Background: Approved revision to GFR section of Protocol resulted in new validation rules for KPD donors to be activated. Location in CTR: Health Tab of the KPD Living Donor Patient Record.
Minimum Required Tests
eGFR: Serum creatinine on 2 separate occasions; each reported serum creatinine should also report an eGFR using CKD-EPI with the result expressed as mL/min per 1.73 m2.
- If one or both eGFRs are within the specified range for the potential donor’s age, then either an in-range 24-hour creatinine clearance or measured GFR (nGFR), is required.
- If both of the eGFRs are out-of-range, then a 24-hour urine to assess creatinine clearance (CrCl) on 2 separate occasions AND measured GFR (nGFR) (such as DTPA, EDTA, iohexol, iothalamate) on at least 1 occasion is required.
The Acceptable eGFR ranges are as follows:
- Living Donor age ≤ 30 then acceptable adjusted is ‘eGFR ≥ 90 mL/min/1.73m2’
- Living Donor age ≥ 31 and ≤ 40 then acceptable adjusted is ‘eGFR ≥ 85 mL/min/1.73m2’
- Living Donor age ≥ 41 and ≤ 65 then acceptable adjusted is ‘eGFR ≥ 80 mL/min/1.73m2’
- Living Donor age > 65 then acceptable adjusted is ‘eGFR ≥ 75 mL/min/1.73m2’
Once the eGFR results are entered, the system will indicate if the specified range is ‘Acceptable’ or ‘Unacceptable’ in the wizard.
| eGFR | 24 HR Urine Creatinine Clearance | nGFR | Donor Acceptable for Enrollment |
|---|---|---|---|
| Acceptable | Acceptable | Acceptable | YES |
| Acceptable | Acceptable | n/a | YES |
| Acceptable | n/a | Acceptable | YES |
| Unacceptable | Acceptable | Acceptable | YES |
| Unacceptable | Unacceptable | Acceptable | NO |
| Unacceptable | Acceptable | Unacceptable | NO |
| Unacceptable | Unacceptable | Unacceptable | NO |
Please note that CTR will not restrict any donors from being entered into the KPD program but if a donor is deemed unacceptable by these new criteria, the system will issue a warning message indicating that the user has to submit the Living Donor Query form to KPD.
The Living Donor Query Form can be located under the Reference Documents section in the main menu of the application.
What Happens When You Try to Update an Old Record?
CTR will issue a warning – “eGFR is not in acceptable range. You must enter at least one 24-HR Urine Creatinine Clearance test result AND at least one nGFR test result.”, if you try to update any data on the health Tab of the donor record that contains GFR results that do not meet the new requirements as outlined above.
Old Donor records must have:
- A minimum of 2 results
- For every eGFR entry in each result, there must be a corresponding entry in either 24 HR Urine Creatinine Clearance or nGFR – based on the eGFR Acceptable Ranges. (as noted above)
- Each result can have the same Test date and value for a specific test type
Please see screenshot below where an eGFR value is entered using the same date on each historic GFR entry.
To update the GFR result of an Old record, double click on any cell under the Result column that needs to be updated-
- The system displays Step#1 of the GFR & Creatinine Wizard
- Select the ‘Next’ button to navigate to Step#2
- Enter the 24HR Urine Creatinine Clearance and select the ‘Next’ button
- Depending on the range of the eGFR, the user may need to add the nGFR or can update results with the 24-HR Urine Creatinine Clearance ONLY
- Please do not create new entries if donor already has a minimum of 2 existing results
- Once each of the Old records are updated and saved, you can then add your new data