Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
J Hepatol. 2019 May;70(5):847-854. doi: 10.1016/j.jhep.2018.12.030. Epub 2019 Jan 8.
BACKGROUND & AIMS: Accurate evaluation of renal function in patients with liver cirrhosis is critical for clinical management. However, there are still discrepancies between the measured glomerular filtration rate (mGFR) and creatinine-based estimated GFR (eGFR). In this study, we compared the performance of 2 common eGFR measurements with mGFR and evaluated the impact of low muscle mass on overestimation of renal function in patients with cirrhosis.
This study included 779 consecutive cirrhotic patients who underwent Cr-ethylenediamine tetra acetic acid (EDTA) (as a mGFR) and abdominal computed tomography (CT). The eGFR was calculated using creatinine or cystatin C. Muscle mass was assessed in terms of the total skeletal muscle at L3 level using CT.
Modification of diet in renal disease (MDRD)-eGFR was overestimated in 47% of patients. A multivariate analysis showed that female sex (adjusted odds ratio [aOR] 4.91), Child B and C vs. A (aOR 1.69 and 1.84) and skeletal muscle mass (aOR 0.89) were independent risk factors associated with overestimation. Interestingly, the effect of skeletal muscle mass on overestimation varied based on sex. Decreased muscle mass significantly enhanced the risk of overestimation of MDRD-eGFR in male patients, but not in female patients. Cystatin C-based eGFR showed a better correlation with mGFR than MDRD-eGFR; it was also better at predicting overall survival and the incidence of acute kidney injury than MDRD-eGFR.
The risk factors associated with overestimation included female sex, impaired liver function, and decreased muscle mass in males. In particular, eGFR in male patients with sarcopenia should be carefully interpreted. Creatinine-based eGFR was overestimated more often than cystatin C-based eGFR, with overestimation of eGFR closely related to poor prognostic performance.
Overestimation of renal function frequently occurs in patients with liver cirrhosis when using serum creatinine. Decreased muscle mass has a great impact on overestimation of kidney function especially in male patients with cirrhosis. Compared with creatinine, cystatin C was more closely correlated with measured glomerular filtration rate and had a higher predictive ability for renal complications and survival than creatinine.
准确评估肝硬化患者的肾功能对于临床管理至关重要。然而，肾小球滤过率（mGFR）的测量值与基于肌酐的估算肾小球滤过率（eGFR）之间仍然存在差异。本研究比较了两种常用的 eGFR 测量方法与 mGFR 的性能，并评估了肌肉量减少对肝硬化患者肾功能高估的影响。
本研究纳入了 779 例连续肝硬化患者，这些患者接受了 Cr-乙二胺四乙酸（EDTA）（作为 mGFR）和腹部 CT 检查。eGFR 通过肌酐或胱抑素 C 计算得出。使用 CT 评估第 3 腰椎水平的总骨骼肌来评估肌肉量。
改良肾脏病饮食研究（MDRD）-eGFR 在 47%的患者中被高估。多变量分析显示，女性（调整后的优势比[OR]4.91）、Child B 和 C 与 A（调整后的 OR 分别为 1.69 和 1.84）和骨骼肌量（调整后的 OR 0.89）是与高估相关的独立危险因素。有趣的是，骨骼肌量对高估的影响因性别而异。在男性患者中，肌肉量减少显著增加了 MDRD-eGFR 高估的风险，但在女性患者中则没有。基于胱抑素 C 的 eGFR 与 mGFR 的相关性优于 MDRD-eGFR；它在预测总生存和急性肾损伤的发生率方面也优于 MDRD-eGFR。
与高估相关的危险因素包括女性、肝功能受损和男性肌肉量减少。特别是，应仔细解释男性肝硬化伴肌少症患者的 eGFR。基于肌酐的 eGFR 比基于胱抑素 C 的 eGFR 更常被高估，而 eGFR 的高估与不良预后表现密切相关。
肝硬化患者使用血清肌酐时，肾功能常被高估。肌肉量减少对肝硬化患者肾功能高估的影响很大，尤其是对肝硬化男性患者。与肌酐相比，胱抑素 C 与测量的肾小球滤过率更密切相关，并且对肾脏并发症和生存的预测能力高于肌酐。
