基于肌酐的肾小球滤过率估计在肝病患者中的应用：新的慢性肾脏病流行病学合作方程并没有更好。

Creatinine-based glomerular filtration rate estimation in patients with liver disease: the new Chronic Kidney Disease Epidemiology Collaboration equation is not better.

机构信息

Department of Internal Medicine, University of Bonn, Bonn, Germany.

出版信息

Eur J Gastroenterol Hepatol. 2011 Nov;23(11):969-73. doi: 10.1097/MEG.0b013e32834991f1.

DOI:10.1097/MEG.0b013e32834991f1

PMID:21897265

Abstract

OBJECTIVES

Limitations of serum creatinine in patients with an impaired liver function are well known. The commonly used modification of diet in renal disease (MDRD) equation has a low diagnostic performance to approximate kidney function in patients after liver transplantation (LT) and patients with liver cirrhosis (LC). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula has been shown to provide a more accurate estimation of kidney function in patients with chronic kidney disease, but studies in patients with liver disease are lacking.

METHODS

We evaluated the diagnostic performance of CKD-EPI in comparison with the re-expressed MDRD formula in patients after LT (group 1; n=59) and in patients suffering from LC (group 2; n=44). GFR was measured by 99mTc-diethylenetriamine penta-acetic acid (group 1) and inulin clearance (group 2). Bias, precision, and accuracy as compared with the measured GFR were determined.

RESULTS

The measured mean GFR (95% confidence interval) was 52.3 ml/min/1.73 m2 (47.7; 56.9; group 1) and 35.3 ml/min/1.73 m2 (29.12; 41.3; group 2), respectively. In transplanted patients GFR estimation by CKD-EPI and MDRD did not significantly differ with respect to bias (9.7 vs. 4.3 ml/min/1.73 m2), precision (16.9 vs. 15.5 ml/min/1.73 m2) and accuracy (64.4 vs. 69.5% within 30% of 'true GFR'). In patients with LC, both formulae showed a very high bias (42.5 vs. 40.1 ml/min/1.73 m2), a very low precision (20.7 vs. 25.7 ml/min/1.73 m2) and accuracy (6.8 within 30% of the measured GFR in both groups).

CONCLUSION

The CKD-EPI equation does not improve the creatinine-based GFR estimation in patients after LT. In patients with LC, both equations should not be applied as they extremely overestimate GFR.

摘要

目的

众所周知，血清肌酐在肝功能受损患者中的应用存在局限性。常用于评估肾功能的改良肾脏病膳食改良公式（MDRD）在肝移植（LT）后患者和肝硬化（LC）患者中，其对肾功能的诊断性能较低。慢性肾脏病流行病学协作组（CKD-EPI）公式已被证明可更准确地评估慢性肾脏病患者的肾功能，但在肝病患者中研究较少。

方法

我们评估了 CKD-EPI 公式与重新表达的 MDRD 公式在 LT 后患者（第 1 组；n=59）和 LC 患者（第 2 组；n=44）中的诊断性能。GFR 通过 99mTc-二乙三胺五乙酸（第 1 组）和菊粉清除率（第 2 组）进行测量。确定与实测 GFR 相比，其偏差、精密度和准确性。

结果

测量的平均 GFR（95%置信区间）分别为 52.3 ml/min/1.73 m2（47.7；56.9；第 1 组）和 35.3 ml/min/1.73 m2（29.12；41.3；第 2 组）。在移植患者中，CKD-EPI 和 MDRD 公式的 GFR 估计值在偏差（9.7 与 4.3 ml/min/1.73 m2）、精密度（16.9 与 15.5 ml/min/1.73 m2）和准确性（64.4 与 69.5%，在“真实 GFR”的 30%以内）方面均无显著差异。在 LC 患者中，两种公式的偏差均很高（42.5 与 40.1 ml/min/1.73 m2），精密度均较低（20.7 与 25.7 ml/min/1.73 m2），准确性也较低（两组中，有 6.8%的 GFR 在 30%以内）。