基于肌酐和胱抑素C的估算肾小球滤过率（eGFR）方程在中国老年慢性肾脏病患者中的评估
Assessment of creatinine and cystatin C-based eGFR equations in Chinese older adults with chronic kidney disease.
作者信息
Guan Changjie, Liang Ming, Liu Riguang, Qin Shuguang, He Feng, Li Jianwen, Zhu Xusheng, Dai Hui, Fu Junzhou
机构信息
Department of Nephrology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China.
Department of Nuclear Medicine, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China.
出版信息
Int Urol Nephrol. 2018 Dec;50(12):2229-2238. doi: 10.1007/s11255-018-1909-7. Epub 2018 Jun 13.
INTRODUCTION
Glomerular filtration rate (GFR) estimation equations using creatinine and Cystatin-C appear to be superior to those based on creatinine or Cystatin-C in older adults. We sought to compare the performances of those based on creatinine and Cystatin-C in Chinese older adults with chronic kidney disease (CKD).
METHODS
A total of 368 Chinese elderly with CKD underwent the dynamic imaging with technetium-m diethylene-triamine-pentaacetic acid (mTc-DTPA), and serum creatinine and Cystatin-C were measured on the same day. The comparison of GFR equations which were creatinine and Cystatin-C-based including chronic kidney disease epidemiology collaboration (CKD-EPI) equation (CKD-EPI-Cr-Cys), Berlin Initiative Study (BIS) equation (BIS-Cr-Cys, also known as BIS-2), MA equation (MA-Cr-Cys), and FENG equation (FENG-Cr-Cys) was conducted.
RESULTS
Four equations overestimated GFR except for BIS-2 equation in mGFR ≥ 60 ml/min/1.73 m (bias: - 1.40, p = 0.7) and CKD-EPI-Cr-Cys equation in mGFR < 30 ml/min/1.73 m (bias: - 1.82, p = 0.2) were unbiased. BIS-2 equation had the smallest interquartile range (IQR, ml/min/1.73 m) from 12.73 in age < 75 years group to 16.05 in age ≥ 75 years group. BIS-2 equation achieved highest values of 79.1% in overall participants, and 80.77% in age ≥ 75 years group, respectively, and CKD-EPI-Cr-Cys equation 82.26% in age < 75 years group. Lowest values of root-mean-square error (RMSE, ml/min/1.73 m) were seen in BIS-2 equation from 13.22 in age < 75 years group to 16.18 in age ≥ 75 years group. BIS-2 equation had the lowest misclassification rates of 41.76% in age ≥ 75 years group and 34.41% in age < 75 years group.
CONCLUSIONS
BIS-2 equation may be optimal for Chinese older adults with CKD especially in older adults ≥ 75 years and with mGFR ≥ 30 ml/min/1.73 m, while CKD-EPI-Cr-Cys equation could yield a better performance than BIS-2 equation, especially in those < 75 years and mGFR < 30 ml/min/1.73 m.
引言
在老年人中，使用肌酐和胱抑素C估算肾小球滤过率（GFR）的方程似乎优于基于肌酐或胱抑素C的方程。我们试图比较基于肌酐和胱抑素C的方程在中国老年慢性肾脏病（CKD）患者中的表现。
方法
共有368例中国老年CKD患者接受了锝-99m二乙三胺五乙酸（mTc-DTPA）动态显像，并于同日测定血清肌酐和胱抑素C。对基于肌酐和胱抑素C的GFR方程进行比较，包括慢性肾脏病流行病学协作组（CKD-EPI）方程（CKD-EPI-Cr-Cys）、柏林倡议研究（BIS）方程（BIS-Cr-Cys，也称为BIS-2）、MA方程（MA-Cr-Cys）和冯氏方程（FENG-Cr-Cys）。
结果
在mGFR≥60 ml/min/1.73 m时，除BIS-2方程外，其他四个方程均高估了GFR（偏差：-1.40，p = 0.7）；在mGFR<30 ml/min/1.73 m时，CKD-EPI-Cr-Cys方程无偏差（偏差：-1.82，p = 0.2）。BIS-2方程的四分位数间距（IQR，ml/min/1.73 m）最小，年龄<75岁组为12.73，年龄≥75岁组为16.05。BIS-2方程在所有参与者中的最高值分别为79.1%，在年龄≥75岁组中为80.77%，而CKD-EPI-Cr-Cys方程在年龄<75岁组中为82.26%。均方根误差（RMSE，ml/min/1.73 m）的最低值出现在BIS-2方程中，年龄<75岁组为13.22，年龄≥75岁组为
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