Legrand Helen, Werner Karin, Christensson Anders, Pihlsgård Mats, Elmståhl Sölve
Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 20502, Malmö, Sweden.
Department of Geriatrics, Skåne University Hospital, Malmö, Sweden.
BMC Nephrol. 2017 Dec 4;18(1):350. doi: 10.1186/s12882-017-0759-3.
Differences in cystatin C and creatinine-based estimated glomerular filtration rate (eGFR) can lead to clinical uncertainty. Existing eGFR equations perform poorly in a subset of individuals. This study aims to describe the prevalence of differences between cystatin C-based (eGFR) and creatinine-based (eGFR) eGFR in older adults and to explore which subsets of individuals may be most affected by differing estimations.
In this cross-sectional study, participants from a cohort of community-dwelling older adults were examined at a baseline visit in 2001-2004 as part of the larger "Good Aging in Skåne" study. Exposure variables were obtained from questionnaires, interviews, examinations, and medical records. Blood samples were taken during the baseline visit, cryopreserved, and analyzed at a later time for biomarkers. The CKD-EPI equations were used to estimate GFR. Initial descriptive analyses were performed on 2931 individuals. A total of 2532 participants were included in the final multiple linear regression.
Nearly two-thirds of participants had eGFR differences exceeding 10%, with nearly 20 % of participants having eGFR differences exceeding 30%. Smoking, age, body mass index (BMI), C-reactive protein (CRP), glucocorticoid use, and mean eGFR were correlated with differences between eGFR and eGFR.
Differences between eGFR and eGFR are common and often of large magnitude in this community-dwelling population of older adults. The finding of multiple non-GFR determinants correlated to differences in GFR estimations can help direct future research to improve eGFR equations for subgroups prone to conflicting GFR estimations or to guide choice of biomarker for GFR estimation in these subgroups.
基于胱抑素C和肌酐的估计肾小球滤过率（eGFR）的差异可能导致临床不确定性。现有的eGFR方程在一部分个体中表现不佳。本研究旨在描述老年人中基于胱抑素C的eGFR和基于肌酐的eGFR之间差异的发生率，并探讨哪些个体亚组可能受不同估计值的影响最大。
在这项横断面研究中，作为规模更大的“斯科讷地区健康老龄化”研究的一部分，对一组社区居住的老年人队列中的参与者在2001年至2004年的基线访视时进行了检查。暴露变量通过问卷、访谈、检查和医疗记录获得。在基线访视期间采集血样，冷冻保存，随后进行生物标志物分析。使用CKD-EPI方程估计肾小球滤过率（GFR）。对2931名个体进行了初步描述性分析。最终的多元线性回归纳入了2532名参与者。
近三分之二的参与者eGFR差异超过10%，近20%的参与者eGFR差异超过30%。吸烟、年龄、体重指数（BMI）、C反应蛋白（CRP）、糖皮质激素使用情况和平均eGFR与基于胱抑素C的eGFR和基于肌酐的eGFR之间的差异相关。
在这个社区居住的老年人群中，基于胱抑素C的eGFR和基于肌酐的eGFR之间的差异很常见，而且往往幅度较大。发现多个非肾小球滤过率决定因素与肾小球滤过率估计值的差异相关，有助于指导未来的研究，以改进易出现肾小球滤过率估计值冲突的亚组的eGFR方程，或指导这些亚组中肾小球滤过率估计生物标志物的选择。
