Vervoort Gerald, Willems Hans L, Wetzels Jack F M
Department of Nephrology, University Medical Centre Nijmegen, The Netherlands.
Nephrol Dial Transplant. 2002 Nov;17(11):1909-13. doi: 10.1093/ndt/17.11.1909.
Based on the data derived from the Modification of Diet in Renal Disease (MDRD) study, a new equation was developed for the estimation of glomerular filtration rate (GFR). This equation, which takes into account body weight, age, sex, serum creatinine, race, serum urea, and serum albumin, provided a more accurate estimation of GFR in patients with renal insufficiency. However, this prediction equation has not been validated in subjects with normal or supra-normal GFR.
In a cross-sectional study, we measured GFR by inulin clearance in 46 healthy controls and 46 non-complicated type 1 diabetic patients. In this study population, GFR was predicted by measured creatinine clearance, the Cockcroft-Gault formula, and the MDRD equation.
In the healthy subjects, mean GFR (+/-SD) was 107+/-11 as compared to 122+/-18 ml/min per 1.73 m(2) in the diabetic patients. This difference in GFR was reflected by a lower serum creatinine (76+/-8 vs 71+/-8 micro mol/l) in the diabetic patients. In the healthy controls, median absolute differences (and the 50th-75th-90th percentile of percentage absolute differences) between predicted and measured GFR were 5.2 ml/min per 1.73 m(2) (4.9-9.8-18.5%) for creatinine clearance, 9.0 ml/min per 1.73 m(2) (8.6-14.3-24.6%) for the Cockcroft-Gault formula, and 10.7 ml/min per 1.73 m(2) (10.9-16.3-25.5%) for the MDRD equation. In the diabetic patients, these differences were 8.3 ml/min per 1.73 m(2) (7.6-9.3-13.0%) for creatinine clearance; 11.8 ml/min per 1.73 m(2) (10.1-16.0-22.5%) for the Cockcroft-Gault formula, and 18.8 ml/min per 1.73 m(2) (16.0-24.2-31.9%) for the MDRD equation.
In subjects with a normal or increased GFR, the new MDRD-prediction equation of GFR is less accurate than creatinine clearance or the Cockcroft-Gault formula, and offers no advantage.
基于肾脏疾病饮食改良（MDRD）研究得出的数据，开发了一种新的估算肾小球滤过率（GFR）的方程。该方程考虑了体重、年龄、性别、血清肌酐、种族、血清尿素和血清白蛋白，能更准确地估算肾功能不全患者的GFR。然而，该预测方程尚未在GFR正常或高于正常的受试者中得到验证。
在一项横断面研究中，我们通过菊粉清除率测量了46名健康对照者和46名无并发症的1型糖尿病患者的GFR。在该研究人群中，通过测量的肌酐清除率、Cockcroft - Gault公式和MDRD方程来预测GFR。
健康受试者的平均GFR（±标准差）为107±11，而糖尿病患者为122±18 ml/min per 1.73 m²。糖尿病患者较低的血清肌酐（76±8 vs 71±8 μmol/l）反映了这种GFR差异。在健康对照者中，预测GFR与测量GFR之间的中位数绝对差异（以及绝对差异百分比的第50 - 75 - 90百分位数），肌酐清除率为5.2 ml/min per 1.73 m²（4.9 - 9.8 - 18.5%），Cockcroft - Gault公式为9.0 ml/min per 1.73 m²（8.6 - 14.3 - 24.6%），MDRD方程为10.7 ml/min per 1.73 m²（10.9 - 16.3 - 25.5%）。在糖尿病患者中，这些差异分别为：肌酐清除率8.3 ml/min per 1.73 m²（7.6 - 9.3 - 13.0%）；Cockcroft - Gault公式11.8 ml/min per 1.73 m²（10.1 - 16.0 - 22.5%），MDRD方程18.8 ml/min per 1.73 m²（16.0 - 24.2 - 31.9%）。
在GFR正常或升高的受试者中，新的MDRD - GFR预测方程不如肌酐清除率或Cockcroft - Gault公式准确，且无优势。
