肌肉量对日本终末期癌症患者肾小球滤过率估算的影响。

Influence of muscle mass on the estimation of glomerular filtration rate in Japanese terminal cancer patients.

机构信息

Department of Pharmacy, Fujita Health University Okazaki Medical Center, 1, Gotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan.

Department of Pharmacy, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodori, Tsu, Mie, 514-1295, Japan.

出版信息

Clin Exp Nephrol. 2020 Oct;24(10):876-884. doi: 10.1007/s10157-020-01906-8. Epub 2020 Jul 3.

DOI:10.1007/s10157-020-01906-8

PMID:32621075

Abstract

BACKGROUND

Estimated glomerular filtration rate (eGFR) based on serum cystatin C (Scys) is useful for patients with decreased muscle mass, but has been also reported to be affected by cancer. The usefulness of Scys in eGFR in terminal cancer patients with decreased muscle mass is unknown. Therefore, we analyzed appropriate eGFR formulae for terminal cancer patients.

METHODS

Study design was a retrospective observational study. Based on creatinine height index (CHI), 184 terminal cancer patients were stratified into CHI ≥ 90% (normal muscle mass, 59 patients); CHI 60-89% (mildly to moderately decreased muscle mass, 64 patients); and CHI < 60% (severely decreased muscle mass, 61 patients) groups. Twenty-four-hour creatinine clearance was measured and converted to the glomerular filtration rate (GFR) as a renal function measure. To estimate GFR, various eGFR formulae for Japanese were used: eGFR, eGFR and eGFR, eGFR and eGFR, and eGFR, based on Scys, serum creatinine (Scr), Scys and Scr combined, and Cockcroft-Gault formula (CG), respectively. Errors between measured and estimated values of renal function were verified using mean prediction errors (ME). When a 95% confidence interval (CI) of ME included 0, the accuracy of the eGFR formula was graded as good.

RESULTS

eGFR ME was 0.2 (95% CI lower limit - 3.7, upper limit 4.0) mL/min/1.73 m in CHI 60-89% group and 9.2 (6.1, 12.9) mL/min/1.73 m in CHI < 60% group. eGFR was most accurate among the eGFR formulae.

CONCLUSIONS

eGFR based on Scys was demonstrated as useful in terminal cancer patients with decreased muscle mass.

摘要

背景

基于血清胱抑素 C（Scys）的估算肾小球滤过率（eGFR）对于肌肉量减少的患者很有用，但也有报道称其受到癌症的影响。在肌肉量减少的终末期癌症患者中，Scys 在 eGFR 中的作用尚不清楚。因此，我们分析了适用于终末期癌症患者的 eGFR 公式。

方法

研究设计为回顾性观察性研究。根据肌酐身高指数（CHI），将 184 名终末期癌症患者分为 CHI≥90%（正常肌肉量，59 例）；CHI 60-89%（轻度至中度肌肉量减少，64 例）；和 CHI<60%（严重肌肉量减少，61 例）组。测量 24 小时肌酐清除率并转换为肾小球滤过率（GFR）作为肾功能指标。为了估计 GFR，使用了各种适用于日本人的 eGFR 公式：eGFR、eGFR 和 eGFR、eGFR 和 eGFR、eGFR 和 Scys、血清肌酐（Scr）、Scys 和 Scr 组合以及 Cockcroft-Gault 公式（CG）。通过平均预测误差（ME）验证肾功能测量值和估计值之间的误差。当 ME 的 95%置信区间（CI）包含 0 时，eGFR 公式的准确性被评为良好。