比较使用 CKD-EPI 和 MDRD 研究 GFR 估算方程的 CKD 患病率和死亡率风险：AusDiab（澳大利亚糖尿病、肥胖和生活方式）研究。
Comparison of the prevalence and mortality risk of CKD in Australia using the CKD Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) Study GFR estimating equations: the AusDiab (Australian Diabetes, Obesity and Lifestyle) Study.
机构信息
The George Institute for International Health, Sydney, NSW, Australia.
出版信息
Am J Kidney Dis. 2010 Apr;55(4):660-70. doi: 10.1053/j.ajkd.2009.12.011.
BACKGROUND
The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) is more accurate than the Modification of Diet in Renal Disease (MDRD) Study equation. We applied both equations in a cohort representative of the Australian adult population.
STUDY DESIGN
Population-based cohort study.
SETTING & PARTICIPANTS: 11,247 randomly selected noninstitutionalized Australians aged >or= 25 years who attended a physical examination during the baseline AusDiab (Australian Diabetes, Obesity and Lifestyle) Study survey.
PREDICTORS & OUTCOMES: Glomerular filtration rate (GFR) was estimated using the MDRD Study and CKD-EPI equations. Kidney damage was defined as urine albumin-creatinine ratio >or= 2.5 mg/mmol in men and >or= 3.5 mg/mmol in women or urine protein-creatinine ratio >or= 0.20 mg/mg. Chronic kidney disease (CKD) was defined as estimated GFR (eGFR) >or= 60 mL/min/1.73 m(2) or kidney damage. Participants were classified into 3 mutually exclusive subgroups: CKD according to both equations; CKD according to the MDRD Study equation, but no CKD according to the CKD-EPI equation; and no CKD according to both equations. All-cause mortality was examined in subgroups with and without CKD.
MEASUREMENTS
Serum creatinine and urinary albumin, protein, and creatinine measured on a random spot morning urine sample.
RESULTS
266 participants identified as having CKD according to the MDRD Study equation were reclassified to no CKD according to the CKD-EPI equation (estimated prevalence, 1.9%; 95% CI, 1.4-2.6). All had an eGFR >or= 45 mL/min/1.73 m(2) using the MDRD Study equation. Reclassified individuals were predominantly women with a favorable cardiovascular risk profile. The proportion of reclassified individuals with a Framingham-predicted 10-year cardiovascular risk >or= 30% was 7.2% compared with 7.9% of the group with no CKD according to both equations and 45.3% of individuals retained in stage 3a using both equations. There was no evidence of increased all-cause mortality in the reclassified group (age- and sex-adjusted hazard ratio vs no CKD, 1.01; 95% CI, 0.62-1.97). Using the MDRD Study equation, the prevalence of CKD in the Australian population aged >or= 25 years was 13.4% (95% CI, 11.1-16.1). Using the CKD-EPI equation, the prevalence was 11.5% (95% CI, 9.42-14.1).
LIMITATIONS
Single measurements of serum creatinine and urinary markers.
CONCLUSIONS
The lower estimated prevalence of CKD using the CKD-EPI equation is caused by reclassification of low-risk individuals.
背景
慢性肾脏病流行病学协作组（CKD-EPI）比改良肾脏病饮食研究（MDRD）方程更准确。我们在代表澳大利亚成年人群体的队列中应用了这两个方程。
研究设计
基于人群的队列研究。
设置和参与者
在基线 AusDiab（澳大利亚糖尿病、肥胖和生活方式）研究调查期间参加体检的 11247 名随机选择的非住院澳大利亚人，年龄≥25 岁。
预测因子和结果
使用 MDRD 研究和 CKD-EPI 方程估计肾小球滤过率（GFR）。肾脏损伤定义为男性尿白蛋白-肌酐比≥2.5mg/mmol 和女性尿白蛋白-肌酐比≥3.5mg/mmol 或尿蛋白-肌酐比≥0.20mg/mg。慢性肾脏病（CKD）定义为估计肾小球滤过率（eGFR）≥60mL/min/1.73m2或肾脏损伤。参与者分为 3 个相互排斥的亚组：根据两个方程诊断为 CKD；根据 MDRD 研究方程诊断为 CKD，但根据 CKD-EPI 方程诊断为非 CKD；根据两个方程均诊断为非 CKD。在有和没有 CKD 的亚组中检查了全因死亡率。
测量
在随机清晨尿样中测量血清肌酐和尿白蛋白、蛋白和肌酐。
结果
根据 MDRD 研究方程被诊断为 CKD 的 266 名参与者被重新分类为根据 CKD-EPI 方程无 CKD（估计患病率，1.9%；95%CI，1.4-2.6）。所有患者使用 MDRD 研究方程的 eGFR≥45mL/min/1.73m2。重新分类的患者主要为女性，心血管风险状况良好。重新分类个体的Framingham 预测 10 年心血管风险≥30%的比例为 7.2%，而根据两个方程诊断为无 CKD 的组为 7.9%，根据两个方程诊断为 3a 期的个体为 45.3%。在重新分类组中没有证据表明全因死亡率增加（年龄和性别调整的危险比与无 CKD 相比，1.01；95%CI，0.62-1.97）。使用 MDRD 研究方程，≥25 岁澳大利亚人群中 CKD 的患病率为 13.4%（95%CI，11.1-16.1）。使用 CKD-EPI 方程，患病率为 11.5%（95%CI，9.42-14.1）。
局限性
血清肌酐和尿标志物的单次测量。
结论
使用 CKD-EPI 方程估计的 CKD 患病率较低，是由于低风险个体的重新分类所致。
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