评估儿童肾小球滤过率估计的成人公式。
Assessment of adult formulas for glomerular filtration rate estimation in children.
机构信息
Division of Paediatric Nephrology, Department of Pediatrics, Lausanne University Hospital, Rue Bugnon 46, 1011 Lausanne, Switzerland.
出版信息
Pediatr Nephrol. 2013 Jan;28(1):105-14. doi: 10.1007/s00467-012-2298-2. Epub 2012 Sep 13.
BACKGROUND
Estimated glomerular filtration rate (eGFR) is an important diagnostic instrument in clinical practice. The National Kidney Foundation-Kidney Disease Quality Initiative (NKF-KDOQI) guidelines do not recommend using formulas developed for adults to estimate GFR in children; however, studies confirming these recommendations are scarce. The aim of our study was to evaluate the accuracy of the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, the Modification of Diet in Renal Disease (MDRD) formula, and the Cockcroft-Gault formula in children with various stages of chronic kidney disease (CKD).
METHODS
A total of 550 inulin clearance (iGFR) measurements for 391 children were analyzed. The cohort was divided into three groups: group 1, with iGFR >90 ml/min/1.73 m(2); group 2, with iGFR between 60 and 90 ml/min/1.73 m(2); group 3, with iGFR of <60 ml/min/1.73 m(2).
RESULTS
All formulas overestimate iGFR with a significant bias (p < 0.001), present poor accuracies, and have poor Spearman correlations. For an accuracy of 10 %, only 11, 6, and 27 % of the eGFRs are accurate when using the MDRD, CKD-EPI, and Cockcroft-Gault formulas, respectively. For an accuracy of 30 %, these formulas do not reach the NKF-KDOQI guidelines for validation, with only 25, 20, and 70 % of the eGFRs, respectively, being accurate.
CONCLUSIONS
Based on our results, the performances of all of these formulas are unreliable for eGFR in children across all CKD stages and cannot therefore be applied in the pediatric population group.
背景
估算肾小球滤过率（eGFR）是临床实践中的重要诊断工具。国家肾脏基金会-肾脏病预后质量倡议（NKF-KDOQI）指南不建议在儿童中使用为成年人开发的公式来估算 GFR；然而，证实这些建议的研究很少。我们的研究目的是评估新的慢性肾脏病流行病学合作（CKD-EPI）公式、肾脏病饮食改良公式（MDRD）和 Cockcroft-Gault 公式在各种慢性肾脏病（CKD）阶段儿童中的准确性。
方法
共分析了 391 名儿童的 550 次菊粉清除率（iGFR）测量值。该队列分为三组：第 1 组，iGFR>90ml/min/1.73m(2)；第 2 组，iGFR 在 60 至 90ml/min/1.73m(2)之间；第 3 组，iGFR<60ml/min/1.73m(2)。
结果
所有公式均高估了 iGFR，且具有显著的偏差（p<0.001），准确性较差，Spearman 相关性也较差。对于准确性为 10%，仅当使用 MDRD、CKD-EPI 和 Cockcroft-Gault 公式时，分别有 11%、6%和 27%的 eGFR 是准确的。对于准确性为 30%，这些公式不符合 NKF-KDOQI 的验证标准，只有 25%、20%和 70%的 eGFR 是准确的。
结论
根据我们的结果，所有这些公式在所有 CKD 阶段的儿童 eGFR 中表现均不可靠，因此不能在儿科人群中应用。
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