Clinical Chemistry, St. Vincent's University Hospital, Dublin, Dublin, Ireland
Clinical Chemistry, St. Vincent's University Hospital, Dublin, Dublin, Ireland.
J Clin Pathol. 2021 Sep;74(9):608-611. doi: 10.1136/jclinpath-2020-206713. Epub 2020 Oct 1.
Estimates of glomerular filtration rate (eGFR) help assess kidney function. Estimated GFR can be used to classify patients into one of six Chronic Kidney Disease (CKD) categories as recommended by the Kidney Disease Improving Global Outcomes clinical practice guidelines; CKD1 ≥90, CKD2 60-89, CKD3a 45-59, CKD3b 30-44, CKD4 15-29 or CKD5 ≤15 mL/min/1.73 m The Modification of Diet and Renal Disease (MDRD) study formula was widely adopted to calculate eGFR. The CKD Epidemiology Collaboration (CKD-EPI) formula improved accuracy of CKD staging at eGFR ≥60 mL/min/1.73 m MDRD and CKD-EPI eGFR were calculated on 111 444 serum creatinine results from adult patients measured as part of the routine Clinical Chemistry service. Application of CKD-EPI eGFR reclassified 18% to a lower (13.9%) or higher (4.0%) CKD stage. CKD staging was lower when <65 years and higher when ≥65 years. Females were more often reclassified compared with males (2.6% vs 0.8%). Overall, CKD-EPI eGFR classified less with CKD (stages 3a-5), unless ≥75 years. Older males and inpatients had higher CKD stages when CKD-EPI eGFR was applied. It has been recommended to replace MDRD eGFR with CKD-EPI eGFR. In general, doing this will have little impact, however, for some patients their CKD classification will be different.
肾小球滤过率（eGFR）的估计有助于评估肾功能。根据肾脏病改善全球结局组织（Kidney Disease Improving Global Outcomes，KDIGO）临床实践指南的建议，估算的肾小球滤过率可用于将患者分为慢性肾脏病（Chronic Kidney Disease，CKD）的六个类别之一；CKD1≥90、CKD260-89、CKD3a45-59、CKD3b30-44、CKD415-29 或 CKD5≤15mL/min/1.73m。改良肾脏病膳食研究（Modification of Diet and Renal Disease，MDRD）公式被广泛用于计算 eGFR。CKD 流行病学协作组（Chronic Kidney Disease Epidemiology Collaboration，CKD-EPI）公式提高了 eGFR≥60mL/min/1.73m 的 CKD 分期的准确性。MDRD 和 CKD-EPI eGFR 是根据常规临床化学服务中测量的 111444 例成年患者的血清肌酐结果计算得出的。应用 CKD-EPI eGFR 将 18%的患者重新分类为较低（13.9%）或较高（4.0%）的 CKD 分期。年龄<65 岁时 CKD 分期较低，年龄≥65 岁时 CKD 分期较高。与男性相比（2.6%与 0.8%），女性更常被重新分类。总体而言，CKD-EPI eGFR 分类为 CKD（3a-5 期）的患者较少，除非年龄≥75 岁。应用 CKD-EPI eGFR 时，年龄较大的男性和住院患者的 CKD 分期较高。有人建议用 CKD-EPI eGFR 替代 MDRD eGFR。一般来说，这样做的影响不大，但对于某些患者，他们的 CKD 分类将会不同。
