Tufts Medical Center, Boston, MA; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD.
Tufts Medical Center, Boston, MA; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD.
Adv Chronic Kidney Dis. 2018 Jan;25(1):67-75. doi: 10.1053/j.ackd.2017.10.004.
The recent Kidney Disease Improving Global Outcomes 2012 CKD guidelines recommend estimating GFR from serum creatinine (eGFR) as a first-line test to assess kidney function and using cystatin C or measured glomerular filtration rate (GFR) as confirmatory tests. eGFR may be inaccurate in people with variation in muscle mass or diet, and eGFR is not more accurate than eGFR eGFR is more accurate than either, but it is not independent of eGFR. Measured GFR is not practical and is susceptible to error due to variation in clearance methods and in the behavior of exogenous filtration markers. Over the past few years, we have hypothesized, and begun to test the hypothesis, that a panel of filtration markers (panel eGFR) from a single blood draw would require fewer demographic or clinical variables and could estimate GFR as accurately as measured GFR. In this article, we describe the conceptual background and rationale for this hypothesis and summarize our work thus far including evaluation of novel low-molecular-weight proteins and metabolites and then outline how we envision that such a panel could be used in clinical practice, research, and public health.
最近的肾脏病改善全球结果 2012 年慢性肾脏病指南建议使用血清肌酐（eGFR）估算肾小球滤过率（GFR）作为评估肾功能的一线检测方法，并使用胱抑素 C 或测量的肾小球滤过率（GFR）作为确认性检测。eGFR 在肌肉量或饮食变化的人群中可能不准确，并且 eGFR 并不比 eGFR 更准确，eGFR 比 eGFR 更准确，但它不独立于 eGFR。测量的 GFR 不切实际，并且由于清除方法的变化和外源性滤过标志物的行为，容易产生误差。在过去几年中，我们假设并开始检验这一假设，即来自单次血液采集的一组滤过标志物（面板 eGFR）所需的人口统计学或临床变量更少，并可以像测量的 GFR 一样准确地估计 GFR。在本文中，我们描述了这一假设的概念背景和基本原理，并总结了我们迄今为止的工作，包括对新型低分子量蛋白和代谢物的评估，然后概述了我们设想如何在临床实践、研究和公共卫生中使用这样的面板。
