Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
Eur J Heart Fail. 2014 Jan;16(1):86-94. doi: 10.1093/eurjhf/hft128. Epub 2013 Dec 3.
The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula estimates glomerular filtration rate (GFR) better than the simplified Modification of Diet in Renal Disease (sMDRD) formula in numerous populations. It has not previously been validated in heart failure patients.
The GFR was measured in 120 patients with chronic systolic heart failure (CHF) using [(125)I]iothalamate clearance (GFR(IOTH)) and estimated using the sMDRD and CKD-EPI equations. Accuracy, bias, and prognostic performance were compared. Cockcroft-Gault, CKD-EPI serum cystatin C, and CKD-EPI creatinine-serum cystatin C equations were compared in secondary analyses. Mean age was 59 ± 12 years, 80% were male. Mean LVEF was 29 ± 10%. Mean GFR(IOTH) was 74 ± 27 mL/min/1.73 m(2), and mean estimated GFR was 66 ± 23 mL/min/1.73 m(2) (CKD-EPI) and 63 ± 21 mL/min/1.73m(2) (sMDRD). CKD-EPI showed less bias than sMDRD (-8 ± 15 vs. -11 ± 16 mL/min/1.73 m(2), P < 0.001). Both equations underestimate at higher and overestimate at lower GFR(IOTH). Eleven patients (9%) were accurately reclassified into lower CKD classes with CKD-EPI. Cockcroft-Gault showed lower bias (-3 ± 16 mL/min/1.73 m(2)) but worse precision and accuracy. Cystatin C-based estimation showed the lowest bias (-3 ± 14 mL/min/1.73 m(2)) and the best precision and accuracy. Prognostic value did not differ between all GFR estimates
The CKD-EPI equation more accurately estimates measured GFR than the sMDRD equation in CHF patients, with less bias and greater accuracy and precision. The prognostic power of all GFR assessments was equivalent. Based on better performance and equal risk prediction, we believe the CKI-EPI equation should be the preferred creatinine-based GFR estimation method in heart failure patients, particularly those with preserved or moderately impaired renal function.
慢性肾脏病流行病学协作组（CKD-EPI）公式在许多人群中比简化肾脏病饮食改良公式（sMDRD）更能准确估算肾小球滤过率（GFR）。该公式尚未在心力衰竭患者中进行验证。
采用碘[125I]噻唑啉酸清除率（GFR（IOTH））测量了 120 例慢性收缩性心力衰竭（CHF）患者的 GFR，并分别使用 sMDRD 和 CKD-EPI 方程进行了估计。比较了准确性、偏倚和预后表现。在次要分析中比较了 Cockcroft-Gault、CKD-EPI 血清胱抑素 C 和 CKD-EPI 肌酐-血清胱抑素 C 方程。平均年龄为 59 ± 12 岁，80%为男性。平均 LVEF 为 29 ± 10%。平均 GFR（IOTH）为 74 ± 27 mL/min/1.73 m2，平均估计 GFR 为 66 ± 23 mL/min/1.73 m2（CKD-EPI）和 63 ± 21 mL/min/1.73 m2（sMDRD）。CKD-EPI 比 sMDRD 显示出更小的偏倚（-8 ± 15 与-11 ± 16 mL/min/1.73 m2，P < 0.001）。两种方程在较高 GFR（IOTH）时低估，在较低 GFR（IOTH）时高估。11 例（9%）患者用 CKD-EPI 更准确地归入较低的 CKD 分期。Cockcroft-Gault 显示出更低的偏倚（-3 ± 16 mL/min/1.73 m2），但精度和准确性较差。基于胱抑素 C 的估计显示出最低的偏倚（-3 ± 14 mL/min/1.73 m2）和最佳的精度和准确性。所有 GFR 估计的预后价值均无差异。
在心力衰竭患者中，CKD-EPI 方程比 sMDRD 方程更能准确地估计测量的 GFR，具有更小的偏倚、更高的准确性和精度。所有 GFR 评估的预后能力相当。基于更好的性能和相等的风险预测，我们认为 CKI-EPI 方程应该是心力衰竭患者，特别是保留或中度肾功能受损患者的首选基于肌酐的 GFR 估算方法。
