Tang Z, Tao J, Sun L, Han Z, Chen H, Huang Z, Zhou W, Zhao C, Fei S, Que H, Li Y, Tan R, Gu M
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Transplant Proc. 2018 Jan-Feb;50(1):85-91. doi: 10.1016/j.transproceed.2017.12.004.
Currently, there is no dedicated equation to estimate glomerular filtration rate (GFR) for transplanted kidneys. This study aimed to compare the performance of serum creatinine (Scr)- and cystatin C (CysC)-based equations in Chinese renal transplant recipients.
A total of 252 stable renal transplant recipients were enrolled in this study. The plasma clearance of Tc-DTPA (rGFR) was used as a reference standard. The Scr, CysC, and rGFR of the patients were measured on the same day. The bias, precision, accuracy (percentage of estimates within 10%, 30%, and 50% of rGFR), and agreements of 8 Scr and 5 CysC eGFR equations were assessed. The factors affecting the accuracy were also evaluated.
Among the Scr-based equations, the Japanese Society of Nephrology-Chronic Kidney Disease Initiatives (JSN-CKDI) equation had the best overall performance with a bias of -6.2 mL/min/1.73 m, and 96.1% of its estimates were within 30% of the rGFR. For the CysC-based equations, the Filler equation had the best performance with a bias of -3.9 mL/min/1.73 m, and 93.7% of its estimates were within 30% of the rGFR. Overall, the CysC-based equations showed better performance than the Scr-based equations. In addition, significant differences were observed between bias and gender and between bias and rGFR value in some equations, whereas transplantation time and immunosuppressive regimens were not correlated with the bias.
The JSN-CKDI equation provides the best estimation of the GFR equations, and the CysC-based equations performed better than the Scr-based equations in this population.
目前，尚无专门用于估算移植肾肾小球滤过率（GFR）的公式。本研究旨在比较基于血清肌酐（Scr）和胱抑素C（CysC）的公式在中国肾移植受者中的性能。
本研究共纳入252例稳定的肾移植受者。将Tc-DTPA的血浆清除率（rGFR）用作参考标准。在同一天测量患者的Scr、CysC和rGFR。评估了8个Scr和5个CysC估算肾小球滤过率（eGFR）公式的偏差、精密度、准确性（估算值在rGFR的10%、30%和50%范围内的百分比）以及一致性。还评估了影响准确性的因素。
在基于Scr的公式中，日本肾脏病学会-慢性肾脏病倡议（JSN-CKDI）公式的总体性能最佳，偏差为-6.2 mL/min/1.73 m²，其估算值的96.1%在rGFR的30%范围内。对于基于CysC的公式，Filler公式的性能最佳，偏差为-3.9 mL/min/1.73 m²，其估算值的93.7%在rGFR的30%范围内。总体而言，基于CysC的公式比基于Scr的公式表现更好。此外，在一些公式中，偏差与性别以及偏差与rGFR值之间存在显著差异，而移植时间和免疫抑制方案与偏差无关。
JSN-CKDI公式对GFR公式的估算最佳，在该人群中，基于CysC的公式比基于Scr的公式表现更好。
