不同估算肾小球滤过率（eGFR）方程在百岁及近百岁老人中的实用性：我们应选择哪个方程？
The practicality of different eGFR equations in centenarians and near-centenarians: which equation should we choose?
作者信息
Han Qiuxia, Zhang Dong, Zhao Yali, Liu Liang, Li Jing, Zhang Fu, Luan Fuxin, Duan Jiayu, Liu Zhangsuo, Cai Guangyan, Chen Xiangmei, Zhu Hanyu
机构信息
Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China.
School of Medicine, Nankai University, Tianjin, China.
出版信息
PeerJ. 2020 Feb 21;8:e8636. doi: 10.7717/peerj.8636. eCollection 2020.
BACKGROUND
No studies have examined the practicality of the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) and Berlin Initiative Study 1 (BIS1) equations for the estimated glomerular filtration rate (eGFR) in a large sample of centenarians. We aim to investigate the differences among the equations and suggest the most suitable equation for centenarians and near-centenarians.
METHODS
A total of 966 centenarians and 787 near-centenarians were enrolled, and the eGFR was calculated using the three equations mentioned above. Agreement among the equations was investigated with the statistic and Bland-Altman plots. Sources of discrepancy were investigated using a partial correlation analysis.
RESULTS
The three equations for assessing eGFR are not considered interchangeable in centenarians and near-centenarians. Δ(MDRD, CKD-EPI) and Δ(MDRD, BIS1) increased with age, but Δ(CKD-EPI, BIS1) was relatively stable with age. Δ(MDRD, CKD-EPI) and Δ(MDRD, BIS1) were considerable in subjects with Scr levels less than 0.7 mg/dL and decreased with the Scr level. A considerable difference between CKD-EPI and BIS1 was observed for participants with Scr levels ranging from 0.5 to 1.5 mg/dL. This difference increased with Scr levels ranging from 0.5 to 0.7 mg/dL, was relatively stable for Scr levels ranging from 0.7 to 0.9 mg/dL, and decreased with Scr levels ranging from 0.9 to 1.5 mg/dL. The differences in the three comparisons were all greater in women than in men ( < 0.05).
CONCLUSIONS
We tend to suggest the MDRD equation to calculate the glomerular filtration rate (GFR) in elderly individuals >95 years old who have no risk factors for cardiovascular disease; the BIS1 equation to calculate the eGFR for elderly individuals younger than 94 years old who have risk factors for cardiovascular disease; the CKD-EPI equation to calculate the eGFR of elderly individuals with Scr levels greater than 1.5 mg/dL; and the BIS1 equation to calculate the eGFR of older women with Scr levels less than 0.7 mg/dL.
背景
尚无研究在大量百岁老人样本中检验肾脏病饮食改良（MDRD）公式、慢性肾脏病流行病学合作组（CKD-EPI）公式及柏林倡议研究1（BIS1）公式用于估算肾小球滤过率（eGFR）的实用性。我们旨在研究这些公式之间的差异，并为百岁老人及接近百岁的老人推荐最合适的公式。
方法
共纳入966名百岁老人和787名接近百岁的老人，使用上述三个公式计算eGFR。采用统计量和Bland-Altman图研究公式之间的一致性。使用偏相关分析研究差异来源。
结果
在百岁老人和接近百岁的老人中，用于评估eGFR的三个公式不可互换使用。Δ（MDRD，CKD-EPI）和Δ（MDRD，BIS1）随年龄增加，而Δ（CKD-EPI，BIS1）随年龄相对稳定。在血清肌酐（Scr）水平低于0.7mg/dL的受试者中，Δ（MDRD，CKD-EPI）和Δ（MDRD，BIS1）较大，并随Scr水平降低。在Scr水平为0.5至1.5mg/dL的参与者中，观察到CKD-EPI和BIS1之间存在显著差异。该差异在Scr水平为0.5至0.7mg/dL时随Scr水平增加，在Scr水平为0.7至0.9mg/dL时相对稳定，在Scr水平为0.9至1.5mg/dL时随Scr水平降低。三项比较中的差异在女性中均大于男性（P<0.05）。
结论
我们倾向于建议，对于无心血管疾病危险因素的95岁以上老年人，使用MDRD公式计算肾小球滤过率（GFR）；对于有心血管疾病危险因素的94岁以下老年人，使用BIS1公式计算eGFR；对于Scr水平大于1.5mg/dL的老年人，使用CKD-EPI公式计算eGFR；对于Scr水平低于0.7mg/dL的老年女性，使用BIS1公式计算eGFR。
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