Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Med J Aust. 2012 Aug 20;197(4):224-5. doi: 10.5694/mja11.11329.
The publication of the Australasian Creatinine Consensus Working Group's position statements in 2005 and 2007 resulted in automatic reporting of estimated glomerular filtration rate (eGFR) with requests for serum creatinine concentration in adults, facilitated the unification of units of measurement for creatinine and eGFR, and promoted the standardisation of assays. New advancements and continuing debate led the Australasian Creatinine Consensus Working Group to reconvene in 2010. The working group recommends that the method of calculating eGFR should be changed to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, and that all laboratories should report eGFR values as a precise figure to at least 90 mL/min/1.73 m(2). Age-related decision points for eGFR in adults are not recommended, as although an eGFR < 60 mL/min/1.73 m(2) is very common in older people, it is nevertheless predictive of significantly increased risks of adverse clinical outcomes, and should not be considered a normal part of ageing.If using eGFR for drug dosing, body size should be considered, in addition to referring to the approved product information. For drugs with a narrow therapeutic index, therapeutic drug monitoring or a valid marker of drug effect should be used to individualise dosing. The CKD-EPI formula has been validated as a tool to estimate GFR in some populations of non-European ancestry living in Western countries. Pending publication of validation studies, the working group also recommends that Australasian laboratories continue to automatically report eGFR in Aboriginal and Torres Strait Islander peoples. The working group concluded that routine calculation of eGFR is not recommended in children and youth, or in pregnant women. Serum creatinine concentration (preferably using an enzymatic assay for paediatric patients) should remain as the standard test for kidney function in these populations.
2005 年和 2007 年，澳大利亚肌酐共识工作组发布了立场声明，要求成年人检测血清肌酐浓度并自动报告估算肾小球滤过率（eGFR），这促进了肌酐和 eGFR 单位的统一，并推动了检测方法的标准化。新的进展和持续的争论促使澳大利亚肌酐共识工作组于 2010 年重新召开会议。工作组建议改变 eGFR 的计算方法，采用慢性肾脏病流行病学合作组（CKD-EPI）公式，并建议所有实验室将 eGFR 值报告为至少 90 mL/min/1.73 m(2)的精确数值。工作组不建议根据年龄确定成年人的 eGFR 切点，因为虽然 eGFR<60 mL/min/1.73 m(2)在老年人中非常常见，但它仍然预示着不良临床结局的风险显著增加，不应被视为衰老的正常组成部分。如果使用 eGFR 进行药物剂量调整，除了参考已批准的产品信息外，还应考虑体型。对于治疗指数较窄的药物，应使用治疗药物监测或药物效应的有效标志物进行个体化给药。CKD-EPI 公式已被验证为一种在西方国家某些非欧洲裔人群中估计 GFR 的工具。在验证研究公布之前，工作组还建议澳大利亚实验室继续自动报告澳大利亚原住民和托雷斯海峡岛民的 eGFR。工作组得出结论，不建议在儿童和青少年或孕妇中常规计算 eGFR。在这些人群中，血清肌酐浓度（最好为儿科患者使用酶法检测）应继续作为肾功能的标准检测。
