碘海醇血浆清除率在儿童中的应用：多种公式和单点采样时间的验证。
Iohexol plasma clearance in children: validation of multiple formulas and single-point sampling times.
机构信息
Department of Pediatrics, Haukeland University Hospital, 5021, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
出版信息
Pediatr Nephrol. 2018 Apr;33(4):683-696. doi: 10.1007/s00467-017-3841-y. Epub 2017 Nov 13.
BACKGROUND
The non-ionic agent iohexol is increasingly used as the marker of choice for glomerular filtration rate (GFR) measurement. Estimates of GFR in children have low accuracy and limiting the number of blood-draws in this patient population is especially relevant. We have performed a study to evaluate different formulas for calculating measured GFR based on plasma iohexol clearance with blood sampling at only one time point (GFR1p) and to determine the optimal sampling time point.
METHODS
Ninety-six children with chronic kidney disease (CKD) stage 1-5 (median age 9.2 years; range 3 months to 17.5 years) were examined in a cross-sectional study using iohexol clearance and blood sampling at seven time points within 5 h (GFR7p) as the reference method. Median GFR7p was 66 (range 6-153) mL/min/1.73 m. The performances of six different single time-point formulas (Fleming, Ham and Piepsz, Groth and Aasted, Stake, Jacobsson- and Jacobsson-modified) were validated against the reference. The two-point GFR (GFR2p) was calculated according to the Jødal and Brøchner-Mortensen formula.
RESULTS
The GFR1p calculated according to Fleming with sampling at 3 h (GFR1p-Fleming) had the best overall performance, with 82% of measures within 10% of the reference value (P10). In children with a GFR ≥ 30 mL/min/1.73 m (n = 78), the GFR1p-Fleming had a P10 of 92.3%, which is not significantly different (p = 0.29) from that of GFR2p (P10 = 96.2%). Considerable differences within and between the different formulas were found for different CKD stages and different time points for blood sampling.
CONCLUSIONS
For determination of mGFR in children with CKD and an assumed GFR of ≥ 30 mL/min/1.73 m we recommend GFR1p-Fleming as the preferred single-point method as an alternative to GFR2p. For children with a GFR < 30 mL/min/1.73 m, we recommend the slope-GFR with at least two blood samples.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov , Identifier NCT01092260, https://clinicaltrials.gov/ct2/show/NCT01092260?term=tondel&rank=2.
背景
非离子型造影剂碘海醇越来越多地被用作肾小球滤过率（GFR）测量的首选标志物。儿童 GFR 的估计准确性较低，特别是在该患者人群中限制采血次数尤为重要。我们进行了一项研究，以评估基于单次采血时血浆碘海醇清除率（GFR1p）计算的不同公式来估算 GFR 的准确性，并确定最佳采血时间点。
方法
96 例慢性肾脏病（CKD）1-5 期的儿童（中位年龄 9.2 岁；范围 3 个月至 17.5 岁）纳入本横断面研究，使用碘海醇清除率和 5 小时内 7 个时间点的采血（GFR7p）作为参考方法。中位 GFR7p 为 66（6-153）mL/min/1.73m。评估了 6 种不同的单点公式（Fleming、Ham 和 Piepsz、Groth 和 Aasted、Stake、Jacobsson 和 Jacobsson 改良公式）的性能，并与参考值进行了比较。两点 GFR（GFR2p）是根据 Jødal 和 Brøchner-Mortensen 公式计算的。
结果
在 3 小时采血时，根据 Fleming 公式计算的 GFR1p（GFR1p-Fleming）具有最佳的总体性能，82%的测量值在参考值的 10%以内（P10）。在 GFR≥30mL/min/1.73m 的儿童（n=78）中，GFR1p-Fleming 的 P10 为 92.3%，与 GFR2p（P10=96.2%）无显著差异（p=0.29）。对于不同 CKD 分期和不同采血时间点，不同公式之间和内部存在显著差异。
结论
对于 CKD 儿童 mGFR 的测定，如果假设 GFR≥30mL/min/1.73m，我们建议将 GFR1p-Fleming 作为 GFR2p 的替代方法，作为单点法的首选。对于 GFR＜30mL/min/1.73m 的儿童，我们建议至少采集两次血样进行斜率-GFR。
临床试验注册
ClinicalTrials.gov，标识符 NCT01092260，https://clinicaltrials.gov/ct2/show/NCT01092260?term=tondel&rank=2。
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