Kopeć Jerzy, Januszek Rafał, Wieczorek-Surdacka Ewa, Kuźniewski Marek, Sułowicz Władysław
Katedra i Klinika Nefrologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków.
Przegl Lek. 2009;66(12):1011-9.
The aim of the study was to compare three methods of GFR estimation as simplified MDRD formula, Cockcroft-Gault formula and 24 hour urine collection used in evaluation of kidney function. The study was conducted at the outpatient clinic and enclosed 1183 patients aged between 17 and 98 years (mean 64.7) with creatinine level >120 micromol/l and/or creatinine clearance <90 ml/min/1.73 m2, described in detail in part I. After calculation we obtained different mean GFR values adequately to the method: 38.4 +/- 15.13 ml/min/1.73 m2 (simplified MDRD formula), 44.51 +/- 20.59 ml/min/1.73 m2 (Cockcroft-Gault formula) and 45.63 +/- 25.55 ml/min/1.73 m2 (24-h urine collection). Results of the GFR assessment were different according to the applied method of calculation. The smallest data dispersion was observed in GFR values calculated based on abbreviated MDRD formula and the highest when obtained based on to the 24-hour urine collection. The GFR values obtained based on 24 hour urine collection showed positive correlations with BMI (p<0.01), hemoglobine (p<0.01), hematocrite (p<0.01), diastolic blood pressure (p=0.01), albumin (p=0.041), iron (p=0.03), AIAT activity (p=0.01), and negative with age (p<0.01), phosphate (p<0.01), alkaline phosphatase activity (p=0.039), parathormone (p=0.03), potassium (p<0.01) and magnesium (p<0.01). In the group of patients with GFR values below 30 ml/min in comparison with patients with GFR values above 30 ml/min, in all three methods of GFR estimation it was shown significantly higher values of phosphate, potassium, age, and lower hemoglobin, hematocrite. It was shown also in the group with GFR below 30 ml/min values estimated based on Cockcroft-Gault formula and 24 hour urine collection significantly lower BMI.
本研究的目的是比较三种评估肾小球滤过率(GFR)的方法,即简化的肾脏病饮食改良(MDRD)公式、Cockcroft-Gault公式以及用于评估肾功能的24小时尿肌酐清除率测定法。本研究在门诊进行,纳入了1183例年龄在17至98岁之间(平均64.7岁)、肌酐水平>120微摩尔/升和/或肌酐清除率<90毫升/分钟/1.73平方米的患者,第一部分对此有详细描述。计算后,我们根据不同方法获得了不同的平均GFR值:38.4±15.13毫升/分钟/1.73平方米(简化MDRD公式)、44.51±20.59毫升/分钟/1.73平方米(Cockcroft-Gault公式)和45.63±25.55毫升/分钟/1.73平方米(24小时尿肌酐清除率测定法)。根据所应用的计算方法,GFR评估结果有所不同。基于简化MDRD公式计算的GFR值数据离散度最小,而基于24小时尿肌酐清除率测定法获得的GFR值数据离散度最大。基于24小时尿肌酐清除率测定法获得的GFR值与体重指数(BMI)(p<0.01)、血红蛋白(p<0.01)、血细胞比容(p<0.01)、舒张压(p=0.01)、白蛋白(p=0.041)、铁(p=0.03)、谷丙转氨酶(AIAT)活性(p=0.01)呈正相关,与年龄(p<0.01)、磷酸盐(p<0.01)、碱性磷酸酶活性(p=0.039)、甲状旁腺激素(p=0.03)、钾(p<0.01)和镁(p<0.01)呈负相关。在GFR值低于30毫升/分钟的患者组中,与GFR值高于30毫升/分钟的患者相比,在所有三种GFR评估方法中,磷酸盐、钾、年龄的值均显著更高,而血红蛋白、血细胞比容的值更低。在GFR低于30毫升/分钟的患者组中还显示,基于Cockcroft-Gault公式和24小时尿肌酐清除率测定法估算的BMI值显著更低。