不同方程估算小儿肾移植受者肾小球滤过率的准确性。
Accuracy of different equations in estimating GFR in pediatric kidney transplant recipients.
作者信息
de Souza Vandréa, Cochat Pierre, Rabilloud Muriel, Selistre Luciano, Wagner Mario, Hadj-Aissa Aoumeur, Dolomanova Olga, Ranchin Bruno, Iwaz Jean, Dubourg Laurence
机构信息
Universidade Federal do Rio Grande do Sul, Programa de Pós graduação em Saúde da Criança e do Adolescente, Porto Alegre, Brazil; Universidade de Caxias do Sul, Centro de Ciências da Saúde, Caxias do Sul, Brazil; Exploration Fonctionnelle Rénale et Métabolique, Groupement Hospitalier Edouard Herriot, Fellow CAPES-Foundation, Ministry of Education of Brazil, Brasilia/DF, Brazil;
Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatriques, and Université Claude Bernard, Lyon 1, Lyon, France; CNRS UMR 5305, Biologie tissulaire et Ingénierie thérapeutique, Lyon, France;
出版信息
Clin J Am Soc Nephrol. 2015 Mar 6;10(3):463-70. doi: 10.2215/CJN.06300614. Epub 2015 Jan 23.
BACKGROUND AND OBJECTIVE
The knowledge of renal function is crucial for the management of pediatric kidney transplant recipients. In this population, the most commonly used plasma creatinine (PCr)-based or cystatin C (CystC)-based GFR-predicting formulas may underperform (e.g., corticosteroids and trimethoprim may affect PCr concentration, whereas prednisone and calcineurin inhibitors may affect CystC concentration). This study evaluated the performance of six formulas in pediatric kidney transplant recipients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The study used PCr-based formulas (bedside Schwartz, Schwartz-Lyon), CystC-based formulas (Hoek, Filler), and combined PCr-CystC-based formulas (CKD in Children [CKiD] 2012 and Zappitelli). The performance of these formulas was compared using inulin clearance as reference and assessed according to CKD stages in a historical cohort that included 73 pediatric kidney transplant recipients (199 measurements). The ability of the formulas to identify GFRs<60, <75, and <90 ml/min per 1.73 m(2) was assessed.
RESULTS
At measured GFR (mGFR) ≥90 ml/min per 1.73 m(2) (nine patients; 23 measurements), the Zappitelli formula had the highest 30% accuracy (P30) (95% [95% confidence interval (95% CI), 87% to 100%]) and the bedside Schwartz had the highest 10% accuracy (P10) (56% [95% CI, 32% to 72%]). At mGFR≥60 and <90 ml/min per 1.73 m(2) (22 patients; 91 measurements), all formulas had P30 values >80%. However, only the CKiD 2012 formula had a P10 value >50%. At mGFR<60 ml/min per 1.73 m(2) (42 patients; 85 measurements), the CKiD 2012 and Schwartz-Lyon formulas had the highest P10 (45% [95% CI, 34% to 55%] and 43% [95% CI, 33% to 54%]) and P30 (90% [95% CI, 84% to 97%] and 91% [95% CI, 86% to 98%]). All studied equations except Hoek and Filler had areas under the receiver-operating characteristic curves significantly >90% in discriminating patients with renal dysfunction at various CKD stages (GFR<60, <75, and <90 ml/min per 1.73 m(2)).
CONCLUSIONS
In pediatric kidney transplant recipients, the CKiD 2012 formula had the best performance at mGFRs<90 ml/min per 1.73 m(2). CystC-based formulas were not superior to PCr-based formulas.
背景与目的
了解肾功能对于小儿肾移植受者的管理至关重要。在这一人群中，最常用的基于血肌酐（PCr）或基于胱抑素C（CystC）的肾小球滤过率（GFR）预测公式可能表现不佳（例如，皮质类固醇和甲氧苄啶可能影响PCr浓度，而泼尼松和钙调神经磷酸酶抑制剂可能影响CystC浓度）。本研究评估了六种公式在小儿肾移植受者中的性能。
设计、地点、参与者和测量：本研究使用了基于PCr的公式（床边施瓦茨公式、施瓦茨-里昂公式）、基于CystC的公式（胡克公式、菲勒公式）以及基于PCr-CystC的联合公式（2012年儿童慢性肾脏病[CKiD]公式和扎皮泰利公式）。以菊粉清除率作为参考，比较这些公式的性能，并在一个包含73名小儿肾移植受者（199次测量）的历史队列中，根据慢性肾脏病（CKD）分期进行评估。评估这些公式识别GFR<60、<75和<90 ml/（min·1.73 m²）的能力。
结果
在测得的GFR（mGFR）≥90 ml/（min·1.73 m²）时（9名患者；23次测量），扎皮泰利公式的30%准确度（P30）最高（95%[95%置信区间（95%CI），87%至100%]），床边施瓦茨公式的10%准确度（P10）最高（56%[95%CI，32%至72%]）。在mGFR≥60且<90 ml/（min·1.73 m²）时（22名患者；91次测量），所有公式的P30值均>80%。然而，只有2012年CKiD公式的P10值>50%。在mGFR<60 ml/（min·1.73 m²）时（42名患者；85次测量），2012年CKiD公式和施瓦茨-里昂公式的P10（分别为45%[95%CI，34%至55%]和43%[95%CI，33%至54%]）和P30（分别为90%[95%CI，84%至97%]和91%[95%CI，86%至98%]）最高。除胡克公式和菲勒公式外，所有研究的方程在区分不同CKD分期（GFR<60、<75和<90 ml/（min·1.73 m²））的肾功能不全患者时，其受试者工作特征曲线下面积均显著>90%。
结论
在小儿肾移植受者中，2012年CKiD公式在mGFR<90 ml/（min·1.73 m²）时性能最佳。基于CystC的公式并不优于基于PCr的公式。
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