基于肌酐的方程与内源性肌酐清除率估计肾小球滤过率的性能比较。
Performance of creatinine-based equations for estimating glomerular filtration rate compared to endogenous creatinine clearance.
机构信息
Universidade de Caxias do Sul, Programa de Pós-Graduação em Ciências da Saúde Brasil, Caxias do Sul, RS, Brasil.
Hospital Geral de Caxias do Sul, Caxias do Sul, RS, Brasil.
出版信息
J Bras Nefrol. 2022 Apr-Jun;44(2):179-186. doi: 10.1590/2175-8239-JBN-2021-0109.
INTRODUCTION
The guidelines recommend estimating the glomerular filtration rate using serum creatinine-based equations as a predictor of kidney disease, preferably adjusted for local population groups.
METHODS
Cross-sectional study that evaluated the performance of four equations used for estimating GFR compared to endogenous creatinine clearance (ClCr) in 1,281 participants. Modification of Diet equations in Renal Disease Study Group (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), CKD-EPI with adjustment for local population (CKD-EPI local) and Full Age Spectrum (FAS) in comparison with endogenous creatinine clearance (ClCr). We used the Quantile Regression to calculate the median bias, interquartile range (IQR), Bland-Altman agreement analysis and 30% margin of error (P30).
RESULTS
The mean age of participants was 52.5 ± 16.5 years with 466 women (38%), median ClCr[IQR] of 92.0 [58.0; 122.0] mL/min/1.73 m2, with 320 (25%) participants presenting ClCr < 60 mL/min/1.73 m2. The performance of the local CKD-EPI and FAS equations were superior to MDRD and CKD-EPI in relation to variability (0.92 [0.89; 0.94]) and P30 (90.5% [88.7; 92, 0]). In the group with ClCr < 60 mL/min/1.73 m2, the local CKD-EPI and FAS equations showed less variability than the CKD-EPI and MDRD (0.90 [0.86; 0.98] and 1.05 [0.97; 1.09] vs. 0.63 [0.61; 0.68] and 0.65 [0.62; 0.70], P < 0.01) and best P30 (85.5) % [81.0; 90.0], 88.0% [84.0; 92.0] vs. 52.0% (46.0; 58.0) and 53.0% [47.0; 58 .5], P < 0.01).
CONCLUSION
Local CKD-EPI and FAS equations performed better than CKD-EPI and MDRD when compared to ClCr.
简介
指南建议使用血清肌酐为基础的公式来估计肾小球滤过率，作为预测肾脏疾病的指标，最好根据当地人群进行调整。
方法
本研究为横断面研究，共纳入了 1281 名参与者，评估了用于估计 GFR 的四种公式（改良肾脏病饮食研究组（MDRD）、慢性肾脏病流行病学合作研究（CKD-EPI）、针对当地人群的 CKD-EPI（CKD-EPI local）和全年龄谱（FAS））与内源性肌酐清除率（ClCr）相比的性能。我们使用分位数回归计算中位数偏差、四分位间距（IQR）、Bland-Altman 一致性分析和 30%误差边界（P30）。
结果
参与者的平均年龄为 52.5 ± 16.5 岁，其中女性 466 人（38%），中位 ClCr[IQR]为 92.0[58.0；122.0]mL/min/1.73 m2，320 名（25%）参与者的 ClCr<60 mL/min/1.73 m2。与 MDRD 和 CKD-EPI 相比，当地的 CKD-EPI 和 FAS 方程在变异性（0.92[0.89；0.94]）和 P30（90.5%[88.7；92，0]）方面表现更优。在 ClCr<60 mL/min/1.73 m2 的组中，当地的 CKD-EPI 和 FAS 方程的变异性小于 CKD-EPI 和 MDRD（0.90[0.86；0.98]和 1.05[0.97；1.09] vs. 0.63[0.61；0.68]和 0.65[0.62；0.70]，P<0.01），P30 最佳（85.5）%[81.0；90.0]，88.0%[84.0；92.0] vs. 52.0%（46.0；58.0）和 53.0%[47.0；58.5]，P<0.01）。
结论
与 ClCr 相比，当地的 CKD-EPI 和 FAS 方程在比较时比 CKD-EPI 和 MDRD 表现更好。
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