Yamwong Sukit, Kitiyakara Chagriya, Vathesatogkit Prin, Saranburut Krittika, Chittamma Anchalee, Cheepudomwit Sayan, Vanavanan Somlak, Akrawichien Tawatchai, Sritara Piyamitr
Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Research Center, Mahidol University, Bangkok, Thailand.
Nephrology (Carlton). 2016 Aug;21(8):678-86. doi: 10.1111/nep.12660.
There are limited data on the risks of chronic kidney disease (CKD) in Southeast Asian populations. Several GFR estimating equations have been developed in diverse Asian populations, but they produce markedly discrepant results. We investigated the impact of Asian equations on the mortality risk of CKD in a Thai cohort during long term follow-up, and explored the differences between equations grouped according to the reference GFR methods used to develop them.
Employees of the Electricity Generating Authority of Thailand (n = 3430) were enrolled in a health survey and followed up for 22 years. The risks for all-cause mortality for each GFR stage classified by CKD-EPI or different Asian equations were assessed by using Cox proportional hazard models.
Equations derived from DTPA clearance (Chinese MDRD, Thai GFR, Singapore CKD-EPI) produced higher GFR, whereas equations from inulin clearance (Japanese CKD-EPI, Taiwan MDRD or Taiwan CKD-EPI) produced lower GFR compared to CKD-EPI. (Average ΔGFR: inulin, -14.9 vs. DTPA +5.80 mL/min per 1.73 m(2) , P < 0.001). CKD prevalence varied widely (0.7 to 24 %) with inulin-based equations being higher than DTPA-based. GFR stage concordance was over 80% for equations using similar reference method compared to less than 40% between inulin and DTPA-based equations. Low GFR (<45) was an independent mortality risk factor when DTPA-based equations were used, but not when inulin-based equations were used.
Chronic kidney disease prevalence and prognosis in Thais varied widely depending on the equation used. Differences in the reference GFR methods could be an important cause for the discrepancies between Asian equations.
关于东南亚人群慢性肾脏病（CKD）风险的数据有限。已在不同亚洲人群中开发了几种估算肾小球滤过率（GFR）的方程，但它们产生的结果差异显著。我们调查了亚洲方程对泰国队列中CKD长期随访期间死亡风险的影响，并探讨了根据用于开发方程的参考GFR方法分组的方程之间的差异。
泰国发电管理局的员工（n = 3430）参加了一项健康调查，并随访了22年。使用Cox比例风险模型评估由CKD-EPI或不同亚洲方程分类的每个GFR阶段的全因死亡风险。
与CKD-EPI相比，由二乙三胺五乙酸（DTPA）清除率得出的方程（中国肾脏病饮食改良试验方程、泰国GFR、新加坡CKD-EPI）产生的GFR较高，而由菊粉清除率得出的方程（日本CKD-EPI、台湾肾脏病饮食改良试验方程或台湾CKD-EPI）产生的GFR较低。（平均GFR差值：菊粉清除率方程为-14.9，而DTPA清除率方程为+5.80 mL/min per 1.73 m(2)，P < 0.001）。基于菊粉清除率的方程得出的CKD患病率差异很大（0.7%至24%），高于基于DTPA清除率的方程。使用相似参考方法的方程之间GFR阶段一致性超过80%，而基于菊粉清除率和基于DTPA清除率的方程之间则不到40%。当使用基于DTPA清除率的方程时，低GFR（<45）是独立的死亡风险因素，但使用基于菊粉清除率的方程时则不是。
泰国人CKD的患病率和预后因所使用的方程而异。参考GFR方法的差异可能是亚洲方程之间差异的重要原因。
