Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok10110, Thailand.
BMC Nephrol. 2012 Jan 6;13:1. doi: 10.1186/1471-2369-13-1.
Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) group recommended that patients with CKD should be assigned to stages and composite relative risk groups according to GFR (G) and proteinuria (A) criteria. Asians have among the highest rates of ESRD in the world, but establishing the prevalence and prognosis CKD is a problem for Asian populations since there is no consensus on the best GFR estimating (eGFR) equation. We studied the effects of the choice of new Asian and Caucasian eGFR equations on CKD prevalence, stage distribution, and risk categorization using the new KDIGO classification.
The prevalence of CKD and composite relative risk groups defined by eGFR from with Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI); standard (S) or Chinese(C) MDRD; Japanese CKD-EPI (J-EPI), Thai GFR (T-GFR) equations were compared in a Thai cohort (n = 5526)
There was a 7 fold difference in CKD3-5 prevalence between J-EPI and the other Asian eGFR formulae. CKD3-5 prevalence with S-MDRD and CKD-EPI were 2 - 3 folds higher than T-GFR or C-MDRD. The concordance with CKD-EPI to diagnose CKD3-5 was over 90% for T-GFR or C-MDRD, but they only assigned the same CKD stage in 50% of the time. The choice of equation also caused large variations in each composite risk groups especially those with mildly increased risks. Different equations can lead to a reversal of male: female ratios. The variability of different equations is most apparent in older subjects. Stage G3aA1 increased with age and accounted for a large proportion of the differences in CKD3-5 between CKD-EPI, S-MDRD and C-MDRD.
CKD prevalence, sex ratios, and KDIGO composite risk groupings varied widely depending on the equation used. More studies are needed to define the best equation for Asian populations.
最近，肾脏病：改善全球预后（KDIGO）组织建议根据肾小球滤过率（G）和蛋白尿（A）标准将慢性肾脏病（CKD）患者分配到阶段和综合相对风险组。亚洲人是世界上终末期肾病（ESRD）发病率最高的人群之一，但由于对最佳肾小球滤过率估计（eGFR）方程没有共识，因此确定亚洲人群的 CKD 患病率和预后是一个问题。我们使用新的 KDIGO 分类研究了选择新的亚洲和高加索 eGFR 方程对 CKD 患病率、阶段分布和风险分类的影响。
在泰国队列（n = 5526）中比较了使用慢性肾脏病-流行病学合作（CKD-EPI）；标准（S）或中国（C）MDRD；日本 CKD-EPI（J-EPI），泰国 GFR（T-GFR）方程的 eGFR 定义的 CKD 患病率和复合相对风险组。
J-EPI 与其他亚洲 eGFR 公式之间的 CKD3-5 患病率差异高达 7 倍。S-MDRD 和 CKD-EPI 的 CKD3-5 患病率是 T-GFR 或 C-MDRD 的 2-3 倍。T-GFR 或 C-MDRD 与 CKD-EPI 诊断 CKD3-5 的一致性超过 90%，但它们仅在 50%的时间内分配相同的 CKD 阶段。方程的选择也会导致每个复合风险组的差异很大，特别是那些风险略有增加的风险组。不同的方程可能导致男性：女性比例的逆转。不同方程的可变性在年龄较大的受试者中最为明显。随着年龄的增长，G3aA1 期增加，并导致 CKD-EPI、S-MDRD 和 C-MDRD 之间 CKD3-5 差异的大部分。
CKD 患病率、性别比例和 KDIGO 复合风险分组因所使用的方程而异。需要进一步研究来定义亚洲人群的最佳方程。
