Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing 100853, China.
Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology of Zhengzhou University, Key laboratory of precision diagnosis and treatment for chronic kidney disease in Henan province, Zhengzhou, Henan 450052, China.
Chin Med J (Engl). 2019 Mar 5;132(5):512-518. doi: 10.1097/CM9.0000000000000079.
Accurate estimation of the glomerular filtration rate (GFR) and staging of chronic kidney disease (CKD) are important. Currently, there is no research on the differences in several estimated GFR equations for staging CKD in a large sample of centenarians. Thus, this study aimed to investigate the differences in CKD staging with the most commonly used equations and to analyze sources of discrepancy.
A total of 966 centenarians were enrolled in this study from June 2014 to December 2016 in Hainan province, China. The GFR with the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Berlin Initiative Study 1 (BIS1) equations were estimated. Agreement between these equations was investigated with the κ statistic and Bland-Altman plots. Sources of discrepancy were investigated by partial correlation analysis.
The κ values of the MDRD and CKD-EPI equations, MDRD and BIS1 equations, and CKD-EPI and BIS1 equations were 0.610, 0.253, and 0.381, respectively. Serum creatinine (Scr) explained 10.96%, 41.60% and 17.06% of the variability in these three comparisons, respectively. Serum uric acid (SUA) explained 3.65% and 5.43% of the variability in the first 2 comparisons, respectively. Gender was associated with significant differences in these 3 comparisons (P < 0.001).
The strengths of agreement between the MDRD and CKD-EPI equations were substantial, but those between the MDRD and BIS1 equations and the CKD-EPI and BIS1 equations were fair. The difference in CKD staging of the first 2 comparisons strongly depended on Scr, SUA and gender, and that of CKD-EPI and BIS1 equations strongly depended on Scr and gender. The incidence at various stages of CKD staging was quite different. Thus, a new equation that is more suitable for the elderly needs to be built in the future.
准确估计肾小球滤过率（GFR）和分期慢性肾脏病（CKD）非常重要。目前，对于使用几种最常用的 GFR 方程在一个大样本的百岁老人中分期 CKD 的差异，还没有相关研究。因此，本研究旨在探讨最常用的方程在分期 CKD 方面的差异，并分析差异的来源。
本研究共纳入 2014 年 6 月至 2016 年 12 月海南省的 966 名百岁老人。采用改良肾脏病饮食研究（MDRD）、慢性肾脏病流行病学合作研究（CKD-EPI）和柏林倡议研究 1（BIS1）方程估计 GFR。通过κ统计量和 Bland-Altman 图来评估这些方程之间的一致性。通过偏相关分析来探讨差异的来源。
MDRD 和 CKD-EPI 方程、MDRD 和 BIS1 方程、CKD-EPI 和 BIS1 方程的κ值分别为 0.610、0.253 和 0.381。血清肌酐（Scr）分别解释了这三种比较中 10.96%、41.60%和 17.06%的变异性。血清尿酸（SUA）分别解释了前两种比较中 3.65%和 5.43%的变异性。性别与这三种比较中的差异显著相关（P<0.001）。
MDRD 和 CKD-EPI 方程之间的一致性较强，但 MDRD 和 BIS1 方程以及 CKD-EPI 和 BIS1 方程之间的一致性较弱。前两种比较的 CKD 分期差异主要取决于 Scr、SUA 和性别，而 CKD-EPI 和 BIS1 方程的差异主要取决于 Scr 和性别。不同 CKD 分期的发生率差异较大。因此，未来需要建立一种更适合老年人的新方程。
