Tubular Secretion of Creatinine in Autosomal Dominant Polycystic Kidney Disease: Consequences for Cross-sectional and Longitudinal Performance of Kidney Function Estimating Equations

Edwin M. Spithoven, Esther Meijer, Wendy E. Boertien, Steef J. Sinkeler, Hilde Tent, Paul E. de Jong, Gerjan Navis, Ron T. Gansevoort*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

21 Citations (Scopus)


Background: Autosomal dominant polycystic kidney disease (ADPKD) is characterized by renal tubular cell proliferation and dedifferentiation, which may influence tubular secretion of creatinine (CCr[TS]).

Study Design: Diagnostic test study.

Setting & Participants: We therefore investigated CCr(TS) in patients with ADPKD and controls and studied consequences for the performance of glomerular filtration rate (GFR) estimating equations.

Index & Reference Tests: In patients with ADPKD and healthy controls, we measured GFR as I-125-iothalamate clearance while simultaneously determining creatinine clearance.

Other Measurements: 24-hour urinary albumin excretion.

Results: In 121 patients with ADPKD (56% men; mean age, 40 +/- 11 [SD] years) and 215 controls (48% men; mean age, 53 +/- 10 years), measured GFR (mGFR) was 78 +/- 30 and 98 +/- 17 mL/min/1.73 m(2), respectively, and CCr(TS) was 15.9 +/- 10.8 and 10.9 +/- 10.6 mL/min/1.73 m(2), respectively (P <0.001). The higher CCr(TS) in patients with ADPKD remained significant after adjustment for covariates and appeared to be dependent on mGFR. Correlation and accuracy between mGFR and CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) estimated GFR (eGFR) were 0.95 and 99%, respectively; between mGFR and MDRD (Modification of Diet in Renal Disease) Study eGFR, they were 0.93 and 97%, respectively. Values for bias, precision, and accuracy were similar or slightly better than in controls. In addition, change in mGFR during 3 years of follow-up in 45 patients with ADPKD correlated well with change in eGFR.

Limitations: Cross-sectional, single center.

Conclusions: CCr(TS) in patients with ADPKD is higher than that in controls, but this effect is limited and observed at only high-normal mGFR. Consequently, the CKD-EPI and MDRD Study equations perform relatively well in estimating GFR and change in GFR in patients with ADPKD. (C) 2013 by the National Kidney Foundation, Inc.

Original languageEnglish
Pages (from-to)531-540
Number of pages10
JournalAmerican Journal of Kidney Diseases
Issue number3
Publication statusPublished - Sep-2013


  • Autosomal dominant polycystic kidney disease (ADPKD)
  • creatinine
  • tubular secretion of creatinine
  • estimated glomerular filtration rate (eGFR)
  • measured GFR
  • MASS

Cite this