Tang Ying, Hou Ling, Sun Tingting, Li Shanping, Cheng Junli, Xue Dan, Wang Xiuli, Du Yue
Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
Pediatr Nephrol. 2023 Jan;38(1):237-247. doi: 10.1007/s00467-022-05552-y. Epub 2022 Apr 25.
There is currently no specific equation for estimating glomerular filtration rate (GFR) in Chinese children with chronic kidney disease (CKD). The commonly used equations are less robust than expected; we therefore sought to derive more appropriate equations for GFR estimation.
A total of 751 Chinese children with CKD were divided into 2 groups, training group (n = 501) and validation group (n = 250). In the training group, a univariate linear regression model was used to calculate predictability of variables associated with GFR. Residuals were compared to determine multivariate predictability of GFR in the equation. Standard regression techniques for Gaussian data were used to determine coefficients of GFR-estimating equations after logarithmic transformation of measured GFR (iGFR), height/serum creatinine (height/Scr), cystatin C, blood urea nitrogen (BUN), and height. These were compared with other well-known equations using the validation group.
Median Tc-DTPA GFR was 90.1 (interquartile range: 67.3-108.6) mL/min/1.73 m in training dataset. Our CKD equation, eGFR (mL/min/1.73 m) = 91.021 [height(m)/Scr(mg/dL)/2.7] [1.2/Cystatin C(mg/L)] [13.7/BUN (mg/dL)] [ 0.991] [height(m)/1.4], was derived. This was further tested in the validation group, with percentages of eGFR values within 30% and 15% of iGFR (P30 and P15) of 76.00% and 48.40%, respectively. For centres with no access to cystatin C, a creatinine-based equation, eGFR (mL/min/1.73 m) = 89.674 [height(m)/Scr(mg/dL)/2.7] [ 1.007] [height(m)/1.4], was derived, with P30 and P15 73.60% and 49.20%, respectively. These were significantly higher compared to other well-known equations (p < 0.05).
We developed equations for GFR estimation in Chinese children with CKD based on Scr, BUN and cystatin C. These are more accurate than commonly used equations in this population.
目前尚无用于估算中国慢性肾脏病（CKD）儿童肾小球滤过率（GFR）的特定方程。常用方程的稳健性低于预期；因此，我们试图推导更合适的GFR估算方程。
总共751名中国CKD儿童被分为两组，训练组（n = 501）和验证组（n = 250）。在训练组中，使用单变量线性回归模型计算与GFR相关变量的预测能力。比较残差以确定方程中GFR的多变量预测能力。在对测量的GFR（iGFR）、身高/血清肌酐（身高/Scr）、胱抑素C、血尿素氮（BUN）和身高进行对数转换后，使用高斯数据的标准回归技术确定GFR估算方程的系数。使用验证组将这些与其他知名方程进行比较。
训练数据集中Tc-DTPA GFR的中位数为90.1（四分位间距：67.3 - 108.6）mL/min/1.73m²。我们得出了CKD方程，eGFR（mL/min/1.73m²）= 91.021 [身高（m）/Scr（mg/dL）/2.7] [1.2/胱抑素C（mg/L）] [13.7/BUN（mg/dL）] [0.991] [身高（m）/1.4]。在验证组中对其进行了进一步测试，eGFR值在iGFR的30%和15%以内（P30和P15）的百分比分别为76.00%和48.40%。对于无法检测胱抑素C的中心，得出了一个基于肌酐的方程，eGFR（mL/min/1.73m²）= 89.674 [身高（m）/Scr（mg/dL）/2.7] [1.007] [身高（m）/1.4]，P30和P15分别为73.60%和49.20%。与其他知名方程相比，这些值显著更高（p < 0.05）。
我们基于Scr、BUN和胱抑素C推导了中国CKD儿童GFR估算方程。这些方程在该人群中比常用方程更准确。
