Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
Clinical Studies Sweden, Skåne University Hospital, Lund, Sweden.
Scand J Clin Lab Invest. 2020 Oct;80(6):456-463. doi: 10.1080/00365513.2020.1774641. Epub 2020 Jul 6.
The aim of this study was to establish creatinine growth curves separately for males and females that can be used to adjust childhood levels of serum creatinine to corresponding adult levels. Linear regression with fractional polynomials of age as independent variable was used to construct creatinine growth curves for a reference cohort (n = 83,157 samples from Belgium and Sweden, age 2-40 years). Adjusted creatinine obtained from the growth curves was used to improve accuracy of estimated glomerular filtration rate (eGFR) based on the Lund-Malmö revised (LMR) equation in children. The LMR equation based on creatinine values adjusted to age 18 years was validated against measured GFR (mGFR) in a separate cohort of 4005 children from four different European countries. Validation metrics included median bias, precision, and accuracy expressed as percentage of estimates within ±30% (P) of mGFR. Remarkable improvements in bias and accuracy were observed; P increased from 56% to 74% after creatinine adjustments in children with mGFR <75 mL/min/1.73 m ( = 932), while P was relatively unchanged (89-90%) at mGFR ≥75 mL/min/1.73 m (n = 3073). The suggested approach with adjusted creatinine makes LMR applicable in children irrespective of their renal function.
本研究旨在分别为男性和女性建立肌酐生长曲线，以便将儿童血清肌酐水平调整至相应的成人水平。采用线性回归和年龄的分数多项式作为自变量，为参考队列（来自比利时和瑞典的 83157 个样本，年龄 2-40 岁）构建肌酐生长曲线。使用生长曲线得出的调整后肌酐，改进基于 Lund-Malmö 修订（LMR）方程估算肾小球滤过率（eGFR）的准确性，该方程在来自四个不同欧洲国家的 4005 名儿童的独立队列中进行验证。验证指标包括中位数偏差、精度和准确性，用估计值与 mGFR 的差异在 ±30%（P）内的百分比表示。在 mGFR<75 mL/min/1.73 m（ = 932）的儿童中，肌酐调整后显著改善了偏差和准确性，P 从 56%增加到 74%，而在 mGFR≥75 mL/min/1.73 m（n = 3073）的儿童中，P 相对不变（89-90%）。调整后的肌酐方法使 LMR 适用于所有肾功能的儿童。
