Zheng Ke, Gong Mengchun, Qin Yan, Song Hongmei, Shi Ximin, Wu Yuan, Li Fang, Li Xuemei
Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
PLoS One. 2017 Jul 6;12(7):e0180565. doi: 10.1371/journal.pone.0180565. eCollection 2017.
Glomerular filtration rate (GFR) is essential for renal function evaluation and classification of chronic kidney disease (CKD), while the reference method in children are cumbersome. In the Chinese children, there was no data about GFR measured through plasma or renal clearance of the exogenous markers, and therefore no validated GFR-estimating tools in this population.
We measured GFR with double-sample plasma clearance of 99mTc-DTPA (mGFR) in 87 hospitalized children with renal injury. Using mGFR as the golden standard, we evaluate the efficiency of four different GFR estimation equations (the original and update Schwartz equation, the Filler equation, the CKiD equation) by statistical parameters of correlation, precision and accuracy.
In our population, mGFR was 97.0± 31.9 mL/min/1.73m2. The updated Schwartz equation, the Filler equation and the CKiD equation, produced eGFR with strong correlation with mGFR, strong explanation capacity of variance in mGFR, small bias, satisfactory performance in Bland-Altman analysis, high intra-class correlation coefficients, high ratio of eGFR within mGFR±10% and eGFR within mGFR±30%, good agreement in CKD staging between eGFR and mGFR. The original Schwartz equation produced eGFR with large bias, poor precision and accuracy.
The validated equations to estimate GFR in our patients are the updated Schwartz equation, which is simple for bedside use, the Filler equation and the CKiD equation, which provide more accurate eGFR. The original Schwartz equation should not be applied to estimate GFR in Chinese children with kidney injuries.
肾小球滤过率（GFR）对于肾功能评估及慢性肾脏病（CKD）的分类至关重要，而儿童的参考方法较为繁琐。在中国儿童中，尚无通过外源性标志物的血浆或肾脏清除率测定GFR的数据，因此该人群中也没有经过验证的GFR估算工具。
我们对87例住院的肾损伤儿童采用99mTc-DTPA双样本血浆清除率测定GFR（mGFR）。以mGFR作为金标准，通过相关性、精密度和准确性的统计参数评估四种不同的GFR估算方程（原始及更新的Schwartz方程、Filler方程、CKiD方程）的效能。
在我们的研究人群中，mGFR为97.0±31.9 mL/min/1.73m²。更新的Schwartz方程、Filler方程和CKiD方程得出的估算肾小球滤过率（eGFR）与mGFR具有强相关性，对mGFR的方差具有较强的解释能力，偏差小，在Bland-Altman分析中表现令人满意，组内相关系数高，eGFR在mGFR±10%范围内及eGFR在mGFR±30%范围内的比例高，eGFR与mGFR在CKD分期方面一致性良好。原始的Schwartz方程得出的eGFR偏差大，精密度和准确性差。
在我们的患者中，经过验证的估算GFR的方程为更新的Schwartz方程（便于床边使用）、Filler方程和CKiD方程（能提供更准确的eGFR）。原始的Schwartz方程不适用于估算中国肾损伤儿童的GFR。
