慢性肾脏病：一项基于大规模人群的关于引入慢性肾脏病流行病学合作组织（CKD-EPI）估算肾小球滤过率（eGFR）报告公式影响的研究

Chronic kidney disease: a large-scale population-based study of the effects of introducing the CKD-EPI formula for eGFR reporting.

作者信息

O'Callaghan Christopher A, Shine Brian, Lasserson Daniel S

机构信息

Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK.

出版信息

BMJ Open. 2011 Dec 19;1(2):e000308. doi: 10.1136/bmjopen-2011-000308. Print 2011.

DOI:10.1136/bmjopen-2011-000308

PMID:22184586

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3244664/

Abstract

Objective To evaluate the effects of introducing the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) formula for estimated glomerular filtration rate (eGFR) reporting in the adult population in routine clinical practice with clinician-directed testing. Design Retrospective study of all creatinine measurements and calculation of eGFRs using Modification of Diet in Renal Disease (MDRD) and CKD-EPI formulae. Setting General population, Oxfordshire, UK. Participants An unselected population of around 660 000. Interventions Reporting of eGFRs using MDRD or CKD-EPI formulae. Primary and secondary outcome measures Evaluation of the effects of the CKD-EPI formula on the prevalence of different stages of chronic kidney disease (CKD). Results The CKD-EPI formula reduced the prevalence of CKD (stages 2-5) by 16.4% in patients tested in primary care. At the important stage 2-stage 3 cut-off, there was a relative reduction of 7.5% in the prevalence of CKD stages 3-5 from 15.7% to 14.5%. The CKD-EPI formula reduced the prevalence of CKD stages 3-5 in those aged <70 but increased it at ages >70. Above 70 years, the prevalence of stages 3-5 was similar with both equations for women (around 41.2%) but rose in men from 33.3% to 35.5%. CKD stages 4-5 rose by 15% due exclusively to increases in the over 70s, which could increase specialist referral rates. The CKD classification of 18.3% of all individuals who had a creatinine measurement was altered by a change from the MDRD to the CKD-EPI formula. In the UK population, the classification of up to 3 million patients could be altered, the prevalence of CKD could be reduced by up to 1.9 million and the prevalence of CKD stages 3-5 could fall by around 200 000. Conclusions Introduction of the CKD-EPI formula for eGFR reporting will reduce the prevalence of CKD in a primary care setting with current testing practice but will raise the prevalence in the over 70s age group. This has implications for clinical practice, healthcare policy and current prevalence-based funding arrangements.

摘要

目的评估在临床医生指导检测的常规临床实践中，引入慢性肾脏病流行病学协作组（CKD-EPI）公式报告成人估计肾小球滤过率（eGFR）的效果。设计对所有肌酐测量值进行回顾性研究，并使用肾病饮食改良（MDRD）公式和CKD-EPI公式计算eGFR。地点英国牛津郡的普通人群。参与者约66万未经过筛选的人群。干预措施使用MDRD公式或CKD-EPI公式报告eGFR。主要和次要结局指标评估CKD-EPI公式对慢性肾脏病（CKD）不同阶段患病率的影响。结果在初级保健机构接受检测的患者中，CKD-EPI公式使CKD（2-5期）的患病率降低了16.4%。在重要的2-3期分界点，CKD 3-5期的患病率从15.7%相对降低了7.5%，降至14.5%。CKD-EPI公式降低了70岁以下人群中CKD 3-5期的患病率，但在70岁以上人群中却使其升高。70岁以上，女性3-5期的患病率在两个公式下相似（约41.2%），但男性从33.3%升至35.5%。CKD 4-5期仅因70岁以上人群患病率上升了15%（这可能会提高专科转诊率）。从MDRD公式改为CKD-EPI公式后，所有进行过肌酐测量的个体中，18.3%的CKD分类发生了改变。在英国人群中，多达300万患者的分类可能会改变，CKD患病率最多可降低190万，CKD 3-5期患病率可降低约20万。结论引入CKD-EPI公式报告eGFR将降低当前检测实践下初级保健机构中CKD的患病率，但会提高70岁以上年龄组的患病率。这对临床实践、医疗保健政策和当前基于患病率的资金安排具有影响。