Poventud-Fuentes Izmarie, Garnett Emily, Akcan-Arikan Ayse, Devaraj Sridevi
Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA.
Department of Pathology, Texas Children's Hospital, Houston, TX, USA.
J Appl Lab Med. 2022 Sep 1;7(5):1016-1024. doi: 10.1093/jalm/jfac043.
Accurate assessment of kidney function is essential for early detection of kidney damage. While measured glomerular filtration rate (mGFR) is occasionally used as a reference, estimated GFR (eGFR) from serum creatinine- and cystatin C (CysC)-based equations are routinely used in clinical practice as a reliable and less invasive approach. In pediatric populations, CysC-based equations provide a closer approximation as they are independent of body composition. Limited information is available on the performance of CysC-based equations in comparison with mGFR with tracers other than iohexol. Therefore, the goal of our study was to evaluate how eGFR, based on several CysC- and creatinine-based equations, with and without race correction, relates to mGFR in a diverse pediatric population.
A total of 43 patients (7 months to 21 years) from diverse race/ethnicity were retrospectively studied to compare the mGFR from multiple blood sample collections after intravenous tracer injection (Tc-99mDTPA) with eGFR using 9 equations. Deming regression analyses were performed to assess correlation between the mGFR and eGFRs.
The average mGFR for this cohort was 95.0 mL/min/1.73 m2. Race-corrected (RC) equations gave overestimated eGFR across all ethnic groups, with the lowest bias for Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) CysC-creatinine (34.14 mL/min/1.73 m2). The best correlations to mGFR, percentage of eGFR within 30% of mGFR (P30), and lowest biases were from non-race-corrected (NRC) equations Chronic Kidney Disease in Children (CKiD) (0.6460, 65.1%, 2.86 mL/min/1.73 m2), CKD-EPI CysC (0.6858, 69.8%, 11.01 mL/min/1.73 m2), and Schwartz CysC (0.6876, 79.1%, -14.00 mL/min/1.73 m2).
Overall, CysC-based equations without race correction provide a good approximation of mGFR and a less invasive alternative to monitoring kidney function in pediatric population, irrespective of race/ethnicity.
准确评估肾功能对于早期发现肾损伤至关重要。虽然测量的肾小球滤过率（mGFR）偶尔用作参考，但基于血清肌酐和胱抑素C（CysC）的公式估算的肾小球滤过率（eGFR）在临床实践中通常作为一种可靠且侵入性较小的方法使用。在儿科人群中，基于CysC的公式提供了更接近的近似值，因为它们独立于身体组成。与使用除碘海醇以外的示踪剂的mGFR相比，基于CysC的公式的性能信息有限。因此，我们研究的目的是评估基于几个CysC和肌酐的公式（有或没有种族校正）的eGFR与不同儿科人群的mGFR之间的关系。
回顾性研究了43名不同种族/民族的患者（7个月至21岁），以比较静脉注射示踪剂（Tc-99mDTPA）后多次采集血样测得的mGFR与使用9个公式计算的eGFR。进行Deming回归分析以评估mGFR与eGFR之间的相关性。
该队列的平均mGFR为95.0 mL/min/1.73 m2。种族校正（RC）公式在所有种族群体中均高估了eGFR，其中慢性肾脏病流行病学协作组（CKD-EPI）CysC-肌酐公式的偏差最小（34.14 mL/min/1.73 m2）。与mGFR的最佳相关性、eGFR在mGFR的30%以内的百分比（P30）以及最低偏差来自非种族校正（NRC）公式儿童慢性肾脏病（CKiD）（0.6460，65.1%，2.86 mL/min/1.73 m2）、CKD-EPI CysC（0.6858，69.8%，11.01 mL/min/1.73 m2）和Schwartz CysC（0.6876，79.1%，-14.00 mL/min/1.73 m2）。
总体而言，不进行种族校正的基于CysC的公式能很好地近似mGFR，并且是儿科人群中监测肾功能的侵入性较小的替代方法，无论种族/民族如何。
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