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比较新的和传统的 CKD-EPI GFR 估计方程与尿中菊粉清除率：方程性能研究。

Comparison of the new and traditional CKD-EPI GFR estimation equations with urinary inulin clearance: A study of equation performance.

机构信息

Division of Nephrology, Department of Medicine, Etherington Hall, Queen's University, 94 Stuart Street, Kingston, Ontario K7L 4N6, Canada.

Division of Nephrology, Department of Medicine, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 206, Ottawa, Ontario K1H 8L6, Canada; Kidney Research Centre, Ottawa Health Research Institute, 501 Smyth Road, Box 511, Ottawa, ON K1H 8L6, Canada.

出版信息

Clin Chim Acta. 2019 Jan;488:189-195. doi: 10.1016/j.cca.2018.11.019. Epub 2018 Nov 13.

DOI:10.1016/j.cca.2018.11.019

PMID:30445029

Abstract

BACKGROUND

Diagnosis, prognostication and treatment in chronic kidney disease is often informed by an estimate of the glomerular filtration rate (GFR). Commonly used GFR estimation (eGFR) equations are based on serum creatinine (Cr) concentrations and display suboptimal precision and accuracy. Newer equations incorporating additional endogenous markers such as β-Trace Protein (BTP), β-Microglobulin (B2M) and cystatin C (cysC) have been developed but require validation.

METHODS

This prospective cohort study evaluated the performance of 6 eGFR equations developed by the chronic kidney disease - epidemiology collaboration group (CKD-EPI) against urinary inulin clearance GFR in patients recruited from outpatient nephrology clinics.

RESULTS

Mean biases were negligible and similar between equations. The eGFR-EPI Cr/cysC had the best precision and accuracy of all the equations and the best agreement with inulin mGFR when classifying participants into GFR categories. The BTP and B2M equations displayed the worst precisions and accuracies and showed the least consistent performance across levels of GFR. Thus, the eGFR-EPI Cr/cysC is the least biased, most precise and has the highest accuracy as compared to other eGFR-EPI equations.

CONCLUSIONS

The BTP and B2M equations are the worst performing of the eGFR-EPI equations, and no benefit is observed with the addition of BTP or B2M to Cr/cysC.

摘要

背景

慢性肾脏病的诊断、预后和治疗通常依赖于肾小球滤过率（GFR）的估计。常用的 GFR 估计（eGFR）方程基于血清肌酐（Cr）浓度，但显示出较差的精度和准确性。新的方程结合了其他内源性标志物，如β-微量蛋白（BTP）、β2-微球蛋白（B2M）和胱抑素 C（cysC），已经开发出来，但需要验证。

方法

本前瞻性队列研究评估了由慢性肾脏病-流行病学合作组（CKD-EPI）开发的 6 种 eGFR 方程在门诊肾脏病诊所招募的患者中与尿内标清除 GFR 的性能。

结果

平均偏差可以忽略不计，且各方程之间相似。在所有方程中，eGFR-EPI Cr/cysC 具有最佳的精密度和准确性，并且在将参与者分类为 GFR 类别时与内标 mGFR 的一致性最佳。BTP 和 B2M 方程显示出最差的精密度和准确性，并且在 GFR 水平上表现出最不一致的性能。因此，与其他 eGFR-EPI 方程相比，eGFR-EPI Cr/cysC 的偏差最小、最精确、准确性最高。