Guo Mei, Niu Jian-Ying, Ye Xian-Wu, Han Xiao-Jie, Zha Ying, Hong Yang, Fang Hong, Gu Yong
Zhongshan-Xuhui Hospital, Affiliated with Fudan University.
The Fifth People's Hospital of Shanghai, Fudan University.
Clin Interv Aging. 2017 Oct 9;12:1661-1672. doi: 10.2147/CIA.S140289. eCollection 2017.
The clinical assessment of kidney function based on the estimated glomerular filtration rate (GFR) in older patients remains controversial. This study evaluated the concordance and feasibility of using various creatinine-based equations for estimating GFR in elderly Chinese patients with type 2 diabetes mellitus (T2DM).
A cross-sectional analytical study was conducted in 21,723 older diabetic patients (≥60 years) based on electronic health records (EHR) for Minhang District, Shanghai, China. The concordance of chronic kidney disease (CKD) classification among different creatinine-based equations was assessed based on Kappa values, intraclass correlation coefficient (ICC) statistics, and the eGFR agreement between the equations was tested using Bland-Altman plots. The GFR was estimated using the Cockcroft-Gault (CG), Berlin Initiative Study 1 (BIS1), simplified Modification of Diet in Renal Disease (MDRD), MDRD modified for Chinese populations (mMDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), CKD-EPI in Asians (CKD-EPI-Asia), and Ruijin equations.
Overall, the proportion of CKD stages 3-5 (eGFR <60 mL/min/1.73 m) was calculated as 28.9%, 39.1%, 11.8%, 8.4%, 14.3%, 11.5%, and 12.7% by the eGFR, eGFR, eGFR, e, e, e, and e equations, respectively. The concordance of albuminuria and decreased eGFR based on the different equations was poor by both the Kappa (<0.2) and ICC (<0.4) statistics. The CKD-EPI-Asia equation resulted in excellent concordance with the CKD-EPI (ICC =0.931), MDRD (ICC =0.963), mMDRD (ICC =0.892), and Ruijin (ICC =0.956) equations for the classification of CKD stages, whereas the BIS1 equation exhibited good concordance with the CG equation (ICC =0.809). In addition, significant differences were observed for CKD stage 1 among all these equations.
Accurate GFR values are difficult to estimate using creatinine-based equations in older diabetic patients. Kidney function is complex, and the staff need to be aware of the individualized consideration of other risk factors or markers of reduced renal function in clinical practice.
基于估算肾小球滤过率（GFR）对老年患者的肾功能进行临床评估仍存在争议。本研究评估了多种基于肌酐的方程用于估算中国老年2型糖尿病（T2DM）患者GFR的一致性和可行性。
基于中国上海闵行区的电子健康记录（EHR），对21,723名老年糖尿病患者（≥60岁）进行了一项横断面分析研究。基于Kappa值、组内相关系数（ICC）统计评估不同基于肌酐的方程之间慢性肾脏病（CKD）分类的一致性，并使用Bland-Altman图检验方程之间的估算肾小球滤过率（eGFR）一致性。使用Cockcroft-Gault（CG）、柏林倡议研究1（BIS1）、简化版肾脏病饮食改良（MDRD）、针对中国人群改良的MDRD（mMDRD）、慢性肾脏病流行病学协作组（CKD-EPI）、亚洲人CKD-EPI（CKD-EPI-Asia）和瑞金方程估算GFR。
总体而言，根据eGFR、eGFR、eGFR、e、e、e和e方程计算，CKD 3 - 5期（eGFR <60 mL/min/1.73 m²）的比例分别为28.9%、39.1%、11.8%、8.4%、14.3%、11.5%和12.7%。基于Kappa（<0.2）和ICC（<0.4）统计，不同方程之间蛋白尿和eGFR降低的一致性较差。CKD-EPI-Asia方程在CKD分期分类方面与CKD-EPI（ICC =0.931）、MDRD（ICC =0.963）、mMDRD（ICC =0.892）和瑞金（ICC =0.956）方程具有极佳的一致性，而BIS1方程与CG方程表现出良好的一致性（ICC =0.809）。此外，所有这些方程在CKD 1期存在显著差异。
在老年糖尿病患者中，使用基于肌酐的方程难以准确估算GFR值。肾功能复杂，临床实践中工作人员需要意识到对其他肾功能降低的风险因素或标志物进行个体化考量。
