Cachat Francois, Combescure Christophe, Cauderay Michel, Girardin Eric, Chehade Hassib
Department of Pediatrics, Division of Pediatric Nephrology, University Hospital, Lausanne, Switzerland;
CRC and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva University Hospitals of Geneva, Geneva, Switzerland;
Clin J Am Soc Nephrol. 2015 Mar 6;10(3):382-9. doi: 10.2215/CJN.03080314. Epub 2015 Jan 7.
Evaluation of glomerular hyperfiltration (GH) is difficult; the variable reported definitions impede comparisons between studies. A clear and universal definition of GH would help in comparing results of trials aimed at reducing GH. This study assessed how GH is measured and defined in the literature.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Three databases (Embase, MEDLINE, CINAHL) were systematically searched using the terms "hyperfiltration" or "glomerular hyperfiltration". All studies reporting a GH threshold or studying the effect of a high GFR in a continuous manner against another outcome of interest were included.
The literature search was performed from November 2012 to February 2013 and updated in August 2014. From 2013 retrieved studies, 405 studies were included. Threshold use to define GH was reported in 55.6% of studies. Of these, 88.4% used a single threshold and 11.6% used numerous thresholds adapted to participant sex or age. In 29.8% of the studies, the choice of a GH threshold was not based on a control group or literature references. After 2004, the use of GH threshold use increased (P<0.001), but the use of a control group to precisely define that GH threshold decreased significantly (P<0.001); the threshold did not differ among pediatric, adult, or mixed-age studies. The GH threshold ranged from 90.7 to 175 ml/min per 1.73 m(2) (median, 135 ml/min per 1.73 m(2)).
Thirty percent of studies did not justify the choice of threshold values. The decrease of GFR in the elderly was rarely considered in defining GH. From a methodologic point of view, an age- and sex-matched control group should be used to define a GH threshold.
肾小球高滤过（GH）的评估存在困难；已报道的定义各不相同，妨碍了研究之间的比较。一个清晰且通用的GH定义将有助于比较旨在降低GH的试验结果。本研究评估了文献中GH是如何测量和定义的。
设计、地点、参与者与测量方法：使用“高滤过”或“肾小球高滤过”等术语对三个数据库（Embase、MEDLINE、CINAHL）进行系统检索。纳入所有报告GH阈值或以连续方式研究高肾小球滤过率（GFR）对另一感兴趣结局影响的研究。
文献检索于2012年11月至2013年2月进行，并于2014年8月更新。从2013年检索到的研究中，纳入了405项研究。55.6%的研究报告了用于定义GH的阈值。其中，88.4%使用单一阈值，11.6%使用根据参与者性别或年龄调整的多个阈值。在29.8%的研究中，GH阈值的选择并非基于对照组或文献参考。2004年后，GH阈值的使用增加（P<0.001），但使用对照组来精确定义该GH阈值的情况显著减少（P<0.001）；儿科、成人或混合年龄研究中的阈值并无差异。GH阈值范围为每1.73 m² 90.7至175 ml/min（中位数为每1.73 m² 135 ml/min）。
30%的研究未对阈值的选择进行论证。在定义GH时很少考虑老年人GFR的下降情况。从方法学角度来看，应使用年龄和性别匹配的对照组来定义GH阈值。
