根据血清肌酐和胱抑素C估算全年龄段的肾小球滤过率。
Estimating glomerular filtration rate for the full age spectrum from serum creatinine and cystatin C.
作者信息
Pottel Hans, Delanaye Pierre, Schaeffner Elke, Dubourg Laurence, Eriksen Bjørn Odvar, Melsom Toralf, Lamb Edmund J, Rule Andrew D, Turner Stephen T, Glassock Richard J, De Souza Vandréa, Selistre Luciano, Goffin Karolien, Pauwels Steven, Mariat Christophe, Flamant Martin, Ebert Natalie
机构信息
Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium.
Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium.
出版信息
Nephrol Dial Transplant. 2017 Mar 1;32(3):497-507. doi: 10.1093/ndt/gfw425.
BACKGROUND
We recently published and validated the new serum creatinine (Scr)-based full-age-spectrum equation (FAS crea ) for estimating the glomerular filtration rate (GFR) for healthy and kidney-diseased subjects of all ages. The equation was based on the concept of normalized Scr and shows equivalent to superior prediction performance to the currently recommended equations for children, adolescents, adults and older adults.
METHODS
Based on an evaluation of the serum cystatin C (ScysC) distribution, we defined normalization constants for ScysC ( Q cysC = 0.82 mg/L for ages <70 years and Q cysC = 0.95 mg/L for ages ≥70 years). By replacing Scr/ Q crea in the FAS crea equation with ScysC/ Q cysC , or with the average of both normalized biomarkers, we obtained new ScysC-based (FAS cysC ) and combined Scr-/ScysC-based FAS equations (FAS combi ). To validate the new FAS cysC and FAS combi we collected data on measured GFR, Scr, ScysC, age, gender, height and weight from 11 different cohorts including n = 6132 unique white subjects (368 children, aged ≤18 years, 4295 adults and 1469 older adults, aged ≥70 years).
RESULTS
In children and adolescents, the new FAS cysC equation showed significantly better performance [percentage of patients within 30% of mGFR (P30) = 86.1%] than the Caucasian Asian Paediatric Adult Cohort equation (P30 = 76.6%; P < 0.0001), or the ScysC-based Schwartz equation (P30 = 68.8%; P < 0.0001) and the FAS combi equation outperformed all equations with P30 = 92.1% (P < 0.0001). In adults, the FAS cysC equation (P30 = 82.6%) performed equally as well as the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI cysC ) (P30 = 80.4%) and the FAS combi equation (P30 = 89.9%) was also equal to the combined CKD-EPI equation (P30 = 88.2%). In older adults, FAS cysC was superior (P30 = 88.2%) to CKD-EPI cysC (P30 = 84.4%; P < 0.0001) and the FAS combi equation (P30 = 91.2%) showed significantly higher performance than the combined CKD-EPI equation (P30 = 85.6%) (P < 0.0001).
CONCLUSION
The FAS equation is not only applicable to all ages, but also for all recommended renal biomarkers and their combinations.
背景
我们最近发表并验证了一种基于血清肌酐（Scr）的全新全年龄谱方程（FAS crea），用于估算各年龄段健康和患肾病受试者的肾小球滤过率（GFR）。该方程基于标准化Scr的概念，在儿童、青少年、成年人和老年人中，其预测性能等同于或优于目前推荐的方程。
方法
基于对血清胱抑素C（ScysC）分布的评估，我们定义了ScysC的标准化常数（年龄<70岁时，Q cysC = 0.82 mg/L；年龄≥70岁时，Q cysC = 0.95 mg/L）。通过将FAS crea方程中的Scr/Q crea替换为ScysC/Q cysC，或替换为两种标准化生物标志物的平均值，我们获得了新的基于ScysC的（FAS cysC）和基于Scr/ScysC的联合FAS方程（FAS combi）。为验证新的FAS cysC和FAS combi，我们从11个不同队列收集了测量的GFR、Scr、ScysC、年龄、性别、身高和体重数据，其中包括n = 6132名独特的白人受试者（368名儿童，年龄≤18岁，4295名成年人和1469名老年人，年龄≥70岁）。
结果
在儿童和青少年中，新的FAS cysC方程表现明显更好[估算肾小球滤过率（mGFR）的30%范围内的患者百分比（P30）= 86.1%]，优于白种人亚洲儿科成人队列方程（P30 = 76.6%；P < 0.0001），或基于ScysC的施瓦茨方程（P30 = 68.8%；P < 0.0001），且FAS combi方程表现最佳，P30 = 92.1%（P < 0.0001）。在成年人中，FAS cysC方程（P30 = 82.6%）的表现与慢性肾脏病流行病学协作组方程（CKD-EPI cysC）（P30 = 80.4%）相当，FAS combi方程（P30 = 89.9%）也与联合CKD-EPI方程（P30 = 88.2%）相当。在老年人中，FAS cysC优于CKD-EPI cysC（P30 = 84.4%；P < 0.0001），FAS combi方程（P30 = 91.2%）的表现显著高于联合CKD-EPI方程（P30 = 85.6%）（P < 0.0001）。
结论
FAS方程不仅适用于所有年龄段，也适用于所有推荐的肾脏生物标志物及其组合。
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