Helldén Anders, Bergman Ulf, Odar-Cederlöf Ingegerd
Clin Nephrol. 2019 Apr;91(4):254-264. doi: 10.5414/CN109536.
To compare renal function by several GFR formulas (particularly cystatin C eGFR-"CAPA") in relation to renal risk drugs (RRDs) in patients admitted to two geriatric wards in a university geriatric department.
This was a prospective quality improvement study including 108 patients, 2/3 women, age ≥ 75 years, admitted with multimorbidity. Renal function tests were performed with Cockcroft & Gault with uncalibrated (C&Guc) and calibrated creatinine (C&Gcc), and 3 - 4 points' iohexol clearance (mGFR) in mL/min, and eGFR with MDRD4, CKD-EPI, CAPA, and BIS2 clearance in mL/min/1.73m. Agreement was tested by Bland & Altman analysis. The number and type of RRDs were analyzed.
Measured GFR, C&Gcc, and C&Guc were mean 37, 39, and 32 mL/min, respectively. Estimated GFR by MDRD4, CKD-EPI, CAPA, and BIS2 were mean 56, 52, 45, and 40 mL/min/1.73m, respectively. Compared to mGFR, women had significantly higher clearance for all estimates except for C&Gcc and C&Guc. C&Gcc, C&Guc, and BIS2 showed the lowest bias. 38 RRDs were identified. 96 patients used a mean of 2.3 RRDs per patient, and 1.7 RRDs needed dose adjustments. Cardiovascular drugs and analgesics were the most frequent RRDs.
The C&Gcc, C&Guc, and BIS2 equations gave the best estimate of kidney function in relation to mGFR for drug dosing in the elderly. The eGFR methods showed significantly higher clearance than mGFR, C&Gcc, C&Guc, and BIS2. RRDs that needed dose adjustment were common in this geriatric population. If the eGFR formulas (MDRD4, CKD-EPI, and CAPA) are used instead of C&Gcc, C&Guc, and BIS2, higher and potentially more risky doses of RRDs may be administered to geriatric patients over 75 years, women in particular.
比较几种肾小球滤过率（GFR）公式（特别是胱抑素C估算肾小球滤过率——“CAPA”）评估老年科两个老年病房收治患者的肾功能与肾风险药物（RRD）的关系。
这是一项前瞻性质量改进研究，纳入108例患者，其中2/3为女性，年龄≥75岁，患有多种疾病。采用未校正的Cockcroft & Gault公式（C&Guc）和校正肌酐的Cockcroft & Gault公式（C&Gcc）进行肾功能检测，以碘海醇清除率（mGFR）（单位：mL/min）及MDRD4、CKD - EPI、CAPA和BIS2估算肾小球滤过率（单位：mL/min/1.73m²）进行检测。采用Bland & Altman分析检验一致性。分析RRD的数量和类型。
实测GFR、C&Gcc和C&Guc的均值分别为37 mL/min、39 mL/min和32 mL/min。MDRD4、CKD - EPI、CAPA和BIS2估算的肾小球滤过率均值分别为56 mL/min/1.73m²、52 mL/min/1.73m²、45 mL/min/1.73m²和40 mL/min/1.73m²。与mGFR相比，除C&Gcc和C&Guc外，所有估算方法在女性中的清除率均显著更高。C&Gcc、C&Guc和BIS2的偏差最小。共识别出38种RRD。96例患者平均每人使用2.3种RRD，其中1.7种RRD需要调整剂量。心血管药物和镇痛药是最常见的RRD。
对于老年人用药剂量的估算，C&Gcc、C&Guc和BIS2公式对肾功能的估算与mGFR最为接近。估算肾小球滤过率（eGFR）方法显示的清除率显著高于mGFR、C&Gcc、C&Guc和BIS2。在该老年人群中，需要调整剂量的RRD很常见。如果使用eGFR公式（MDRD4、CKD - EPI和CAPA）而非C&Gcc、C&Guc和BIS2，可能会给75岁以上的老年患者（尤其是女性）使用更高且潜在风险更大剂量的RRD。
