR using β-trace protein in children
Clinical Journal of the American Society of Nephrology
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Background and objectives Sexmay affect the performance of smallmolecularweight proteins as markers of GFR because of differences in fat mass between the two sexes. The hypothesis was that the diagnostic performance of b-trace protein, a novel marker of GFR, would be significantly better in boys than in girls. Design, setting, participants, & measurements GFR, height, weight, serum creatinine, and β-trace protein were measured in 755 children and adolescents (331 girls) undergoing 99technetium diethylenetriamine penta–acetic acid renal scans from July of 1999 to July of 2006. Boys and girls were separated into formula generation cohorts (284 boys and 220 girls) and formula validation cohorts (140 boys and 111 girls). GFRestimating formulas on the basis of β-trace protein, creatinine, and height were derived using stepwise linear regression analysis of log-transformed data. The slope of the regression lines of the sex-specific eGFRswere compared. Bland–Altman analysis was used for testing agreement between 99technetium diethylenetriamine penta–acetic acid GFR and calculated GFR both with this equation in boys and girls as well as previously established Benlamri, White, and Schwartz formulas. Results In the stepwise regression analysis, β-trace protein (R2=0.73 for boys and R2=0.65 for girls) was more important than creatinine (which increased R2 to 0.81 for boys and R2 to 0.75 for girls) and height (which increased R2 to 0.88 for boys and R2 to 0.80 for girls) in the data generation groups. GFR can be calculated using the following formulas: formula present Bland–Altman analysis showed better performance in boys than in girls. The new formulas performed significantly better than the previous Benlamri, White, and Schwartz formulas with respect to bias, precision, and accuracy. Conclusions Improved and sex-specific formulas for the estimation of GFR in children on the basis of β-trace protein, serum creatinine, and height are now available.