采用慢性肾脏病流行病学合作组织（CKD-EPI）公式，比较含与不含胱抑素C的估算肾小球滤过率预测老年女性临床结局的情况。
Comparison of estimated glomerular filtration rate by the chronic kidney disease epidemiology collaboration (CKD-EPI) equations with and without Cystatin C for predicting clinical outcomes in elderly women.
作者信息
Lim Wai H, Lewis Joshua R, Wong Germaine, Turner Robin M, Lim Ee M, Thompson Peter L, Prince Richard L
机构信息
University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia; Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.
出版信息
PLoS One. 2014 Sep 29;9(9):e106734. doi: 10.1371/journal.pone.0106734. eCollection 2014.
BACKGROUND
Reduced estimated glomerular filtration rate (eGFR) using the cystatin-C derived equations might be a better predictor of cardiovascular disease (CVD) mortality compared with the creatinine-derived equations, but this association remains unclear in elderly individuals.
AIM
The aims of this study were to compare the predictive values of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-creatinine, CKD-EPI-cystatin C and CKD-EPI-creatinine-cystatin C eGFR equations for all-cause mortality and CVD events (hospitalizations±mortality).
METHODS
Prospective cohort study of 1165 elderly women aged>70 years. Associations between eGFR and outcomes were examined using Cox regression analysis. Test accuracy of eGFR equations for predicting outcomes was examined using Receiver Operating Characteristic (ROC) analysis and net reclassification improvement (NRI).
RESULTS
Risk of all-cause mortality for every incremental reduction in eGFR determined using CKD-EPI-creatinine, CKD-EPI-cystatin C and the CKD-EPI-creatinine-cystatic C equations was similar. Areas under the ROC curves of CKD-EPI-creatinine, CKD-EPI-cystatin C and CKD-EPI-creatinine-cystatin C equations for all-cause mortality were 0.604 (95%CI 0.561-0.647), 0.606 (95%CI 0.563-0.649; p = 0.963) and 0.606 (95%CI 0.563-0.649; p = 0.894) respectively. For all-cause mortality, there was no improvement in the reclassification of eGFR categories using the CKD-EPI-cystatin C (NRI -4.1%; p = 0.401) and CKD-EPI-creatinine-cystatin C (NRI -1.2%; p = 0.748) compared with CKD-EPI-creatinine equation. Similar findings were observed for CVD events.
CONCLUSION
eGFR derived from CKD-EPI cystatin C and CKD-EPI creatinine-cystatin C equations did not improve the accuracy or predictive ability for clinical events compared to CKD-EPI-creatinine equation in this cohort of elderly women.
背景
与基于肌酐的方程相比，使用胱抑素C推导的方程得出的估算肾小球滤过率（eGFR）降低可能是心血管疾病（CVD）死亡率更好的预测指标，但在老年人中这种关联仍不明确。
目的
本研究的目的是比较慢性肾脏病流行病学协作组（CKD-EPI）-肌酐、CKD-EPI-胱抑素C和CKD-EPI-肌酐-胱抑素C的eGFR方程对全因死亡率和CVD事件（住院±死亡）的预测价值。
方法
对1165名年龄>70岁的老年女性进行前瞻性队列研究。使用Cox回归分析检查eGFR与结局之间的关联。使用受试者工作特征（ROC）分析和净重新分类改善（NRI）检查eGFR方程预测结局的检验准确性。
结果
使用CKD-EPI-肌酐、CKD-EPI-胱抑素C和CKD-EPI-肌酐-胱抑素C方程确定的eGFR每增加一次降低，全因死亡率风险相似。CKD-EPI-肌酐、CKD-EPI-胱抑素C和CKD-EPI-肌酐-胱抑素C方程对全因死亡率的ROC曲线下面积分别为0.604（95%CI 0.561-0.647）、0.606（95%CI 0.563-0.649；p = 0.963）和0.606（95%CI 0.563-0.649；p = 0.894）。对于全因死亡率，与CKD-EPI-肌酐方程相比，使用CKD-EPI-胱抑素C（NRI -4.1%；p = 0.401）和CKD-EPI-肌酐-胱抑素C（NRI -1.2%；p = 0.748）对eGFR类别进行重新分类没有改善。CVD事件也观察到类似结果。
结论
在这组老年女性中，与CKD-EPI-肌酐方程相比，由CKD-EPI胱抑素C和CKD-EPI肌酐-胱抑素C方程得出的eGFR并未提高临床事件的准确性或预测能力。
Zotero 插件