Liver Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain.
Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, La Laguna, Spain.
Liver Int. 2022 Apr;42(4):884-895. doi: 10.1111/liv.15134. Epub 2022 Jan 17.
BACKGROUND & AIMS: In cirrhosis, the reliability of formulas that estimate renal function, either those specifically developed in this population or the classic equations, has not been properly quantified. We studied the agreement between estimated (eGFR) and measured glomerular filtration rate (mGFR) in cirrhosis.
Renal function was estimated with 56 formulas including specific equations: Glomerular Filtration Rate Assessment in Liver Disease (GRAIL), Royal Free Hospital Cirrhosis (RFHC) and Mindikoglu-eGFR, and measured with a gold standard procedure; plasma clearance of iohexol using dried blood spots sampling in a group of cirrhotics. The agreement eGFR-mGFR was evaluated with specific tests: total deviation index (TDI), concordance correlation coefficient (CCC) and coverage probability (CP). We defined acceptable agreement as values: TDI < 10%, CCC ≥ 0.9 and CP > 90%.
A total of 146 patients (age 65 ± 9 years, 81% male) were evaluated; 61 (42%) Child A, 67 (46%) Child B and 18 (12%) Child C. Median MELD-Na was 14 (9-15). The agreement between eGFR and mGFR was poor: TDI averaged was of 73% (90% of the estimations ranged from ±73% of mGFR); CCC averaged was 0.7 indicating low concordance and CP averaged 22% indicating that 78% of the estimations have an error > 10%. Specific formulas showed also poor agreement: TDI was 82%, 70% and 37% for the GRAIL, RFHC and Mindikoglu equations, respectively.
Overall, formulas poorly estimated renal function in cirrhotic patients. Specific formulas designed for cirrhosis did not outperform classic equations. eGFR must be considered with caution in cirrhotic patients.
在肝硬化中，用于估计肾功能的公式（无论是专为该人群开发的公式还是经典公式）的可靠性尚未得到充分量化。我们研究了肝硬化中估算肾小球滤过率（eGFR）与实测肾小球滤过率（mGFR）之间的一致性。
使用包括特定方程的 56 种公式来评估肾功能：肝脏疾病肾小球滤过率评估（GRAIL）、皇家自由医院肝硬化（RFHC）和 Mindikoglu-eGFR，并使用金标准程序通过干血斑采样测量血浆 iohexol 清除率。使用特定的测试评估 eGFR-mGFR 的一致性：总偏差指数（TDI）、一致性相关系数（CCC）和覆盖率概率（CP）。我们将可接受的一致性定义为：TDI<10%，CCC≥0.9 和 CP>90%。
共评估了 146 例患者（年龄 65±9 岁，81%为男性）；61 例（42%）为 Child A，67 例（46%）为 Child B，18 例（12%）为 Child C。中位 MELD-Na 为 14（9-15）。eGFR 与 mGFR 之间的一致性较差：TDI 平均为 73%（90%的估计值范围在 mGFR 的±73%以内）；CCC 平均为 0.7，表明一致性低，CP 平均为 22%，表明 78%的估计值误差>10%。特定公式也显示出较差的一致性：GRAIL、RFHC 和 Mindikoglu 方程的 TDI 分别为 82%、70%和 37%。
总体而言，公式在肝硬化患者中对肾功能的估计较差。专为肝硬化设计的特定公式并未优于经典公式。在肝硬化患者中必须谨慎考虑 eGFR。
