肌氨酸酐与胱抑素 C：接受抗凝剂治疗的住院退伍军人的肾功能估计值不同。
Creatinine Versus Cystatin C: Differing Estimates of Renal Function in Hospitalized Veterans Receiving Anticoagulants.
机构信息
San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
出版信息
J Gen Intern Med. 2018 Aug;33(8):1299-1306. doi: 10.1007/s11606-018-4461-3. Epub 2018 May 31.
BACKGROUND
Current practice in anticoagulation dosing relies on kidney function estimated by serum creatinine using the Cockcroft-Gault equation. However, creatinine can be unreliable in patients with low or high muscle mass. Cystatin C provides an alternative estimation of glomerular filtration rate (eGFR) that is independent of muscle.
OBJECTIVE
We compared cystatin C-based eGFR (eGFR) with multiple creatinine-based estimates of kidney function in hospitalized patients receiving anticoagulants, to assess for discordant results that could impact medication dosing.
DESIGN
Retrospective chart review of hospitalized patients over 1 year who received non-vitamin K antagonist anticoagulation, and who had same-day measurements of cystatin C and creatinine.
PARTICIPANTS
Seventy-five inpatient veterans (median age 68) at the San Francisco VA Medical Center (SFVAMC).
MAIN MEASURES
We compared the median difference between eGFR by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) study equation using cystatin C (eGFR) and eGFRs using three creatinine-based equations: CKD-EPI (eGFR), Modified Diet in Renal Disease (eGFR), and Cockcroft-Gault (eGFR). We categorized patients into standard KDIGO kidney stages and into drug-dosing categories based on each creatinine equation and calculated proportions of patients reclassified across these categories based on cystatin C.
KEY RESULTS
Cystatin C predicted overall lower eGFR compared to creatinine-based equations, with a median difference of - 7.1 (IQR - 17.2, 2.6) mL/min/1.73 m versus eGFR, - 21.2 (IQR - 43.7, - 8.1) mL/min/1.73 m versus eGFR, and - 25.9 (IQR - 46.8, - 8.7) mL/min/1.73 m versus eGFR. Thirty-one to 52% of patients were reclassified into lower drug-dosing categories using cystatin C compared to creatinine-based estimates.
CONCLUSIONS
We found substantial discordance in eGFR comparing cystatin C with creatinine in this group of anticoagulated inpatients. Our sample size was limited and included few women. Further investigation is needed to confirm these findings and evaluate implications for bleeding and other clinical outcomes.
NIH TRIAL REGISTRY NUMBER
Not applicable.
背景
目前，抗凝药物剂量的确定依赖于血清肌酐通过 Cockcroft-Gault 方程估算的肾功能。然而，对于肌肉量低或高的患者，肌酐可能并不可靠。胱抑素 C 提供了一种替代肾小球滤过率 (eGFR) 的估计方法，与肌肉无关。
目的
我们比较了接受抗凝治疗的住院患者中基于胱抑素 C 的 eGFR（eGFR）与多种基于肌酐的肾功能估计值，以评估可能影响药物剂量的不一致结果。
设计
对旧金山退伍军人事务医疗中心 (SFVAMC) 超过 1 年的接受非维生素 K 拮抗剂抗凝治疗的住院患者进行回顾性图表审查，这些患者在同一天进行了胱抑素 C 和肌酐的检测。
参与者
旧金山退伍军人事务医疗中心的 75 名住院退伍军人（中位年龄 68 岁）。
主要措施
我们比较了使用胱抑素 C（eGFR）的慢性肾脏病流行病学合作研究方程计算的 eGFR 与使用三种基于肌酐的方程计算的 eGFR 的中位数差异：慢性肾脏病流行病学合作研究方程（eGFR）、改良肾脏病饮食方程（eGFR）和 Cockcroft-Gault 方程（eGFR）。我们根据每个肌酐方程将患者分为标准 KDIGO 肾脏分期和药物剂量分类，并计算根据胱抑素 C 重新分类的患者在这些分类中的比例。
主要结果
与基于肌酐的方程相比，胱抑素 C 预测的整体 eGFR 较低，中位数差异为 -7.1（IQR -17.2，2.6）mL/min/1.73m 与 eGFR，-21.2（IQR -43.7，-8.1）mL/min/1.73m 与 eGFR，和 -25.9（IQR -46.8，-8.7）mL/min/1.73m 与 eGFR。与基于肌酐的估计相比，31%至 52%的患者被重新分类为较低的药物剂量类别。
结论
我们发现，在接受抗凝治疗的住院患者中，胱抑素 C 与肌酐相比，eGFR 存在很大差异。我们的样本量有限，且包括的女性较少。需要进一步研究以确认这些发现并评估其对出血和其他临床结果的影响。
NIH 临床试验注册号：不适用。
Zotero 插件