Moodley Nareshni, Hariparshad Sudesh, Peer Fozy, Gounden Verena
Department of Chemical Pathology, Inkosi Albert Luthuli Central Hospital, National Health Laboratory Services and University of Kwa-Zulu Natal, South Africa.
Department of Nephrology, Nelson R Mandela Medical School of Medicine, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, South Africa.
Clin Biochem. 2018 Sep;59:43-49. doi: 10.1016/j.clinbiochem.2018.06.014. Epub 2018 Jun 22.
The estimation of glomerular filtration rate (GFR) plays a vital role in assessment of the renal function. This study evaluated the performance of the CKD-EPI and MDRD equations in the South African Kwa-Zulu Natal population.
The objectives if the study were to compare the of CKD-EPI and MDRD equations in the selected population to the measured GFR using Sodium Technetium-99 m-diethylene-triamine-pentaacetate clearance derived GFR.
Records of adult patients with measured GFR performed at the Nuclear Medicine Department at Inkosi Albert Luthuli Central Hospital, Durban, South Africa from 1 April 2014 to 31 March 2016 were reviewed. eGFR for all included patients was calculated using the MDRD equation without African American correction factor and the CKD-EPI equation with and without the African American correction factor for the Black African patients. Statistical comparison of the eGFR with measured GFR was performed with Bland Altman bias plots, Wilcoxon match pairs signed ranks test and accuracy within 10% and 30%.ROC curve analysis assessed the sensitivity and specificity at eGFR <90 and < 60 ml/min/1.73m.
After exclusion, 287 patients were included for analysis with sufficient numbers for only the Black African and Indian patients. None of the equations showed accuracy of eGFR within 30% of measured GFR for 90% of patients. In the Black African population, the CKD-EPI equation without the correction factor performed best. 17% and 14.4% of the Black African participants would be reclassified with the CKD-EPI equation without and with the African American correction factor respectively compared to mGFR at a cut-off of 60 mls/min/1.73m.
None of the evaluated equations attained the 2002 KDOQI benchmark of P >90%. 11.1-17% of individuals would have been incorrectly classified using the CKD-EPI equation.
肾小球滤过率（GFR）的估算在肾功能评估中起着至关重要的作用。本研究评估了慢性肾脏病流行病学协作组（CKD-EPI）方程和肾脏病饮食改良（MDRD）方程在南非夸祖鲁-纳塔尔人群中的表现。
本研究的目的是在选定人群中，将CKD-EPI方程和MDRD方程与使用锝-99m-二乙三胺五乙酸清除率得出的实测GFR进行比较。
回顾了2014年4月1日至2016年3月31日在南非德班因科西·阿尔伯特·卢图利中央医院核医学科进行实测GFR的成年患者记录。对于所有纳入患者，使用未校正非裔美国人校正因子的MDRD方程以及针对黑人非洲患者使用和未使用非裔美国人校正因子的CKD-EPI方程计算估算肾小球滤过率（eGFR）。使用布兰德-奥特曼偏差图、威尔科克森配对符号秩检验以及10%和30%范围内的准确性对eGFR与实测GFR进行统计学比较。ROC曲线分析评估了eGFR<90和<60 ml/min/1.73m时的敏感性和特异性。
排除后，纳入287例患者进行分析，其中只有黑人非洲人和印度患者数量充足。对于90%的患者，没有一个方程显示eGFR在实测GFR的30%以内的准确性。在黑人非洲人群中，未校正因子的CKD-EPI方程表现最佳。与实测肾小球滤过率（mGFR）相比，在截断值为60 mls/min/1.73m时，分别有17%和14.4%的黑人非洲参与者使用未校正和校正了非裔美国人校正因子的CKD-EPI方程会被重新分类。
没有一个评估方程达到2002年美国肾脏病基金会肾脏病预后质量倡议（KDOQI）设定的P>90%的基准。使用CKD-EPI方程会有11.1%-17%的个体被错误分类。
