Department of Internal Medicine I, University of Bonn, Bonn, Germany.
Nephrol Dial Transplant. 2011 Dec;26(12):4104-8. doi: 10.1093/ndt/gfr183. Epub 2011 May 5.
Accurate calculation of glomerular filtration rate (GFR) is crucial in the management of patients after kidney transplantation (KTx). Recently, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula was introduced to estimate GFR in chronic kidney disease patients. However, to date the diagnostic value of this equation remains to be determined in patients after KTx.
We analysed the CKD-EPI formula in comparison to the re-expressed Modification of Diet in Renal Disease (MDRD) equation in 170 stable patients after renal transplantation. Correlation, bias, precision and accuracy within 30 and 50% of true GFR were determined. GFR was measured by technetium-diethylenetriamine pentaacetic acid clearance [39.6, 95% confidence interval (CI): 37.3-42.0 mL/min/1.73m(2)].
The results for the MDRD and CKD-EPI equations correlated well with GFR (0.82; 0.83, respectively). GFR calculated by MDRD (44.1, 95% CI: 41.6-46.8 mL/min/1.73m(2)) and CKD-EPI (47.7, 95% CI: 44.7-50.7 mL/min/1.73m(2)) overestimated true GFR significantly (P < 0.001). Precision was not significantly different between MDRD and CKD-EPI (10.9 versus 10.0 mL/min/1.73m(2), respectively). Accuracy within 30% of true GFR was significantly higher for MDRD (71.8%) than for CKD-EPI (64.1%, P = 0.0014). Accuracy within 50% of true GFR did not differ significantly (MDRD: 89.4% versus CKD-EPI: 84.7%, P = 0.06).
The new CKD-EPI formula did not improve the estimation of GFR in Caucasian patients after renal transplantation in this study.
准确计算肾小球滤过率（GFR）对于肾移植（KTx）患者的管理至关重要。最近，慢性肾脏病流行病学协作组（CKD-EPI）公式被引入用于估算慢性肾脏病患者的 GFR。然而，迄今为止，该方程在 KTx 后的患者中的诊断价值仍有待确定。
我们分析了在 170 例肾移植后稳定的患者中，CKD-EPI 公式与重新表达的肾脏病饮食改良公式（MDRD）的比较。确定了在真实 GFR 的 30%和 50%以内的相关性、偏差、精度和准确性。GFR 通过锝-二乙三胺五乙酸清除率测定[39.6，95%置信区间（CI）：37.3-42.0 mL/min/1.73m(2)]。
MDRD 和 CKD-EPI 方程的结果与 GFR 相关性良好（0.82；0.83）。MDRD 计算的 GFR（44.1，95%CI：41.6-46.8 mL/min/1.73m(2)）和 CKD-EPI（47.7，95%CI：44.7-50.7 mL/min/1.73m(2)）显著高估了真实 GFR（P < 0.001）。MDRD 和 CKD-EPI 之间的精度没有显著差异（分别为 10.9 和 10.0 mL/min/1.73m(2)）。在真实 GFR 的 30%以内，MDRD 的准确性明显高于 CKD-EPI（71.8%比 64.1%，P = 0.0014）。在真实 GFR 的 50%以内，准确性没有显著差异（MDRD：89.4%比 CKD-EPI：84.7%，P = 0.06）。
在这项研究中，新的 CKD-EPI 公式并没有改善白人肾移植后患者 GFR 的估计。
