Discipline of General Practice, National University of Ireland, Galway, Ireland.
Nephrol Dial Transplant. 2011 Sep;26(9):2793-8. doi: 10.1093/ndt/gfq849. Epub 2011 Feb 9.
Over the past decade, chronic kidney disease (CKD) has become an area of intensive clinical and epidemiological research. Despite the clarity provided by the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, there appears to be within the CKD research literature significant disagreement on how to define CKD and measure kidney function.
The objectives of this study were to investigate the variety of methods used to define CKD and to measure kidney function in original research papers as well as to investigate whether the quality of the journal had any effect on the quality of the methodology used. This was a descriptive review and not a meta-analysis. Information was extracted from each article including publication details (including the journal's impact factor), definition of CKD, method used to estimate kidney function and quantity of serum creatinine readings used to define CKD. An electronic search of MEDLINE through OVID was completed using the search term CKD. The search was limited to articles in English published in 2009. Studies were included in the review only if they were original research articles including patients with CKD. Articles were excluded if they reported data from a paediatric population, a population solely on dialysis or if there was no full-text access through OVID. Each article was assessed for quality with respect to using KDOQI CKD definition criteria. A description of the pooled data was completed and chi-square tests were used to investigate the relation between article quality and journal quality. Analysis was carried out using SPSS (15.0) and a P-value of <0.05 was considered to indicate statistical significance.
The final review included 301 articles. There were a variety of methods used to define CKD in original research articles. Less than 20% (n = 59) of the articles adhered to the established international criteria for defining CKD. The majority of articles (52.1%) did not indicate the quantity of serum creatinine measurements used to define CKD. The impact factor or specialist nature of the scientific journal appears to have no bearing on whether or not published articles use the gold standard KDOQI guidelines for labelling a patient with a diagnosis of CKD.
This review of literature found that a variety of definitions are being used in original research articles to define CKD and measure kidney function which calls into question the validity and reliability of such research findings and associated clinical guidelines. International consensus is urgently required to improve validity and generalizability of CKD research findings.
在过去的十年中，慢性肾脏病（CKD）已成为临床和流行病学研究的热点领域。尽管肾脏病预后质量倡议（KDOQI）指南提供了明确的指导，但在 CKD 研究文献中，对于如何定义 CKD 和测量肾功能似乎存在很大的分歧。
本研究的目的是调查原始研究论文中用于定义 CKD 和测量肾功能的各种方法，并调查期刊质量是否对所用方法的质量有影响。这是一个描述性综述，而不是荟萃分析。从每篇文章中提取信息，包括出版细节（包括期刊影响因子）、CKD 的定义、估计肾功能的方法以及用于定义 CKD 的血清肌酐读数数量。通过 OVID 对 MEDLINE 进行电子搜索，使用搜索词“CKD”。搜索仅限于 2009 年发表的英文原始研究文章。只有包含 CKD 患者的研究才被纳入综述。如果文章报告的数据来自儿科人群、仅透析人群或无法通过 OVID 获得全文，则将其排除在外。根据使用 KDOQI CKD 定义标准的情况，对每篇文章进行质量评估。完成了汇总数据的描述，并使用卡方检验调查了文章质量与期刊质量之间的关系。使用 SPSS（15.0）进行分析，P 值<0.05 被认为具有统计学意义。
最终的综述包括 301 篇文章。原始研究文章中使用了多种方法来定义 CKD。不到 20%（n=59）的文章符合既定的国际 CKD 定义标准。大多数文章（52.1%）没有指出用于定义 CKD 的血清肌酐测量数量。期刊的影响因子或科学性质似乎与发表的文章是否使用金标准 KDOQI 指南来诊断 CKD 患者无关。
本文献综述发现，原始研究文章中使用了多种定义来定义 CKD 和测量肾功能，这使得此类研究结果和相关临床指南的有效性和可靠性受到质疑。迫切需要国际共识来提高 CKD 研究结果的有效性和普遍性。
