肾移植受者估算肾小球滤过率（eGFR）方程的验证
The validation of estimated glomerular filtration rate (eGFR) equation for renal transplant recipients.
作者信息
Townamchai Natavudh, Praditpornsilpa Kearkiat, Chawatanarat Tawatchai, Avihingsanon Yingyos, Tiranathanagul Khajohn, Katavetin Pisut, Susantitaphong Paweena, Kanjanabuch Talerngsak, Tungsanga Kriang, Eiam-Ong Somchai
机构信息
Division of Nephrology, Department of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross Society, Bangkok, Thailand.
出版信息
Clin Nephrol. 2013 Mar;79(3):206-13. doi: 10.5414/CN107662.
BACKGROUND
The re-expressed Modification of Diet in the Renal Disease (MDRD) equation and the Chronic Kidney Disease Epidemiology (CKD-EPI) equation were developed to estimate glomerular filtration rate in non-transplant chronic kidney disease (CKD) patients. The Nankivell equation was created to estimate GFR in transplant recipients. However, none of these formulas have been validated in Asian renal transplant patients. Several recently published studies have highlighted the need to adapt estimated glomerular filtration rate (eGFR) equations to the race of their patients. Although the eGFR equation for Thai CKD has been derived, it has not been validated for transplant recipients. Our study aimed validating the Nankivell equation, re-expressed MDRD equation, CKD-EPI, re-expressed MDRD equation with Thai racial factor correction, as well as the Thai eGFR equation in Thai renal transplant recipients.
METHODS
A total of 97 adult Thai renal transplant recipients were studied. The 99mTc-DTPA plasma clearance was used as a reference GFR. The serum creatinine was determined by IDMS reference enzymatic methods (CrEnz).
RESULTS
The mean reference GFR and CrEnz were 67.86 ± 20.72 ml/min/1.73 m2 and 1.23 ± 0.59 mg/dl. The bias estimated by Bland-Altman analysis can be expressed as -12.11 ± 15.87 ml/ min/1.73 m2 for the Nankivell equation, 2.72 ± 13.90 ml/min/1.73 m2 for the re-expressed IDMS-traceable MDRD equation, -2.59 ± 14.16 ml/min/1.73 m2 for the CKD-EPI equation, -7.05 ± 17.34 ml/min/1.73 m2 for the Thai re-expressed MDRD with Thai racial factor, and -8.62 ± 16.00 ml/min/1.73 m2 for the Thai eGFR equation. The CKD-EPI equation provided the best accuracy and precision in terms of Pearson correlation coefficient, mean difference, error, and accuracy within 10%, 20%, and 30%.
CONCLUSIONS
The equations derived mainly from Caucasian and/or non-transplant status can be applied to Thai transplantation recipients with some bias. The CKD-EPI had the least bias compared with other eGFR equations.
背景
重新表述的肾病饮食改良（MDRD）方程和慢性肾脏病流行病学（CKD-EPI）方程用于估算非移植慢性肾脏病（CKD）患者的肾小球滤过率。南基韦尔方程用于估算移植受者的肾小球滤过率。然而，这些公式均未在亚洲肾移植患者中得到验证。最近发表的几项研究强调，估算肾小球滤过率（eGFR）方程需要根据患者的种族进行调整。虽然泰国CKD的eGFR方程已经推导出来，但尚未在移植受者中得到验证。我们的研究旨在验证南基韦尔方程、重新表述的MDRD方程、CKD-EPI方程、校正泰国种族因素后的重新表述的MDRD方程以及泰国eGFR方程在泰国肾移植受者中的有效性。
方法
共研究了97名成年泰国肾移植受者。采用99mTc-DTPA血浆清除率作为参考肾小球滤过率。血清肌酐通过同位素稀释质谱法参考酶法（CrEnz）测定。
结果
参考肾小球滤过率和CrEnz的平均值分别为67.86±20.72 ml/min/1.73 m2和1.23±0.59 mg/dl。通过Bland-Altman分析估计的偏差，南基韦尔方程为-12.11±15.87 ml/min/1.73 m2，重新表述的可溯源至IDMS的MDRD方程为2.72±13.90 ml/min/1.73 m2，CKD-EPI方程为-2.59±14.16 ml/min/1.73 m2，校正泰国种族因素后的泰国重新表述MDRD方程为-7.05±17.34 ml/min/1.73 m2，泰国eGFR方程为-8.62±16.00 ml/min/1.73 m2。就Pearson相关系数、平均差异、误差以及10%、20%和30%范围内的准确性而言，CKD-EPI方程提供了最佳的准确性和精密度。
结论
主要源自白种人和/或非移植状态的方程应用于泰国移植受者时会存在一定偏差。与其他eGFR方程相比，CKD-EPI方程的偏差最小。
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