Keio University School of Medicine, Nephrology, Endocrinology and Metabolism.
Asahi Kasei Pharma Corporation.
Proc Jpn Acad Ser B Phys Biol Sci. 2017;93(9):746-754. doi: 10.2183/pjab.93.046.
It is difficult to distinguish the onset of renal function decline from the typical variation in estimated glomerular filtration rate (eGFR) measurements in clinical practice. In this study, we used data analysis incorporating smoothing techniques to identify significant trends despite large amounts of noise. We identified the starting points of meaningful eGFR decline based on eGFR trajectories. This was a retrospective observational study of 2533 type 2 diabetes patients. We calculated 1-year eGFR decline rates from the difference between each eGFR value and that of the previous year. We examined the prediction capacity of 1-year eGFR decline rate for renal prognosis. When we performed receiver operating characteristic analysis, the area under the curve of 1-year eGFR decline rate was 0.963 (95% confidence interval: 0.953-0.973). With a cut-off value of more than 7.5% eGFR decline during a 1-year period, the sensitivity was 98.8% and specificity was 82.3%. The predictive accuracy of 1-year eGFR decline rate for renal prognosis was high.
在临床实践中，很难区分肾功能下降的起始与估算肾小球滤过率（eGFR）测量的典型变化。在这项研究中，我们使用数据分析结合平滑技术来识别有意义的趋势，尽管存在大量的噪声。我们根据 eGFR 轨迹确定了有意义的 eGFR 下降的起点。这是一项对 2533 名 2 型糖尿病患者的回顾性观察研究。我们通过计算每个 eGFR 值与前一年的差值来计算 1 年 eGFR 下降率。我们检查了 1 年 eGFR 下降率对肾脏预后的预测能力。当我们进行接收者操作特征分析时，1 年 eGFR 下降率的曲线下面积为 0.963（95%置信区间：0.953-0.973）。当 1 年内 eGFR 下降超过 7.5%时，灵敏度为 98.8%，特异性为 82.3%。1 年 eGFR 下降率对肾脏预后的预测准确性较高。
