活体肾移植后基于胱抑素C和肌酐的肾小球滤过率估算方程的比较。
Comparison of cystatin C and creatinine-based equations for GFR estimation after living kidney donation.
作者信息
Issa Naim, Kukla Aleksandra, Jackson Scott, Riad Samy M, Foster Meredith C, Matas Arthur J, Eckfeldt John H, Ibrahim Hassan N
机构信息
1 Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN. 2 Division of Nephrology, University of Alabama, Birmingham, AL. 3 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 4 Division of Transplant Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN. 5 Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN. 6 Address correspondence to: Hassan N. Ibrahim, M.D., M.S., Division of Renal Diseases and Hypertension, University of Minnesota, 717 Delaware Street SE, Suite 353, Mail Code 1932, Minneapolis, MN 55414.
出版信息
Transplantation. 2014 Oct 27;98(8):871-7. doi: 10.1097/TP.0000000000000129.
BACKGROUND
The performance of glomerular filtration rate (GFR) equations incorporating both cystatin C (CysC) and serum creatinine (Creat) in living kidney donors has not been studied before.
METHODS
From a population of 3,698 living kidney donors, 257 donors were randomly selected to undergo GFR measurement (mGFR) by the plasma disappearance of iohexol. GFR was estimated with the Modification of Diet in Renal Disease (MDRD) equation and the Chronic Kidney Disease Epidemiology Collaboration study eGFR(CKD-EPI-Creat) in 257 donors and the two newly developed equations using CysC with and without Creat, eGFR(CKD-EPI-CysC) and eGFR(CKD-EPI-Creat+CysC), in 215 donors.
RESULTS
Mean mGFR was 71.8±11.8 mL/min/1.73 m. The eGFR(MDRD) exhibited least and only negative bias and the three other models were comparable in terms of bias. The eGFR(CKD-EPI-Creat+CysC) equation was most precise; r=0.64. Both eGFR(MDRD) and eGFR(CKD-EPI-Creat+CysC) had high percentage (94.4% and 92.6%, respectively) of estimates falling within 30% of mGFR versus estimates by eGFR(CKD-EPI-Creat) and eGFR(CKD-EPI-CysC) equations (87.2% and 85.1%, respectively). The eGFR(MDRD) was by far most accurate in identifying those with mGFR less than 60 mL/min/1.73 m whereas the CKD-EPI models were extremely accurate in classifying those with mGFR greater than or equal to 60 mL/min/1.73 m.
CONCLUSIONS
eGFR(CKD-EPI-Creat+CysC) equation provides comparable accuracy to the eGFR(MDRD) in overall estimation of mGFR, but with higher precision. However, eGFR(CKD-EPI-Creat+CysC) clearly misses many of those with a post-donation GFR less than 60 mL/min/1.73 m and therefore eGFR(MDRD) is preferable in detecting donors with GFR less than 60 mL/min/1.73 m.
背景
之前尚未对纳入胱抑素C（CysC）和血清肌酐（Creat）的肾小球滤过率（GFR）方程在活体肾供体中的表现进行研究。
方法
在3698名活体肾供体中，随机选取257名供体通过碘海醇的血浆清除率进行GFR测量（mGFR）。使用肾脏疾病饮食改良（MDRD）方程和慢性肾脏病流行病学合作研究的估算肾小球滤过率（eGFR[CKD - EPI - Creat]）对257名供体的GFR进行估算，同时使用两个新开发的方程，即包含和不包含Creat的基于CysC的方程，eGFR[CKD - EPI - CysC]和eGFR[CKD - EPI - Creat + CysC]，对215名供体进行估算。
结果
平均mGFR为71.8±11.8 mL/min/1.73 m²。eGFR（MDRD）表现出最小且仅为负偏差，其他三个模型在偏差方面相当。eGFR（CKD - EPI - Creat + CysC）方程最为精确；r = 0.64。与eGFR（CKD - EPI - Creat）和eGFR（CKD - EPI - CysC）方程相比，eGFR（MDRD）和eGFR（CKD - EPI - Creat + CysC）的估算值落在mGFR的30%范围内的比例较高（分别为94.4%和92.6%）（分别为87.2%和85.1%）。在识别mGFR低于60 mL/min/1.73 m²的个体方面，eGFR（MDRD）目前最为准确，而CKD - EPI模型在对mGFR大于或等于60 mL/min/1.73 m²的个体进行分类时极其准确。
结论
在总体估算mGFR方面，eGFR（CKD - EPI - Creat + CysC）方程与eGFR（MDRD）具有相当的准确性，但精度更高。然而，eGFR（CKD - EPI - Creat + CysC）明显遗漏了许多捐献后GFR低于60 mL/min/1.73 m²的个体，因此在检测GFR低于60 mL/min/1.73 m²的供体时，eGFR（MDRD）更可取
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