Friberg Leif, Gasparini Alessandro, Carrero Juan Jesus
Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Sweden.
University of Leicester, Department of Health Sciences, Leicester, UK.
Clin Kidney J. 2018 Apr;11(2):254-258. doi: 10.1093/ckj/sfx085. Epub 2017 Aug 2.
Information about renal function is important for drug safety studies using administrative health databases. However, serum creatinine values are seldom available in these registries. Our aim was to develop and test a simple scheme for stratification of renal function without access to laboratory test results.
Our scheme uses registry data about diagnoses, contacts, dialysis and drug use. We validated the scheme in the Stockholm CREAtinine Measurements (SCREAM) project using information on approximately 1.1 million individuals residing in the Stockholm County who underwent calibrated creatinine testing during 2006-11, linked with data about health care contacts and filled drug prescriptions. Estimated glomerular filtration rate (eGFR) was calculated with the CKD-EPI formula and used as the gold standard for validation of the scheme.
When the scheme classified patients as having eGFR <30 mL/min/1.73 m, it was correct in 93.5% of cases. The specificity of the scheme was close to 100% in all age groups. The sensitivity was poor, ranging from 68.2% in the youngest age quartile, down to 10.7% in the oldest age quartile. Age-related decline in renal function makes a large proportion of elderly patients fall into the chronic kidney disease (CKD) range without receiving CKD diagnoses, as this often is seen as part of normal ageing.
In the absence of renal function tests, our scheme may be of value for identifying patients with moderate and severe CKD on the basis of diagnostic and prescription data for use in studies of large healthcare databases.
对于利用行政健康数据库进行的药物安全性研究而言，肾功能信息至关重要。然而，这些登记处很少能获取血清肌酐值。我们的目的是开发并测试一种无需实验室检测结果即可对肾功能进行分层的简单方案。
我们的方案利用了有关诊断、就诊、透析和用药的登记数据。我们在斯德哥尔摩肌酐测量（SCREAM）项目中对该方案进行了验证，该项目使用了约110万居住在斯德哥尔摩县的个人信息，这些人在2006 - 2011年期间接受了校准肌酐检测，并与医疗保健就诊数据和填写的药物处方相关联。采用CKD - EPI公式计算估计肾小球滤过率（eGFR），并将其用作该方案验证的金标准。
当该方案将患者分类为eGFR <30 mL/min/1.73 m²时，在93.5%的病例中是正确的。该方案在所有年龄组中的特异性接近100%。敏感性较差，从最年轻年龄四分位数组的68.2%到最年长年龄四分位数组的10.7%不等。与年龄相关的肾功能下降使很大一部分老年患者虽进入慢性肾脏病（CKD）范围但未得到CKD诊断，因为这通常被视为正常衰老的一部分。
在缺乏肾功能检测的情况下，我们的方案可能有助于基于诊断和处方数据识别中重度CKD患者，以供大型医疗保健数据库研究使用。
