Libório Alexandre, Uchoa Russian, Neto João, Valdivia Juan, Daher Elizabeth De Francesco, Mejia Juan
Postgraduate Program on Public Health, Universidade de Fortaleza, Fortaleza, Ceará, Brazil.
Sao Paulo Med J. 2012;130(5):289-93. doi: 10.1590/s1516-31802012000500004.
Severe heart failure is highly associated with chronic kidney disease (CKD). Serum creatinine is a poor indicator of renal function and glomerular filtration rate (GFR) estimation is an accessible method for assessing renal function. The most popular formulas for GFR estimation are the Cockcroft-Gault (CG), the four-variable Simplified Modification of Diet in Renal Disease (sMDRD) and the recently introduced CKD-Epidemiology Collaboration (CKD-EPI). The objective of the study was to analyze the correlation between these three equations for estimating GFR in patients with severe heart failure.
Cross-sectional observational study at a university reference center.
GFR was estimated in patients with severe heart failure who were awaiting heart transplantation, using the CG, sMDRD and CKD-EPI formulas. These estimates were analyzed using Pearson's correlation and Bland-Altman analysis.
This study included 157 patients, of whom 32 (20.3%) were female. Normal serum creatinine concentration was observed in 21.6%. The mean GFR according to CG, sMDRD and CKD-EPI was 70.1 ± 29.5, 70.7 ± 37.5 and 73.7 ± 30.1 ml/min/1.73 m²; P > 0.05. Pearson's coefficient demonstrated good correlations between all the formulas, as did Bland-Altman. However, the patients presented GFR < 60 ml/min more frequently with the sMDRD formula (54.1% versus 40.2% for CG and 43.2% for CKD-EPI; P = 0.02).
Despite the good correlation and agreement between the three methods, the sMDRD formula classified more patients as presenting GFR less than 60 ml/min.
严重心力衰竭与慢性肾脏病（CKD）密切相关。血清肌酐是肾功能的一个欠佳指标，而肾小球滤过率（GFR）估算则是评估肾功能的一种可行方法。估算GFR最常用的公式有Cockcroft-Gault（CG）公式、四变量简化肾脏病饮食改良（sMDRD）公式以及最近推出的CKD流行病学协作组（CKD-EPI）公式。本研究的目的是分析这三种估算严重心力衰竭患者GFR的公式之间的相关性。
在一所大学参考中心开展的横断面观察性研究。
使用CG公式、sMDRD公式和CKD-EPI公式对等待心脏移植的严重心力衰竭患者的GFR进行估算。采用Pearson相关性分析和Bland-Altman分析对这些估算值进行分析。
本研究纳入了157例患者，其中32例（20.3%）为女性。21.6%的患者血清肌酐浓度正常。根据CG公式、sMDRD公式和CKD-EPI公式得出的平均GFR分别为70.1±29.5、70.7±37.5和73.7±30.1 ml/min/1.73 m²；P>0.05。Pearson系数表明所有公式之间均具有良好的相关性，Bland-Altman分析结果亦是如此。然而，sMDRD公式将GFR<60 ml/min的患者分类得更为频繁（54.1%，而CG公式为40.2%，CKD-EPI公式为43.2%；P=0.02）。
尽管这三种方法之间具有良好的相关性和一致性，但sMDRD公式将更多患者分类为GFR低于60 ml/min。
