Botev Rossini, Mallié Jean-Pierre, Couchoud Cecilé, Schück Otto, Fauvel Jean-Pierre, Wetzels Jack F M, Lee Nelson, De Santo Natale G, Cirillo Massimo
Hawaii Permanente Medical Group, 3288 Moanalua Road, Honolulu, Hawaii 96819, USA.
Clin J Am Soc Nephrol. 2009 May;4(5):899-906. doi: 10.2215/CJN.05371008. Epub 2009 Apr 30.
Evaluation of renal function by estimation of the glomerular filtration rate (GFR) is very important for the diagnosis and treatment of patients with chronic kidney disease (CKD). The Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulas are the most commonly used estimations.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Estimated GFR values by each formula were compared with measured GFR (mGFR) by renal inulin clearance in 2208 European adults (46% women, 1.4% Caribbean blacks), with and without CKD, and mean mGFR 72.4 +/- 39.0 (range 2.2 to 177.2) ml/min/1.73 m(2).
Overall, the CG and MDRD formulas showed bias (mean difference) -3.5 ml/min/1.73 m(2) (5.3%), P < 0.001, and -9.8 ml/min/1.73 m(2) (-6.4%), P < 0.001; precision (SD of bias) 21.5 ml/min/1.73 m(2) (43.1%) and 20.0 ml/min/1.73 m(2) (33.0%); limits of agreement (2 SD by Bland-Altman method) 39.5 to -46.5 (range 86.0) ml/min/1.73 m(2) and 30.2 to -49.8 (range 80.0) ml/min/1.73 m(2); and accuracy within +/-30% of mGFR 70.8 and 69.0%, respectively. Both formulas showed a trend for decreasing accuracy with lower mGFR levels. According to the Kidney Disease Outcomes Quality Initiative (K/DOQI)-CKD classification's five GFR groups, the CG and MDRD formulas properly assigned 61.6 and 57.1% of the entire population and had a range of positive predictive values 42.6 to 81.8% and 39.6 to 85.2% and of negative predictive values 81.7 to 96.6% and 76.4 to 97.5%, respectively.
The CG and MDRD formulas had some limitations for proper GFR estimation and K/DOQI-CKD classification by GFR levels alone.
通过估算肾小球滤过率（GFR）来评估肾功能对于慢性肾脏病（CKD）患者的诊断和治疗非常重要。Cockcroft-Gault（CG）公式和肾脏病膳食改良（MDRD）公式是最常用的估算方法。
设计、地点、参与者与测量：比较了2208名欧洲成年人（46%为女性，1.4%为加勒比黑人）中，无论有无CKD，各公式估算的GFR值与通过肾脏菊粉清除率测得的GFR（mGFR），平均mGFR为72.4±39.0（范围2.2至177.2）ml/min/1.73 m²。
总体而言，CG公式和MDRD公式显示出偏差（平均差异）分别为-3.5 ml/min/1.73 m²（5.3%），P<0.001，以及-9.8 ml/min/1.73 m²（-6.4%），P<0.001；精密度（偏差标准差）分别为21.5 ml/min/1.73 m²（43.1%）和20.0 ml/min/1.73 m²（33.0%）；一致性界限（Bland-Altman方法的2倍标准差）分别为39.5至-46.5（范围86.0）ml/min/1.73 m²和30.2至-49.8（范围80.0）ml/min/1.73 m²；在mGFR±30%范围内的准确率分别为70.8%和69.0%。两个公式均显示随着mGFR水平降低，准确率有下降趋势。根据肾脏病生存质量倡议（K/DOQI）-CKD分类的五个GFR组，CG公式和MDRD公式分别正确归类了全部人群的61.6%和57.1%，阳性预测值范围分别为42.6%至81.8%和39.6%至85.2%，阴性预测值范围分别为81.7%至96.6%和76.4%至97.5%。
CG公式和MDRD公式在仅依据GFR水平进行准确的GFR估算和K/DOQI-CKD分类方面存在一些局限性。
