Nabiee Morteza, Vahidfar Nasim, Dashti-Khavidaki Simin, Khatami Mohammad-Reza, Abbasi Mehrshad, Gatmiri Mansoor, Shojamoradi Mohammad-Hossein, Naderi Neda, Alamdari Azam
Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
Department of Nuclear Medicine, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
Iran J Kidney Dis. 2021 May;15(3):213-221.
Estimating glomerular filtration rate (eGFR) using different formulas is common clinical practice for evaluating kidney function and drug dosing. But, the performance of available eGFR equations is questionable during early days after kidney transplantation.
This study compared the performance of three common eGFR equations (Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)) in relation with measured GFR (mGFR) using clearance of Tc-99m-diethylenetriaminepentaacetic acid, 7 to 10 days post kidney transplantation. Agreement of mGFR and different eGFR equations in the staging of kidney function and dosing of 8 common antimicrobials were assessed.
Thirty kidney and 5 simultaneous pancreas-kidney transplant recipients were included. CG applying total body weight (CGTBW) had the lowest bias (-12 mL/min/ 1.73 m2) and the highest percentage of estimation within 30% of mGFR (71.4%). MDRD showed the best precision (13.14 mL/min/ 1.73m2) and linear correlation with mGFR. CKD-EPI and MDRD acted better than CG for staging the level of kidney function. CGTBW had the lowest discordance rate with mGFR for antimicrobials dosing (33.6%). Discordance rates of drug dosing between mGFR and eGFR formulas were greater for drugs that have higher dosing levels such as (val)-ganciclovir (≥ 54.3%).
Until developing more accurate methods for estimating kidney function during first 1 to 2 weeks after kidney transplantation, CGTBW method is suggested for drug dose adjustment and MDRD or CKD-EPI equation for the staging of kidney function in these patients, keeping in mind that these formulas underestimate the level of kidney function in new transplant recipients.
使用不同公式估算肾小球滤过率（eGFR）是评估是评估肾功能和调整药物剂量的常见临床做法。但是，在肾移植后的早期阶段，现有eGFR方程的性能存在疑问。
本研究比较了三种常见的eGFR方程（Cockcroft-Gault（CG）、肾脏病饮食改良（MDRD）和慢性肾脏病流行病学协作组（CKD-EPI））与使用Tc-99m-二乙三胺五乙酸清除率测量的肾小球滤过率（mGFR）之间的性能关系，该测量在肾移植后7至10天进行。评估了mGFR与不同eGFR方程在肾功能分期和8种常见抗菌药物剂量调整方面的一致性。
纳入了30例肾移植受者和5例同期胰肾联合移植受者。应用总体重的CG（CGTBW）偏差最低（-12 mL/min/1.73 m2），且在mGFR的30%范围内估算的百分比最高（71.4%）。MDRD显示出最佳的精密度（13.14 mL/min/1.73m2）以及与mGFR的线性相关性。CKD-EPI和MDRD在肾功能分期方面比CG表现更好。CGTBW在抗菌药物剂量调整方面与mGFR的不一致率最低（33.6%）。对于给药水平较高的药物，如（缬氨酸）-更昔洛韦，mGFR与eGFR公式之间的药物剂量不一致率更高（≥54.3%）。
在开发出更准确的肾移植后1至2周内估算肾功能的方法之前，建议使用CGTBW方法进行药物剂量调整，使用MDRD或CKD-EPI方程进行这些患者的肾功能分期，同时要记住这些公式会低估新移植受者的肾功能水平。
