69岁及以上人群肾小球滤过率的估算：不同计算方法之间的一致性

[Estimation of glomerular filtration rate in persons aged 69 years or older: agreement between distinct calculation methods].

作者信息

Heras Manuel, Guerrero María Teresa, Fernández-Reyes María José, Sánchez Rosa, Muñoz Angélica, Cruz Macías María, Molina Alvaro, Rodríguez Astrid, Prado Florentino, Alvarez-Ude Fernando

机构信息

Servicio de Nefrología, Hospital General de Segovia, Segovia, España.

出版信息

Rev Esp Geriatr Gerontol. 2010 Mar-Apr;45(2):86-8. doi: 10.1016/j.regg.2009.10.001. Epub 2010 Feb 21.

DOI:10.1016/j.regg.2009.10.001

PMID:20176415

Abstract

MATERIAL

Estimation of glomerular filtration rate (eGFR) is the most widely accepted marker of renal function. Precise calculation is not routinely performed in clinical practice. Several methods have been developed for eGFR: creatinine clearance (CCr) calculation or the use of formulae derived from serum creatinine (sCr). The present study aimed to analyze the agreement between distinct methods of calculating eGFR.

MATERIAL AND METHODS

We performed a cross-sectional study between January and April, 2006 in 32 stable elders, aged 69 years or older, evaluated in a general nephrology unit. eGFR was calculated by CCr (considered the gold standard), Cockcroft-Gault (CG) and Modification of Renal Diet in Disease (MDRD) equations. The Mann Whitney U-test, Spearman's correlation coefficient and the Kappa coefficient were used to compare means and determine the concordance between methods.

RESULTS

The overall means+/-SD of GFRe for CCr were 36.14+/-16 ml/min (range 11.75-69.6); CG: 37.02+/-16 ml/min (range 13.3-72.3) and MDRD: 45.52+/-16 ml/min (range 19.2-75.36). Variations in eGFR on comparison of methods were CCr and MDRD: -9.37 ml/min (95% CI:-13.85, -4.9); CCr and CG:-2.54 ml/min (95% CI: -6.95, 1.80); MDRD and CG: 9.0 ml/min (95% CI: 5.96, 12). The correlation between the gold standard (CCr) and sCr-derived formulae was r=0.74 for MDRD (P<0.001) and r=0.77 for CG (P<0.001). The Kappa value for CCr and CG was 0.44 and was 0.35 for CCr and MDRD. When patients were classified by stage of chronic renal disease, discrepancies were found according to the method used: stage 5 (eGFR<15 ml/min) was diagnosed in 13.63% with CG while none were diagnosed with stage 5 with MDRD.

CONCLUSIONS

In the estimation of the renal function in the elderly, eGFRe levels can differ in the same patient according to the method used: in view of the degree of concordance between CG and CCr, this mathematical formula should be used in preference to MDRD.

摘要

材料

估算肾小球滤过率（eGFR）是最广泛认可的肾功能指标。在临床实践中，通常不会进行精确计算。已经开发出了几种用于估算eGFR的方法：肌酐清除率（CCr）计算法或使用源自血清肌酐（sCr）的公式。本研究旨在分析不同的eGFR计算方法之间的一致性。

材料与方法

我们于2006年1月至4月在一个普通肾脏科对32名年龄在69岁及以上的稳定老年人进行了一项横断面研究。通过CCr（被视为金标准）、Cockcroft-Gault（CG）和疾病肾脏饮食改良（MDRD）方程来计算eGFR。使用Mann Whitney U检验、Spearman相关系数和Kappa系数来比较均值并确定方法之间的一致性。

结果

CCr法计算的eGFR总体均值±标准差为36.14±16 ml/分钟（范围11.75 - 69.6）；CG法为37.02±16 ml/分钟（范围13.3 - 72.3）；MDRD法为45.52±16 ml/分钟（范围19.2 - 75.36）。不同方法比较时eGFR的差异为：CCr法与MDRD法：-9.37 ml/分钟（95%置信区间：-13.85，-4.9）；CCr法与CG法：-2.54 ml/分钟（95%置信区间：-6.95，1.80）；MDRD法与CG法：9.0 ml/分钟（95%置信区间：5.96，12）。金标准（CCr）与源自sCr的公式之间的相关性，MDRD法为r = 0.74（P < 0. < 0.001）。CCr法与CG法的Kappa值为0.44，CCr法与MDRD法的Kappa值为0.35。当根据慢性肾病分期对患者进行分类时，发现根据所使用的方法存在差异：CG法诊断出13.6 < 15 ml/分钟），而MDRD法未诊断出任何处于5期的患者。