Creatinine clearance in selection of living kidney donor among the Malaysian population: is it safe?

Abstract

Background

Assessment of donor renal function is made by the measurement of Glomerular Filtration Rate (GFR). Exogenous markers are preferred over creatinine clearance and are widely used for measuring GFR. However, they are difficult to obtain, costly and laborious. This is a study to look into the safety and accuracy of creatinine clearance for renal assessment among the living kidney donors in the Malaysian population.

Methods

This is a retrospective, single-centre study comprising 105 living kidney donor candidates from the year 2007 to 2020. By comparing against 51-Chromium ethylenediamine-tetraacetic acid (⁵¹Cr-EDTA), we analysed creatinine clearance for correlation, bias, precision and accuracy.

Results

The study group had a mean age of 45.68 ± 10.97 years with a mean serum creatinine of 64.43 ± 17.68 µmol/L and a urine volume of 2.06 ± 0.83 L. Mean measured GFR from ⁵¹Cr-EDTA was 124.37 ± 26.83 ml/min/1.73m² whereas mean creatinine clearance was 132.35 ± 38.18 ml/min/1.73m². Creatinine clearance overestimated ⁵¹Cr-EDTA significantly with a correlation coefficient of 0.48 (p < 0.001) and an accuracy of 78.10% and 64.0% within 30% and 20% respectively of ⁵¹Cr-EDTA.

Conclusion

Creatinine clearance is an acceptable and affordable alternative for donor renal assessment in the absence of exogenous markers with an emphasis on adequate urine collection followed by using measured GFR in selected cases.