Sun Han, Pei Xiaohua, Wu Jianqing, Zhao Weihong
Division of Nephrology,Departmentof Geriatrics, The First Affiliated Hospital of Nanjing Medical University,300 Guangzhou Road, Nanjing, Jiangsu 210029, China.
Division of Respiratory, Departmentof Geriatrics, The First Affiliated Hospital of Nanjing Medical University,300 Guangzhou Road, Nanjing, Jiangsu 210029, China.
J Biomed Res. 2017 Nov 1;33(1):46-55. doi: 10.7555/JBR.32.20160172.
Renal dysfunction is a common side-effect of chemotherapeuticagents in patients with hematopathy. Although broadly used, glomerularfiltration rate (GFR) estimation equations were not fully validatedin this special population. Thus, this study was designed to furtherassess the accuracy of various GFR equations, including the newly2012 CKD-EPI equations. Referring to Tc-DTPA clearance method, three Scr-based (MDRD, Peking, and CKD-EPI), three Scys C-based (Steven 1, Steven 2, and CKD-EPI), and three Scr-Scys C combination based (Ma,Steven 3, and CKD-EPI) equationswere included. Bias, P, and misclassificationrate were applied to compare the applicability of the selected equations.A total of 180 Chinese hematological patients were enrolled. Meanbias, absolute mean bias, P misclassificationrate and Bland-Altman plots of the CKD-EPI equation were 7.90 mL/minute/1.73 m,17.77 mL/minute/1.73 m, 73.3%, 38% and79.7 mL/minute/1.73 m, respectively. CKD-EPI predicted the most precise eGFR both in lymphomaand leukemia subgroups. Additionally, CKD-EPI equation in rGFR ≧ 90 mL/minute/1.73 m subgroup and Steven 2 equation in rGFR<90 mL/minute/1.73 m subgroup provided relatively more accurate estimatesin each subgroup.The CKD-EPI equationcould be recommended to monitor kidney function in blood patients.The accuracy of GFR equations might be closely related with GFR leveland kidney function markers, but not the primary cause of hematopathy.
肾功能不全是血液病患者化疗药物常见的副作用。尽管肾小球滤过率(GFR)估算方程被广泛应用,但在这一特殊人群中尚未得到充分验证。因此,本研究旨在进一步评估各种GFR方程的准确性,包括最新的2012年慢性肾脏病流行病学合作(CKD-EPI)方程。参照Tc-DTPA清除率法,纳入了三个基于血清肌酐(Scr)的方程(MDRD、北京方程和CKD-EPI)、三个基于胱抑素C(Scys C)的方程(Steven 1、Steven 2和CKD-EPI)以及三个基于Scr-Scys C组合的方程(马氏方程、Steven 3和CKD-EPI)。采用偏倚、P值和错误分类率来比较所选方程的适用性。共纳入180例中国血液病患者。CKD-EPI方程的平均偏倚、平均绝对偏倚、P错误分类率和Bland-Altman图分别为7.90 ml/分钟/1.73 m²、17.77 ml/分钟/1.73 m²、73.3%、38%和79.7 ml/分钟/1.73 m²。CKD-EPI方程在淋巴瘤和白血病亚组中预测的估算肾小球滤过率(eGFR)最为精确。此外,rGFR≧90 ml/分钟/1.73 m²亚组中的CKD-EPI方程和rGFR<90 ml/分钟/1.73 m²亚组中的Steven 2方程在各亚组中提供了相对更准确的估算值。CKD-EPI方程可推荐用于监测血液病患者的肾功能。GFR方程的准确性可能与GFR水平和肾功能标志物密切相关,但与血液病的主要病因无关。