慢性肾脏病患者的肌酐和胱抑素 C 肾小球滤过率趋势差异：来自 KNOW-CKD 队列的结果。
Discrepant glomerular filtration rate trends from creatinine and cystatin C in patients with chronic kidney disease: results from the KNOW-CKD cohort.
机构信息
Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
出版信息
BMC Nephrol. 2020 Jul 16;21(1):280. doi: 10.1186/s12882-020-01932-4.
BACKGROUND
Serum creatinine (Cr) and cystatin C (CysC) can both be used to estimate glomerular filtration rate (eGFR and eGFR). However, certain conditions may cause discrepancies between eGFR trends from Cr and CysC, and these remain undetermined in patients with chronic kidney disease (CKD).
METHODS
A total of 1069 patients from the Korean CKD cohort (KNOW-CKD), which enrolls pre-dialytic CKD patients, whose Cr and CysC had been followed for more than 4 years were included in the sample. We performed trajectory analysis using latent class mixed modeling and identified members of the discrepancy group when patient trends between eGFR and eGFR differed. Multivariate logistic analyses with Firth's penalized likelihood regression models were performed to identify conditions related to the discrepancy.
RESULTS
Trajectory patterns of eGFR were classified into three groups: two groups with stable eGFR (stable with high eGFR and stable with low eGFR) and one group with decreasing eGFR. Trajectory analysis of eGFR also showed similar patterns, comprising two groups with stable eGFR and one group with decreasing eGFR. Patients in the discrepancy group (decreasing eGFR but stable & low eGFR; n = 55) were younger and had greater proteinuria values than the agreement group (stable & low eGFR and eGFR; n = 706), differences that remained consistent irrespective of the measurement period (4 or 5 years).
CONCLUSIONS
In the present study, we identify conditions related to discrepant trends of eGFR and eGFR. Clinicians should remain aware of such potential discrepancies when tracing both Cr and CysC.
背景
血清肌酐（Cr）和胱抑素 C（CysC）均可用于估计肾小球滤过率（eGFR 和 eGFR）。然而，某些情况下可能会导致 Cr 和 CysC 的 eGFR 趋势之间存在差异，而这些差异在慢性肾脏病（CKD）患者中尚未确定。
方法
本研究共纳入了来自韩国 CKD 队列（KNOW-CKD）的 1069 例患者，这些患者在透析前 CKD 患者中，Cr 和 CysC 的随访时间超过 4 年。我们使用潜在类别混合建模进行轨迹分析，并在 eGFR 和 eGFR 之间的患者趋势存在差异时确定差异组的成员。使用 Firth 的惩罚似然回归模型进行多变量逻辑分析，以确定与差异相关的条件。
结果
eGFR 的轨迹模式分为三组：两组稳定的 eGFR（高 eGFR 稳定和低 eGFR 稳定）和一组 eGFR 下降。eGFR 的轨迹分析也显示出类似的模式，包括两组稳定的 eGFR 和一组 eGFR 下降。差异组（eGFR 下降但稳定和低 eGFR；n=55）患者比一致组（稳定和低 eGFR 和 eGFR；n=706）更年轻，蛋白尿值更高，无论测量期（4 年或 5 年）如何，这些差异都保持一致。
结论
本研究确定了与 eGFR 和 eGFR 差异趋势相关的条件。当追踪 Cr 和 CysC 时，临床医生应始终意识到这种潜在的差异。
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