Rule Andrew D, Jacobsen Steven J, Schwartz Gary L, Mosley Thomas H, Scott Christopher G, Kardia Sharon L R, Boerwinkle Eric, Turner Stephen T
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Am J Hypertens. 2006 Jun;19(6):608-14. doi: 10.1016/j.amjhyper.2005.10.025.
The Modification of Diet in Renal Disease (MDRD) equation is often used to determine an estimated glomerular filtration rate (eGFR) from serum creatinine. This study compared kidney disease as defined by reduced eGFR, elevated serum creatinine, or elevated urinary albumin-to-creatinine ratio (ACR).
As part of the Genetic Epidemiology Network of Arteriopathy study, a community-based sample was ascertained through sibships having at least two members with essential hypertension. Kidney disease was defined by reduced eGFR (<60 mL/min/1.73 m(2)), elevated serum creatinine (>97.5(th) percentile for sex-specific normal individuals), or elevated ACR (>95(th) percentile for sex-specific normal individuals).
The sample (n = 2653) was 65% female, 61% African American, and 77% hypertensive, with a mean (+/- SD) age of 61 +/- 10 years. There was greater agreement between kidney disease defined by elevated ACR and an elevated serum creatinine level (kappa = 0.19) than between kidney disease defined by elevated ACR and a reduced eGFR (kappa = 0.07). The multivariable-adjusted odds ratio of kidney disease for male versus female sex was 0.92 (95% CI, 0.75 to 1.12) by reduced eGFR, but was 2.08 (95% CI, 1.62 to 2.67) by elevated serum creatinine and 2.11 (95% CI, 1.63 to 2.74) by elevated ACR. The multivariable-adjusted odds ratio of kidney disease for subjects of African American versus white ethnicity was 0.27 (95% CI, 0.22 to 0.33) by reduced eGFR but was 1.17 (95% CI, 0.91 to 1.51) by elevated serum creatinine and 3.87 (95% CI, 2.89 to 5.25) by elevated ACR.
In a predominantly hypertensive population, kidney disease identified by elevated ACR was more concordant with elevated serum creatinine than with reduced eGFR. The MDRD equation, derived using kidney disease patients, may misrepresent the gender- and ethnicity-specific risk of kidney disease.
肾脏疾病饮食调整（MDRD）方程常被用于根据血清肌酐来确定估算肾小球滤过率（eGFR）。本研究比较了由降低的eGFR、升高的血清肌酐或升高的尿白蛋白与肌酐比值（ACR）所定义的肾脏疾病。
作为动脉病遗传流行病学网络研究的一部分，通过至少有两名成员患有原发性高血压的同胞关系确定了一个基于社区的样本。肾脏疾病的定义为eGFR降低（<60 ml/min/1.73 m²）、血清肌酐升高（高于特定性别正常个体的第97.5百分位数）或ACR升高（高于特定性别正常个体的第95百分位数）。
样本（n = 2653）中65%为女性，61%为非裔美国人，77%患有高血压，平均（±标准差）年龄为61±10岁。由升高的ACR所定义的肾脏疾病与升高的血清肌酐水平之间的一致性（kappa = 0.19）高于由升高的ACR所定义的肾脏疾病与降低的eGFR之间的一致性（kappa = 0.07）。根据降低的eGFR，男性与女性患肾脏疾病的多变量调整比值比为0.92（95%可信区间，0.75至1.12），但根据升高的血清肌酐为2.08（95%可信区间，1.62至2.67），根据升高的ACR为2.11（95%可信区间，1.63至2.74）。根据降低的eGFR，非裔美国人与白人种族的受试者患肾脏疾病的多变量调整比值比为0.27（95%可信区间，0.22至0.33），但根据升高的血清肌酐为1.17（95%可信区间，0.91至1.51），根据升高的ACR为3.87（95%可信区间，2.89至5.25）。
在以高血压为主的人群中，由升高的ACR所确定的肾脏疾病与升高的血清肌酐比与降低的eGFR更一致。使用肾脏疾病患者推导得出的MDRD方程可能会错误呈现肾脏疾病的性别和种族特异性风险。
