United States Renal System, Minneapolis, Minnesota 55404, USA.
Kidney Int. 2011 Jan;79(1):99-111. doi: 10.1038/ki.2010.291. Epub 2010 Aug 18.
In this study, we attempted to identify threshold values for kidney function measures that maximally discriminate short-term mortality, to identify major population segments in which these thresholds apply, and to classify the hierarchical rank of the thresholds when other classic risk factors are also considered. To do this we retrospectively identified estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR) thresholds to maximize sensitivity and specificity predictions for death in non-institutionalized NHANES III participants, representative of the United States population from 1988 to 1994 and followed through 2000. In a classification tree excluding dichotomizing variables, age 57 years was initially selected; ACR appeared in the second round and eGFR in the third. The prognostic discrimination of optimum eGFR and ACR thresholds exceeded those of commonly advocated public health screening measures, such as LDL cholesterol and fasting blood glucose, with body mass index appearing in the third round, and smoking and LDL cholesterol in the fourth. In a tree permitting dichotomizing variables, the ACR, systolic blood pressure, and glucose first appeared in the third round, with eGFR, smoking, and LDL in the fourth. Thus, the albumin-creatinine ratio and eGFR may be at least as efficient for survival-based clinical triage as most other classic risk factors.
在这项研究中，我们试图确定肾功能指标的阈值，以最大限度地区分短期死亡率，确定这些阈值适用的主要人群群体，并在考虑其他经典危险因素时对这些阈值进行分层排序。为此，我们回顾性地确定了估计肾小球滤过率 (eGFR) 和尿白蛋白/肌酐比值 (ACR) 的阈值，以最大限度地提高非住院 NHANES III 参与者死亡的敏感性和特异性预测，这些参与者代表了 1988 年至 1994 年美国人口，并随访至 2000 年。在排除二分变量的分类树中，年龄 57 岁首先被选中；ACR 出现在第二轮，eGFR 出现在第三轮。最佳 eGFR 和 ACR 阈值的预后判别能力超过了常用的公共卫生筛查措施，如 LDL 胆固醇和空腹血糖，BMI 出现在第三轮，吸烟和 LDL 胆固醇出现在第四轮。在允许二分变量的树中，ACR、收缩压和葡萄糖首先出现在第三轮，eGFR、吸烟和 LDL 出现在第四轮。因此，白蛋白-肌酐比值和 eGFR 可能至少与大多数其他经典危险因素一样，用于基于生存的临床分诊。
