Zealand University Hospital, Roskilde, Denmark.
BMC Nephrol. 2021 Nov 7;22(1):370. doi: 10.1186/s12882-021-02561-1.
It has been suggested that, in patients with CKD stage 5, measured GFR (mGFR), defined as the mean of urea and creatinine clearance, as measured by a 24-h urine collection, is a better measure of renal function than estimated GFR (eGFR), based on the CKD-EPI formula. This could be due to reduced muscle mass in this group. Its use is recommended in the ERBP guidelines. Unplanned dialysis initiation (DI) is associated with increased morbidity, mortality, and reduced modality choice and is generally considered undesirable. We hypothesized that the ratio mGFR/eGFR (M/E) aids prediction of death and DI.
All 24-h measurements of urea and creatinine excretion were extracted from the clinical biochemistry databases in Zealand. Data concerning renal diagnosis, comorbidity, biochemistry, medical treatment, mortality and date of DI, were extracted from patient notes, the National Patient Registry and the Danish Nephrology Registry. Patients were included if their eGFR was < 30 ml/min/1.73m. The last available value for each patient was included. Follow-up was 12 months.
One thousand two hundred sixty-five patients were included. M/E was median 0.91 ± 0.43. It was highly correlated to previous determinations. It was negatively correlated to eGFR, comorbidity, high age and female sex. It was positively related to albumin and negatively to C-reactive protein. M/E was higher in patients treated with ACE inhibitors and diuretics but no other treatment groups. On a multivariate analysis, M/E was negatively correlated with mortality and combined mortality/DI, but not DI. A post hoc analysis showed a negative correlation to DI at 3 months. For patients with an eGFR 10-15 ml/min/1.73m, combined mortality and DI at 3 months was for low M/E (< 0.75) 36%, medium (0.75-1.25) 20%, high (> 1.25) 8%. A low M/E predicted increased need for unplanned DI. A supplementary analysis in 519 patients where body surface area values were available, allowing BSA-corrected M/E to be analyzed, revealed similar results.
A low mGFR/eGFR ratio is associated with comorbidity, malnutrition, and inflammation. It is a marker of early DI, mortality, and unplanned dialysis initiation, independently of eGFR, age and comorbidity. Particular attention paid to patients with a low M/E may lower the incidence of unplanned dialysis requirement.
有人认为，在 CKD 5 期患者中，通过 24 小时尿液收集测量的平均尿素和肌酐清除率（mGFR）作为衡量肾功能的指标优于基于 CKD-EPI 公式的估算肾小球滤过率（eGFR）。这可能是由于该组肌肉质量减少所致。ERBP 指南推荐使用 mGFR。未计划透析开始（DI）与发病率增加、死亡率降低以及选择的方式减少有关，通常被认为是不理想的。我们假设 mGFR/eGFR 比值（M/E）有助于预测死亡和 DI。
从 Zealand 的临床生化数据库中提取所有 24 小时的尿素和肌酐排泄测量值。从患者病历、国家患者登记处和丹麦肾脏病登记处提取有关肾脏诊断、合并症、生化、药物治疗、死亡率和 DI 日期的数据。如果患者的 eGFR<30ml/min/1.73m，则将其纳入研究。纳入了每位患者的最后一次可用值。随访时间为 12 个月。
共纳入 1265 例患者。M/E 的中位数为 0.91±0.43。它与之前的测定高度相关。它与 eGFR、合并症、高龄和女性性别呈负相关。它与白蛋白呈正相关，与 C 反应蛋白呈负相关。接受 ACE 抑制剂和利尿剂治疗的患者的 M/E 较高，但其他治疗组没有。在多变量分析中，M/E 与死亡率和死亡率/DI 合并呈负相关，但与 DI 无关。事后分析显示，M/E 与 3 个月时的 DI 呈负相关。对于 eGFR 为 10-15ml/min/1.73m 的患者，3 个月时低 M/E（<0.75）的死亡率和 DI 合并率为 36%，中值（0.75-1.25）为 20%，高值（>1.25）为 8%。低 M/E 预示着对未计划 DI 的需求增加。在 519 名有体表面积值的患者中进行的补充分析中，允许分析校正体表面积的 M/E，结果相似。
低 mGFR/eGFR 比值与合并症、营养不良和炎症有关。它是 DI、死亡率和未计划透析开始的早期标志物，独立于 eGFR、年龄和合并症。特别关注 M/E 较低的患者可能会降低未计划透析需求的发生率。
