比较 CKD 流行病学协作组（CKD-EPI）和肾脏病饮食改良研究（MDRD）方程在估计肾小球滤过率（GFR）水平在 60 mL/min/1.73 m2 以上的表现。
Comparative performance of the CKD Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) Study equations for estimating GFR levels above 60 mL/min/1.73 m2.
机构信息
Tufts Medical Center, Boston, MA 02111, USA.
出版信息
Am J Kidney Dis. 2010 Sep;56(3):486-95. doi: 10.1053/j.ajkd.2010.03.026. Epub 2010 Jun 16.
BACKGROUND
The Modification of Diet in Renal Disease (MDRD) Study equation underestimates measured glomerular filtration rate (GFR) at levels>60 mL/min/1.73 m2, with variable accuracy among subgroups; consequently, estimated GFR (eGFR)>or=60 mL/min/1.73 m2 is not reported by clinical laboratories. Here, performance of a more accurate GFR-estimating equation, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, is reported by level of GFR and clinical characteristics.
STUDY DESIGN
Test of diagnostic accuracy.
SETTING & PARTICIPANTS: Pooled data set of 3,896 people from 16 studies with measured GFR (not used for the development of either equation). Subgroups were defined by eGFR, age, sex, race, diabetes, prior solid-organ transplant, and body mass index.
INDEX TESTS
eGFR from the CKD-EPI and MDRD Study equations and standardized serum creatinine.
REFERENCE TEST
Measured GFR using urinary or plasma clearance of exogenous filtration markers.
RESULTS
Mean measured GFR was 68+/-36 (SD) mL/min/1.73 m2. For eGFR<30 mL/min/1.73 m2, both equations have similar bias (median difference compared with measured GFR). For eGFR of 30-59 mL/min/1.73 m2, bias was decreased from 4.9 to 2.1 mL/min/1.73 m2 (57% improvement). For eGFR of 60-89 mL/min/1.73 m2, bias was decreased from 11.9 to 4.2 mL/min/1.73 m2 (61% improvement). For eGFR of 90-119 mL/min/1.73 m2, bias was decreased from 10.0 to 1.9 mL/min/1.73 m2 (75% improvement). Similar or improved performance was noted for most subgroups with eGFR<90 mL/min/1.73 m2, other than body mass index<20 kg/m2, with greater variation noted for some subgroups with eGFR>or=90 mL/min/1.73 m2.
LIMITATIONS
Limited number of elderly people and racial and ethnic minorities with measured GFR.
CONCLUSIONS
The CKD-EPI equation is more accurate than the MDRD Study equation overall and across most subgroups. In contrast to the MDRD Study equation, eGFR>or=60 mL/min/1.73 m2 can be reported using the CKD-EPI equation.
背景
改良肾脏病饮食研究（MDRD）方程在肾小球滤过率（GFR）水平>60 mL/min/1.73 m2 时低估了实测 GFR，并且在亚组之间准确性存在差异；因此，临床实验室不报告估计的 GFR（eGFR）>or=60 mL/min/1.73 m2。在这里，报告了一种更准确的 GFR 估计方程，慢性肾脏病流行病学合作（CKD-EPI）方程，按 GFR 水平和临床特征进行报告。
研究设计
诊断准确性测试。
设置和参与者
来自 16 项研究的 3896 人合并数据组，这些研究均具有实测 GFR（未用于开发这两个方程）。亚组按 eGFR、年龄、性别、种族、糖尿病、既往实体器官移植和体重指数进行定义。
索引测试
CKD-EPI 和 MDRD 研究方程中的 eGFR 和标准化血清肌酐。
参考测试
使用外源性滤过标志物的尿液或血浆清除率测量 GFR。
结果
平均实测 GFR 为 68+/-36（SD）mL/min/1.73 m2。对于 eGFR<30 mL/min/1.73 m2，两个方程的偏差相似（与实测 GFR 的中位数差异）。对于 eGFR 为 30-59 mL/min/1.73 m2，偏差从 4.9 降至 2.1 mL/min/1.73 m2（57%改善）。对于 eGFR 为 60-89 mL/min/1.73 m2，偏差从 11.9 降至 4.2 mL/min/1.73 m2（61%改善）。对于 eGFR 为 90-119 mL/min/1.73 m2，偏差从 10.0 降至 1.9 mL/min/1.73 m2（75%改善）。对于 eGFR<90 mL/min/1.73 m2 的大多数亚组，性能相似或有所改善，除了体重指数<20 kg/m2 外，对于 eGFR>or=90 mL/min/1.73 m2 的一些亚组，差异更大。
局限性
具有实测 GFR 的老年人和少数族裔人数有限。
结论
总体而言，CKD-EPI 方程比 MDRD 研究方程更准确，并且在大多数亚组中也是如此。与 MDRD 研究方程不同，使用 CKD-EPI 方程可以报告 eGFR>or=60 mL/min/1.73 m2。
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