Åkerblom Axel, Helmersson-Karlqvist Johanna, Flodin Mats, Larsson Anders
Department of Medical Sciences, University Hospital, Uppsala University, Uppsala, Sweden ; Uppsala Clinical Research Center, Uppsala, Sweden ; Duke Clinical Research Institute, Durham, N.C., USA.
Department of Medical Sciences, University Hospital, Uppsala University, Uppsala, Sweden.
Cardiorenal Med. 2015 Oct;5(4):289-96. doi: 10.1159/000437273. Epub 2015 Aug 6.
Estimation of the glomerular filtration rate (GFR) is essential for identification, evaluation and risk prediction in patients with kidney disease. Estimated GFR (eGFR) is also needed for the correct dosing of drugs eliminated by the kidneys and to identify high-risk individuals in whom coronary angiography or other procedures may lead to kidney failure. Both cystatin C and creatinine are used for the determination of GFR, and we aimed to investigate if eGFR by the two methods differ in cardiology patients.
We compared cystatin C and creatinine (CKD-EPI) eGFR calculated from the same request from a cardiology outpatient unit (n = 2,716), a cardiology ward (n = 980), a coronary care unit (n = 1,464), and an advanced coronary care unit (n = 518) in an observational, cross-sectional study.
The median creatinine eGFR results are approximately 10 ml/min/1.73 m(2) higher than the median cystatin C eGFR that is up to 90 ml/min/1.73 m(2), irrespective of the level of care. Creatinine eGFR resulted in a less advanced eGFR category in the majority of patients with a cystatin C eGFR <60 ml/min/1.73 m(2).
Our study demonstrates a difference between creatinine and cystatin C eGFR in cardiology patients. It is important to be aware of which marker is used for the reported eGFR to minimize erroneous interpretations of the test results, as this could lead to under- or overmedication. Further studies are needed to determine the best method of estimating the GFR in cardiology units.
估算肾小球滤过率（GFR）对于肾病患者的识别、评估及风险预测至关重要。正确调整经肾脏排泄药物的剂量以及识别冠状动脉造影或其他检查可能导致肾衰竭的高危个体也需要估算GFR（eGFR）。胱抑素C和肌酐均可用于测定GFR，我们旨在研究这两种方法计算得出的eGFR在心脏病患者中是否存在差异。
在一项观察性横断面研究中，我们比较了来自心脏病门诊（n = 2716）、心脏病病房（n = 980）、冠心病监护病房（n = 1464）以及高级冠心病监护病房（n = 518）的相同申请单所计算出的胱抑素C和肌酐（CKD-EPI）eGFR。
无论护理级别如何，肌酐eGFR的中位数结果比胱抑素C eGFR的中位数大约高10 ml/min/1.73 m²，最高可达90 ml/min/1.73 m²。在大多数胱抑素C eGFR<60 ml/min/1.73 m²的患者中，肌酐eGFR得出的eGFR分级较低。
我们的研究表明，心脏病患者中肌酐和胱抑素C eGFR存在差异。了解报告的eGFR使用了哪种标志物很重要，以尽量减少对检测结果的错误解读，因为这可能导致用药不足或过量。需要进一步研究以确定心脏病科估算GFR的最佳方法。
