通过南基韦尔公式、肾脏病膳食改良（MDRD）公式和考克饶夫-高尔特公式评估重度肾功能不全移植受者的肾小球滤过率。

Assessment of glomerular filtration rate in transplant recipients with severe renal insufficiency by Nankivell, Modification of Diet in Renal Disease (MDRD), and Cockroft-Gault equations.

作者信息

Rodrigo E, Fernández-Fresnedo G, Ruiz J C, Piñera C, Heras M, de Francisco A L M, Sanz de Castro S, Cotorruelo J G, Zubimendi J A, Arias M

机构信息

Service of Nephrology, Hospital Valdecilla, University of Cantabria, Santander, Spain.

出版信息

Transplant Proc. 2003 Aug;35(5):1671-2. doi: 10.1016/s0041-1345(03)00625-0.

DOI:10.1016/s0041-1345(03)00625-0

PMID:12962751

Abstract

Measurement of glomerular filtration rate (GFR) is time consuming and cumbersome. Several formulas have been developed to predict creatinine clearance (CrCl) or GFR using serum creatinine (Cr) concentrations and demographic characteristics. However, few studies have been performed to discern the best formula to estimate GFR in kidney transplantation. In this study, Cockroft-Gault (CG), Nankivell, and Levey (MDRD) formulas were tested to predict GFR in 125 cadaveric renal transplant patients with severe renal insufficiency (GFR less than 30 mL/min per 1.73 m2). The GFR was estimated as the average Cr and urea clearances. The mean GFR estimated by averaged Cr and urea clearances (22.18+/-5.23 mL/min per 1.73 m2) was significantly different from the mean values yielded by the MDRD formula (20.42+/-6.65 mL/min per 1.73 m2, P=.000), the Nankivell formula (30.14+/-11.98 mL/min per 1.73 m2, P=.000), and the CG formula (29.42+/-8.64 mL/min per 1.73 m2, P=.000). The MDRD formula showed a better correlation (R=0.741, P=.000) than the CG (R=0.698, P=.000) and the Nankivell formulas (R=0.685, P=.000). Analysis of differences using the Bland-Altmann method demonstrated that MDRD gave the lowest bias (MDRD: -1.65+/-4.4 mL/min per 1.73 m2; CG: 7.33+/-6.24 mL/min per 1.73 m2; Nankivell: 8.05+/-9.23 mL/min per 1.73 m2) and narrower limits of agreement (Nankivell: -10.41-26.51 mL/min per 1.73 m2; CG: -5.15-19.81 mL/min per 1.73 m2; MDRD: -10.61-7.31 mL/min per 1.73 m2). In transplant patients with severe renal insufficiency, the MDRD equation seems better than the other formulas to estimate GFR.

摘要

肾小球滤过率（GFR）的测量既耗时又麻烦。已经开发了几种公式，用于使用血清肌酐（Cr）浓度和人口统计学特征来预测肌酐清除率（CrCl）或GFR。然而，很少有研究来辨别在肾移植中估计GFR的最佳公式。在本研究中，对Cockroft-Gault（CG）、Nankivell和Levey（MDRD）公式进行了测试，以预测125例患有严重肾功能不全（GFR低于30 mL/分钟/1.73 m²）的尸体肾移植患者的GFR。GFR被估计为平均Cr和尿素清除率。通过平均Cr和尿素清除率估计的平均GFR（22.18±5.23 mL/分钟/1.73 m²）与MDRD公式（20.42±6.65 mL/分钟/1.73 m²，P = 0.000）、Nankivell公式（30.14±11.98 mL/分钟/1.73 m²，P = 0.000）和CG公式（29.42±8.64 mL/分钟/1.73 m²，P = 0.000）得出的平均值有显著差异。MDRD公式显示出比CG公式（R = 0.698，P = 0.000）和Nankivell公式（R = 0.685，P = 0.000）更好的相关性（R = 0.741，P = 0.000）。使用Bland-Altmann方法进行差异分析表明，MDRD的偏差最低（MDRD：-1.65±4.4 mL/分钟/1.73 m²；CG：7.33±6.24 mL/分钟/1.73 m²；Nankivell：8.05±9.23 mL/分钟/1.73 m²），一致性界限更窄（Nankivell：-10.41 - 26.51 mL/分钟/每1.73 m²；CG：-5.15 - 19.81 mL/分钟/1.73 m²；MDRD：-10.61 - 7.31 mL/分钟/1.73 m²）。在患有严重肾功能不全的移植患者中，MDRD方程在估计GFR方面似乎比其他公式更好。