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Peer-reviewedCC BY 4.0Frontiers in Pharmacology

Refining absolute GFR estimation in children: development and validation of the GROW-GFR equation

  • Kiera H. Harwood1,2
  • Stephen Duffull3
  • Christian Davey4
  • Catherine Quinlan1,5,6
  • Thomas Forbes1,5,6
  • Peter Francis7
  • Tony Lai8,9
  • Sarath Ranganathan1,10,11
  • Amanda Gwee1,2,12
12 affiliations
  1. 1Department of Paediatrics, The University of Melbourne
  2. 2Antimicrobials Group, Murdoch Children’s Research Institute
  3. 3Certara
  4. 4School of Mathematics and Statistics, The University of Melbourne
  5. 5Kidney Regeneration, Murdoch Research Institute
  6. 6Department of Paediatric Nephrology, The Royal Children’s Hospital
  7. 7Department of Medical Imaging, The Royal Children’s Hospital Melbourne
  8. 8Department of Pharmacy, The Children’s Hospital at Westmead
  9. 9Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney
  10. 10Department of Respiratory and Sleep Medicine, The Royal Children’s Hospital
  11. 11Respiratory Diseases Group, Murdoch Children’s Research Institute
  12. 12Department of General Medicine and Infectious Diseases, Royal Children’s Hospital
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Abstract

Background: Accurate estimation of glomerular filtration rate (GFR) is essential when dosing many medications. Existing paediatric GFR equations vary in accuracy, with only one (Modified Schwartz) validated in children <2 years. This study developed a new paediatric GFR equation (GROW-GFR) using a tobramycin population pharmacokinetic model and evaluated its performance against current equations and nuclear medicine (NM)-GFR scans.

Methods: Retrospective analysis of NM-GFR scans from July 2016-November 2023 in children aged 0–19 years at The Royal Children’s Hospital, Melbourne. Results were included if NM-GFR was ≤150 mL/min and height, weight and serum creatinine were recorded. Accuracy of GFR estimates within 30% and 10% of NM-GFR results (p30, p10 accuracy) and bias for the GROW-GFR, Modified Schwartz, Chronic Kidney Disease in Children Under 25 years (CKiD-U25), Full Age Spectrum (FAS), and FAS-height (HT) equations were assessed.

Results: Overall, 1560 NM-GFR results from 711 children (median age 8.5 years; range 0.1–19) were included (median NM-GFR 55 mL/min; range 0.5–150). GROW-GFR showed a p30 accuracy of 76% and bias of −1.9 mL/min, with consistent performance across all ages. The Modified Schwartz equation had a p30 accuracy of 46% and bias of 17.3 mL/min. In children ≥2 years, GROW-GFR outperformed other equations (p30: 76% vs. 49%–58%; bias −1.9 vs. 13.7–18.4 mL/min). After applying linear mixed-effects models, GROW-GFR p30 accuracy and bias were 80% and −2.5 mL/min, outperforming other equations (p < 0.001).

Conclusion: The GROW-GFR equation provided more accurate GFR estimates across all paediatric ages, including children <2 years, compared to existing equations. Therefore, should be considered the preferred GFR estimation method.

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Cite

BibTeXRIS
BibTeX
@article{harwood2026refining,
  title = {{Refining absolute GFR estimation in children: development and validation of the GROW-GFR equation}},
  author = {Kiera H. Harwood and Stephen Duffull and Christian Davey and Catherine Quinlan and Thomas Forbes and Peter Francis and Tony Lai and Sarath Ranganathan and Amanda Gwee},
  journal = {Frontiers in Pharmacology},
  year = {2026},
  month = oct,
  doi = {10.3389/fphar.2026.1855031},
  url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1855031/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Refining absolute GFR estimation in children: development and validation of the GROW-GFR equation
AU  - Kiera H. Harwood
AU  - Stephen Duffull
AU  - Christian Davey
AU  - Catherine Quinlan
AU  - Thomas Forbes
AU  - Peter Francis
AU  - Tony Lai
AU  - Sarath Ranganathan
AU  - Amanda Gwee
PY  - 2026
DA  - 2026/10/22
JO  - Frontiers in Pharmacology
DO  - 10.3389/fphar.2026.1855031
UR  - https://www.frontiersin.org/articles/10.3389/fphar.2026.1855031/full
AB  - Background: Accurate estimation of glomerular filtration rate (GFR) is essential when dosing many medications. Existing paediatric GFR equations vary in accuracy, with only one (Modified Schwartz) validated in children <2 years. This study developed a new paediatric GFR equation (GROW-GFR) using a tobramycin population pharmacokinetic model and evaluated its performance against current equations and nuclear medicine (NM)-GFR scans.  Methods: Retrospective analysis of NM-GFR scans from July 2016-November 2023 in children aged 0–19 years at The Royal Children’s Hospital, Melbourne. Results were included if NM-GFR was ≤150 mL/min and height, weight and serum creatinine were recorded. Accuracy of GFR estimates within 30% and 10% of NM-GFR results (p30, p10 accuracy) and bias for the GROW-GFR, Modified Schwartz, Chronic Kidney Disease in Children Under 25 years (CKiD-U25), Full Age Spectrum (FAS), and FAS-height (HT) equations were assessed.  Results: Overall, 1560 NM-GFR results from 711 children (median age 8.5 years; range 0.1–19) were included (median NM-GFR 55 mL/min; range 0.5–150). GROW-GFR showed a p30 accuracy of 76% and bias of −1.9 mL/min, with consistent performance across all ages. The Modified Schwartz equation had a p30 accuracy of 46% and bias of 17.3 mL/min. In children ≥2 years, GROW-GFR outperformed other equations (p30: 76% vs. 49%–58%; bias −1.9 vs. 13.7–18.4 mL/min). After applying linear mixed-effects models, GROW-GFR p30 accuracy and bias were 80% and −2.5 mL/min, outperforming other equations (p < 0.001).  Conclusion: The GROW-GFR equation provided more accurate GFR estimates across all paediatric ages, including children <2 years, compared to existing equations. Therefore, should be considered the preferred GFR estimation method.
SN  - 1663-9812
ER  -