Md Ralib Azrina, Mohd Hanafiah Farah Nadia, Abd Rashid Iqbalmunawwir, Abd Rahim Mohamad Shahrir, Dzaharudin Fatimah, Mat Nor Mohd Basri
Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia.
Department of Radiology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia.
Int J Nephrol. 2021 Sep 8;2021:3465472. doi: 10.1155/2021/3465472. eCollection 2021.
Accurate assessment of glomerular filtration rate (GFR) is very important for diagnostic and therapeutic intervention. Clinically, GFR is estimated from plasma creatinine using equations such as Cockcroft-Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equations. However, these were developed in the Western population. To the best of our knowledge, there was no equation that has been developed specifically in our population.
We developed a new equation based on the gold standard of Tc-DTPA imaging measured GFR. We then performed an internal validation by comparing the bias, precision, and accuracy of the new equation and the other equations with the gold standard of Tc-DTPA imaging measured GFR.
This was a cross-sectional study using the existing record of patients who were referred for Tc-DTPA imaging at the Nuclear Medicine Centre, International Islamic University Malaysia. As this is a retrospective study utilising routinely collected data from the existing pool of data, the ethical committee has waived the need for informed consent.
Data of 187 patients were analysed from January 2016 to March 2021. Of these, 94 were randomised to the development cohort and 93 to the validation cohort. A new equation of eGFR was determined as 16.637 ∗ 0.9935 ∗ (SCr/23.473). In the validation cohort, both CKD-EPI and the new equation had the highest correlation to Tc-DTPA with a correlation coefficient of 0.81 ( < 0.0001). However, the new equation had the least bias and was the most precise (mean bias of -3.58 ± 12.01) and accurate (P30 of 64.5% and P50 of 84.9%) compared to the other equations.
The new equation which was developed specifically using our local data population was the most accurate and precise, with less bias compared to the other equations. Further study validating this equation in the perioperative and intensive care patients is needed.
准确评估肾小球滤过率（GFR）对于诊断和治疗干预非常重要。临床上，GFR是使用Cockcroft-Gault、肾脏病饮食改良公式和慢性肾脏病流行病学合作组织（CKD-EPI）公式等从血肌酐估算得出。然而，这些公式是在西方人群中开发的。据我们所知，尚未有专门针对我们人群开发的公式。
我们基于锝-二乙三胺五乙酸（Tc-DTPA）显像测量GFR的金标准开发了一个新公式。然后，通过比较新公式和其他公式与Tc-DTPA显像测量GFR金标准的偏差、精密度和准确性进行内部验证。
这是一项横断面研究，使用了马来西亚国际伊斯兰大学核医学中心接受Tc-DTPA显像检查患者的现有记录。由于这是一项利用从现有数据池中常规收集的数据进行的回顾性研究，伦理委员会已免去知情同意的要求。
分析了2016年1月至2021年3月期间187例患者的数据。其中，94例被随机分配到开发队列，93例被随机分配到验证队列。估算肾小球滤过率（eGFR）的新公式确定为16.637 ∗ 0.9935 ∗（血肌酐/23.473）。在验证队列中，CKD-EPI公式和新公式与Tc-DTPA的相关性最高，相关系数为0.81（P < 0.0001）。然而，与其他公式相比，新公式的偏差最小，最精确（平均偏差为-3.58 ± 12.01）且最准确（第30百分位数为64.5%，第50百分位数为84.9%）。
专门使用我们当地数据人群开发的新公式是最准确和精确的，与其他公式相比偏差更小。需要在围手术期和重症监护患者中进一步研究验证该公式。
