["慢性肾脏病流行病学协作组方程"与"肾脏病膳食改良方程"和"柏林倡议研究"在评估老年人肾功能方面的一致性]

[Concordance between the equations "Chronic Kidney Disease Epidemiological Collaboration" and "Modification of Diet in Renal Disease" with the "Berlin Initiative Study" to estimate renal function in the elderly].

作者信息

Escribano-Serrano J, Casto-Jarillo C, Berruguilla-Pérez E, González-Borrachero M, Santotoribio J D, Cañavate-Solano C, Calero-Ruiz M M, Michán-Doña A

机构信息

Unidad de Gestión Clínica (UGC) San Roque, Grupo de Diabetes SEMERGEN, San Roque, Cádiz, España; Grupo GERVA, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, España.

UGC Laboratorio, Hospital La Línea de la Concepción, Cádiz, España; Grupo GERVA, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, España.

出版信息

Semergen. 2019 Oct;45(7):441-448. doi: 10.1016/j.semerg.2019.02.012. Epub 2019 May 28.

DOI:10.1016/j.semerg.2019.02.012

PMID:31151863

Abstract

OBJECTIVE

Estimated glomerular filtration rate (eGFR) is calculated routinely using creatinine-based formulas, but their reliability in the elderly is limited. The aim of this study was to analyse the concordance between the BIS1 equation which is specific for the elderly, and the usual CKD-EPI and MDRD-IDMS in a large population over 70 years of age.

MATERIAL AND METHODS

Retrospective cross-sectional study in which the eGFR was calculated using BIS1, CKD-EPI and MDRD-IDMS equations based on gender, age, and creatinine data of 85,089 subjects (58.5% women, mean age 78 years [IQR 73-83]).The following statistics were carried out: Wilcoxon test, Bland-Altman graphic analysis, study of the concordance using the intraclass correlation coefficient (ICC), and comparison tables for the classification of CKD.

RESULTS

The median of the eGFRs using BIS1 was 58mL/min/1.73m (IQR 48-70), using CKD-EPI was 68mL/min/1.73m (IQR 53-84), and using MDRD it was 68mL/min/1.73m (IQR 53-82). The concordance between BIS1 and CKD-EPI (intraclass correlation coefficient =0.87) was found to be acceptable. It was lower with MDRD (intraclass correlation coefficient =0.81). A mean difference of 8mL/min/1.73m (SD 2.6-18) was found BIS1 vs. CKD-EPI, and 10mL/min/1.73m (SD 6-27) with BIS1 vs. MDRD, which was maintained when stratifying by gender and age groups.

CONCLUSIONS

Despite the acceptable statistical agreement, the eGFR obtained with the BIS1 equation is not interchangeable with CKD-EPI or with MDRD-IDMS. The BIS1 equation gives lower values than CKD-EPI, and classifies patients into a higher level of CKD, mainly when the eGFR is above 30mL/min/1.73 m.

摘要

目的

估算肾小球滤过率（eGFR）通常使用基于肌酐的公式进行计算，但其在老年人中的可靠性有限。本研究旨在分析针对老年人的BIS1方程与常用的CKD-EPI方程和MDRD-IDMS方程在70岁以上的大量人群中的一致性。

材料与方法

进行回顾性横断面研究，基于85089名受试者（58.5%为女性，平均年龄78岁[四分位间距73 - 83岁]）的性别、年龄和肌酐数据，使用BIS1、CKD-EPI和MDRD-IDMS方程计算eGFR。进行了以下统计分析：Wilcoxon检验、Bland-Altman图形分析、使用组内相关系数（ICC）进行一致性研究以及CKD分类比较表。

结果

使用BIS1方程计算的eGFR中位数为58mL/min/1.73m²（四分位间距48 - 70），使用CKD-EPI方程计算的为68mL/min/1.73m²（四分位间距53 - 84），使用MDRD方程计算的为68mL/min/1.73m²（四分位间距53 - 82）。发现BIS1与CKD-EPI之间的一致性（组内相关系数 = 0.87）是可接受的。与MDRD的一致性较低（组内相关系数 = 0.81）。BIS1与CKD-EPI相比，平均差异为8mL/min/1.73m²（标准差2.6 - 18），BIS1与MDRD相比，平均差异为10mL/min/1.73m²（标准差6 - 27），按性别和年龄组分层时该差异依然存在。