改良肾脏病饮食研究方程在住院患者对比剂急性肾损伤风险分层中的应用。

Modification of Diet in Renal Disease equation in the risk stratification of contrast induced acute kidney injury in hospital inpatients.

机构信息

Department of Nuclear Medicine, Cumhuriyet University School of Medicine, Sivas, Turkey.

出版信息

Nefrologia. 2009;29(5):397-403. doi: 10.3265/Nefrologia.2009.29.5.5449.en.full.

DOI:10.3265/Nefrologia.2009.29.5.5449.en.full

PMID:19820751

Abstract

BACKGROUND

Several organizations recommend using estimated glomerular filtration rate (eGFR) in kidney function monitoring, preferably calculated with Modification of Diet in Renal Disease (MDRD) formula. The role of this formula is not clear in the risk stratification of contrast induced acute kidney injury (CIAKI) in nonsteady state patients.

AIM

Comparative evaluation of the MDRD eGFR in risk stratification of CIAKI.

METHOD

GFR was measured twice (pre- and post-examination) by Tc-99m-DTPA, along with serum levels of urea nitrogen and creatinine in 32 patients (mean age+/-SD; 60.1+/-13.2 years) needing hospital care for various reasons and underwent to x-ray examination with contrast media (mean; 90.2+/-16.8 ml). eGFR was calculated by the dedicated formula. Agreement between measured GFR (mGFR) and MDRD eGFR was assessed and patients were scored and stratified for CIAKI by using first mGFR, then eGFR and results were compared.

RESULTS

A moderate correlation was obtained between mGFR and eGFR (r=0.47, p < 0.001) and the difference was not significant. However, Bland & Altman analysis revealed large limits of agreement between mGFR and eGFR (-80.3 to 55.2) with a mean difference of -12.5 ml/min/1.73m2. In ROC analysis, when mGFR values were classified as normal (>60ml/min/1.73m2) and decreased (<60ml/min/1.73m2), AUC was 0.80 (95%CI; 0.62-0.92) for eGFR, with a sensitivity of 29% and specificity of 100%. Furthermore, the risk group categorization, using eGFR instead of mGFR was resulted in a group change for four patients (13%); from moderate to low risk group.

CONCLUSION

It seems that MDRD eGFR differs from mGFR. In nonsteady state patients CIAKI classification using eGFR should be considered with caution.

摘要

背景

一些组织建议使用估算肾小球滤过率（eGFR）监测肾功能，最好使用肾脏病膳食改良试验（MDRD）公式进行计算。在非稳定状态患者中，MDRD 公式在对比剂诱导急性肾损伤（CIAKI）的风险分层中的作用尚不清楚。

目的

比较 MDRD eGFR 在 CIAKI 风险分层中的作用。

方法

对 32 名因各种原因需要住院治疗并接受 X 射线检查的患者（平均年龄+/-标准差；60.1+/-13.2 岁）进行两次（检查前和检查后）Tc-99m-DTPA 肾小球滤过率测量，并检测血清尿素氮和肌酐水平。使用专用公式计算 eGFR。评估测量肾小球滤过率（mGFR）与 MDRD eGFR 之间的一致性，并对患者进行 CIAKI 评分和分层，首先使用 mGFR，然后使用 eGFR，并比较结果。

结果

mGFR 与 eGFR 之间存在中度相关性（r=0.47，p < 0.001），差异无统计学意义。然而，Bland & Altman 分析显示 mGFR 与 eGFR 之间存在较大的一致性限制（-80.3 至 55.2），平均差异为-12.5 ml/min/1.73m2。在 ROC 分析中，当 mGFR 值被分类为正常（>60ml/min/1.73m2）和降低（<60ml/min/1.73m2）时，eGFR 的 AUC 为 0.80（95%CI；0.62-0.92），敏感性为 29%，特异性为 100%。此外，使用 eGFR 代替 mGFR 对四名患者（13%）进行了风险组分类，从中度风险组变为低风险组。