{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T18:28:07Z","timestamp":1773944887305,"version":"3.50.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Accurate glomerular filtration rate (GFR) estimation is crucial for evaluating living kidney donors, especially when measured GFR (mGFR) is unavailable. This study compares the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), full age spectrum (FAS), and European Kidney Function Consortium (EKFC) creatinine- and\/or cystatin C-based estimated GFR (eGFR) equations against iohexol mGFR to determine the optimal equation for donor eligibility assessment in a US population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>1210 kidney donor candidates were retrospectively analyzed, comparing eGFR equations based on creatinine, cystatin C, or both against iohexol mGFR. Accuracy metrics (P10, P30, mean bias) and subgroup analyses for Black donors and age-based bias were evaluated. The classification performance of eGFR equations in donor eligibility was examined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The 2021 CKD-EPIcr [AS (age, sex)] demonstrated the best accuracy across the overall cohort (P10 48.2%, P30 93.2%, mean bias \u22124.8\u2005mL\/min\/1.73\u2005m\u00b2). The 2021 CKD-EPIcr-cys (AS) excelled in Black donors (P10 60.3%, P30 95.4%, mean bias \u22123.6\u2005mL\/min\/1.73\u2005m\u00b2). Cystatin C-based equations showed higher negative bias, with the largest underestimation observed in older donors. All equations demonstrated &amp;lt;35% positive predictive value (PPV) for rejecting ineligible donors (&amp;lt;60\u2005mL\/min\/1.73\u2005m\u00b2) but &amp;gt;85% PPV in determining acceptable donors (\u226590\u2005mL\/min\/1.73\u2005m\u00b2). Overall, 2021 CKD-EPIcr-cys (AS) was the most reliable for identifying acceptable donors (F1 score 83.9 at \u226590\u2005mL\/min\/1.73\u2005m\u00b2). Using age\/sex-specific thresholds improved performance of all equations in donor eligibility classification compared to absolute thresholds.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>No eGFR equation reliably rejected ineligible donors. 2021 CKD-EPIcr-cys (AS) exhibited the best overall performance for donor eligibility assessment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/clinchem\/hvaf071","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T11:07:06Z","timestamp":1751022426000},"page":"870-883","source":"Crossref","is-referenced-by-count":1,"title":["eGFR Inaccuracy in the Assessment of Living Kidney Transplant Donor Eligibility"],"prefix":"10.1093","volume":"71","author":[{"given":"Sarrah","family":"Lahorewala","sequence":"first","affiliation":[{"name":"Department of Pathology and Immunology, Baylor College of Medicine, Baylor St. Luke\u2019s Medical Center , Houston, TX ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zheng","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Radiology, Houston Methodist Hospital , Houston, TX ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Kinskey","sequence":"additional","affiliation":[{"name":"Department of Pathology and Genomic Medicine, Houston Methodist Hospital , Houston, TX ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shane A","family":"Bobart","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hypertension and Transplantation, Department of Medicine, Houston Methodist Hospital , Houston, TX ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelina","family":"Edwards","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hypertension and Transplantation, Department of Medicine, Houston Methodist Hospital , Houston, TX ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Pathology and Genomic Medicine, Houston Methodist Hospital , Houston, TX ,","place":["United States"]},{"name":"Department of Pathology and Laboratory Medicine, Weill Cornell Medical College , New York, NY ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7550-5148","authenticated-orcid":false,"given":"Roger L","family":"Bertholf","sequence":"additional","affiliation":[{"name":"Department of Pathology and Genomic Medicine, Houston Methodist Hospital , Houston, TX ,","place":["United States"]},{"name":"Department of Pathology and Laboratory Medicine, Weill Cornell Medical College , New York, NY ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6824-0743","authenticated-orcid":false,"given":"Xin","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Pathology and Genomic Medicine, Houston Methodist Hospital , Houston, TX ,","place":["United States"]},{"name":"Department of Pathology and Laboratory Medicine, Weill Cornell Medical College , New York, NY ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"2025080103015561800_hvaf071-B1","author":"National Institute of Diabetes and Digestive and Kidney Diseases"},{"key":"2025080103015561800_hvaf071-B2","doi-asserted-by":"crossref","first-page":"e2234971","DOI":"10.1001\/jamanetworkopen.2022.34971","article-title":"Survival benefit of first single-organ deceased donor kidney transplantation compared with long-term dialysis across ages in transplant-eligible patients with kidney failure","volume":"5","author":"Strohmaier","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2025080103015561800_hvaf071-B3","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1111\/ajt.14702","article-title":"An economic assessment of contemporary kidney transplant practice","volume":"18","author":"Axelrod","year":"2018","journal-title":"Am J Transplant"},{"key":"2025080103015561800_hvaf071-B4","author":"National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases"},{"key":"2025080103015561800_hvaf071-B5","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1056\/NEJMoa0804883","article-title":"Long-term consequences of kidney donation","volume":"360","author":"Ibrahim","year":"2009","journal-title":"N Engl J Med"},{"key":"2025080103015561800_hvaf071-B6","doi-asserted-by":"crossref","first-page":"e191851","DOI":"10.1001\/jamanetworkopen.2019.1851","article-title":"Assessment of postdonation outcomes in US living kidney donors using publicly available data sets","volume":"2","author":"Chen","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2025080103015561800_hvaf071-B7","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/TP.0000000000001770","article-title":"KDIGO clinical practice guideline on the evaluation and care of living kidney donors","volume":"101","author":"Lentine","year":"2017","journal-title":"Transplantation"},{"key":"2025080103015561800_hvaf071-B8","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1681\/ASN.2016070790","article-title":"GFR evaluation in living kidney donor candidates","volume":"28","author":"Levey","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"2025080103015561800_hvaf071-B9","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1038\/s41581-019-0191-y","article-title":"Measured and estimated glomerular filtration rate: current status and future directions","volume":"16","author":"Levey","year":"2020","journal-title":"Nat Rev Nephrol"},{"key":"2025080103015561800_hvaf071-B10","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1053\/j.ajkd.2021.04.016","article-title":"Measurement and estimation of GFR for use in clinical practice: core curriculum 2021","volume":"78","author":"Inker","year":"2021","journal-title":"Am J Kidney Dis"},{"key":"2025080103015561800_hvaf071-B11","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1373\/clinchem.2017.282517","article-title":"Biological variation of creatinine, cystatin C, and eGFR over 24 hours","volume":"64","author":"Hilderink","year":"2018","journal-title":"Clin Chem"},{"key":"2025080103015561800_hvaf071-B12","doi-asserted-by":"crossref","first-page":"2202","DOI":"10.1093\/eurheartj\/ehad210","article-title":"Importance of cystatin C in estimating glomerular filtration rate: the PARADIGM-HF trial","volume":"44","author":"Tolomeo","year":"2023","journal-title":"Eur Heart J"},{"key":"2025080103015561800_hvaf071-B13","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1038\/s41581-018-0080-9","article-title":"Estimated GFR: time for a critical appraisal","volume":"15","author":"Porrini","year":"2019","journal-title":"Nat Rev Nephrol"},{"key":"2025080103015561800_hvaf071-B14","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C-based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med"},{"key":"2025080103015561800_hvaf071-B15","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1056\/NEJMoa1114248","article-title":"Estimating glomerular filtration rate from serum creatinine and cystatin C","volume":"367","author":"Inker","year":"2012","journal-title":"N Engl J Med"},{"key":"2025080103015561800_hvaf071-B16","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1053\/j.ajkd.2021.08.003","article-title":"A unifying approach for GFR estimation: recommendations of the NKF-ASN task force on reassessing the inclusion of race in diagnosing kidney disease","volume":"79","author":"Delgado","year":"2022","journal-title":"Am J Kidney Dis"},{"key":"2025080103015561800_hvaf071-B17","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1515\/cclm-2022-0928","article-title":"The new, race-free, Chronic Kidney Disease Epidemiology Consortium (CKD-EPI) equation to estimate glomerular filtration rate: is it applicable in Europe? A position statement by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)","volume":"61","author":"Delanaye","year":"2022","journal-title":"Clin Chem Lab Med"},{"key":"2025080103015561800_hvaf071-B18","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1093\/ndt\/gfv454","article-title":"An estimated glomerular filtration rate equation for the full age spectrum","volume":"31","author":"Pottel","year":"2016","journal-title":"Nephrol Dial Transplant"},{"key":"2025080103015561800_hvaf071-B19","first-page":"497","article-title":"Estimating glomerular filtration rate for the full age spectrum from serum creatinine and cystatin C","volume":"32","author":"Pottel","year":"2017","journal-title":"Nephrol Dial Transplant"},{"key":"2025080103015561800_hvaf071-B20","doi-asserted-by":"crossref","first-page":"183","DOI":"10.7326\/M20-4366","article-title":"Development and validation of a modified full age spectrum creatinine-based equation to estimate glomerular filtration rate: a cross-sectional analysis of pooled data","volume":"174","author":"Pottel","year":"2021","journal-title":"Ann Intern Med"},{"key":"2025080103015561800_hvaf071-B21","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.kint.2023.11.024","article-title":"Performance of the European Kidney Function Consortium (EKFC) creatinine-based equation in United States cohorts","volume":"105","author":"Delanaye","year":"2024","journal-title":"Kidney Int"},{"key":"2025080103015561800_hvaf071-B22","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1093\/ndt\/gfac241","article-title":"Performance of creatinine-based equations to estimate glomerular filtration rate in White and Black populations in Europe, Brazil and Africa","volume":"38","author":"Delanaye","year":"2023","journal-title":"Nephrol Dial Transplant"},{"key":"2025080103015561800_hvaf071-B23","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.7326\/M22-0610","article-title":"Quantifying individual-level inaccuracy in glomerular filtration rate estimation: a cross-sectional study","volume":"175","author":"Shafi","year":"2022","journal-title":"Ann Intern Med"},{"key":"2025080103015561800_hvaf071-B24","author":"Andrews"},{"key":"2025080103015561800_hvaf071-B25","first-page":"1","article-title":"European Renal Best Practice Transplantation Guideline Development Group. ERBP guideline on the management and evaluation of the kidney donor and recipient","volume":"28","author":"Pascual","year":"2013","journal-title":"Nephrol Dial Transplant"},{"key":"2025080103015561800_hvaf071-B26","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.kint.2018.11.029","article-title":"Impact of estimation versus direct measurement of predonation glomerular filtration rate on the eligibility of potential living kidney donors","volume":"95","author":"Gaillard","year":"2019","journal-title":"Kidney Int"},{"key":"2025080103015561800_hvaf071-B27","doi-asserted-by":"crossref","first-page":"6054","DOI":"10.3390\/jcm12186054","article-title":"Accuracy-based glomerular filtration rate assessment by plasma iohexol clearance in kidney transplant donors","volume":"12","author":"Jin","year":"2023","journal-title":"J Clin Med"},{"key":"2025080103015561800_hvaf071-B28","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1053\/j.ajkd.2014.04.010","article-title":"Measuring GFR: a systematic review","volume":"64","author":"Soveri","year":"2014","journal-title":"Am J Kidney Dis"},{"key":"2025080103015561800_hvaf071-B29","author":"Organ Procurement and Transplantation Network (OPTN)"},{"key":"2025080103015561800_hvaf071-B30","doi-asserted-by":"crossref","first-page":"3379","DOI":"10.1111\/ajt.15951","article-title":"The kidney evaluation of living kidney donor candidates: US practices in 2017","volume":"20","author":"Garg","year":"2020","journal-title":"Am J Transplant"},{"key":"2025080103015561800_hvaf071-B31","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1159\/000338450","article-title":"Practice patterns in evaluation of living kidney donors in United Network for Organ Sharing-approved kidney transplant centers","volume":"35","author":"Brar","year":"2012","journal-title":"Am J Nephrol"},{"key":"2025080103015561800_hvaf071-B32","doi-asserted-by":"crossref","first-page":"100710","DOI":"10.1016\/j.xkme.2023.100710","article-title":"Discordance between creatinine-based and cystatin C-based estimated GFR: interpretation according to performance compared to measured GFR","volume":"5","author":"Wang","year":"2023","journal-title":"Kidney Med"},{"key":"2025080103015561800_hvaf071-B33","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1681\/ASN.0000000000000128","article-title":"Accuracy of GFR estimating equations in patients with discordances between creatinine and cystatin C-based estimations","volume":"34","author":"Fu","year":"2023","journal-title":"J Am Soc Nephrol"},{"key":"2025080103015561800_hvaf071-B34","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.ejim.2020.04.044","article-title":"Comparison of bias and accuracy using cystatin C and creatinine in CKD-EPI equations for GFR 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