Mitchell Tim, Hadlow Narelle, Chakera Aron
Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Nephrology (Carlton). 2014 Sep;19(9):581-6. doi: 10.1111/nep.12283.
Most laboratories are moving to report estimated glomerular filtration rates (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. However, data on the prevalence of chronic kidney disease (CKD) in the population and its economic impact have to date been modelled using data derived from the modification of diet in renal disease (MDRD) equation. Evaluating the impact of CKD-EPI on prevalence has important implications for referral patterns and health expenditure.
eGFR were calculated from 2 295313 creatinine results from 833334 patients using the MDRD and CKD-EPI formulae. The proportion of patients in each CKD stage was determined and annual rates of change of eGFR in patients assigned to a new CKD stage compared with their previous CKD stage calculated. The effects of age on eGFR were assessed.
Reporting of eGFR using the CKD-EPI equation reduced the prevalence of CKD stages III-V from 9.2% to 7.6%. A total of 181126 patients were reclassified using CKD-EPI with 171298 changing to a better CKD stage. Reclassification rates were highest in CKD stages II and III. Patients reclassified from stage III to II tended to be younger or female. eGFR declines rapidly after the age of 60.
Introduction of routine eGFR reporting using the CKD-EPI formula will reduce the population prevalence of CKD. CKD-EPI reporting better identifies patients at risk of further decline in renal function. Improvement in the classification should reduce unnecessary costs related to surveillance and referral. The impact of ageing on renal function should be appreciated.
大多数实验室正转向使用慢性肾脏病流行病学协作组（CKD-EPI）公式报告估算肾小球滤过率（eGFR）。然而，迄今为止，关于人群中慢性肾脏病（CKD）的患病率及其经济影响的数据是使用来自肾病饮食改良（MDRD）方程的数据进行建模的。评估CKD-EPI对患病率的影响对转诊模式和医疗支出具有重要意义。
使用MDRD和CKD-EPI公式从833334例患者的2295313份肌酐检测结果中计算eGFR。确定每个CKD阶段的患者比例，并计算新分配到CKD阶段的患者与先前CKD阶段相比eGFR的年变化率。评估年龄对eGFR的影响。
使用CKD-EPI方程报告eGFR使CKD III-V期的患病率从9.2%降至7.6%。共有181126例患者使用CKD-EPI进行了重新分类，其中171298例患者的CKD阶段得到改善。重新分类率在CKD II期和III期最高。从III期重新分类为II期的患者往往更年轻或为女性。60岁以后eGFR迅速下降。
采用CKD-EPI公式进行常规eGFR报告将降低人群中CKD的患病率。CKD-EPI报告能更好地识别肾功能有进一步下降风险的患者。分类的改善应能减少与监测和转诊相关的不必要成本。应认识到衰老对肾功能的影响。
