Musso Carlos G, Casciato Paola, Macías-Nuñez Juan, Ardanuy Ramón, Gonzalez-Torres Henry, Aroca-Martinez Gustavo, Torres-Caro Cristina, Narvaez Adrian, Bonifacio Mariano, Padilla Marlene, Gadano Adrian
Research Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia.
Nephrology (Carlton). 2022 Aug;27(8):658-662. doi: 10.1111/nep.14075. Epub 2022 Jun 23.
Cirrhotic patients can develop acute kidney injury (AKI), and chronic kidney disease (CKD). Therefore, renal functional evaluation is crucial in cirrhotic patients. However, serum creatinine and urea levels, as well as measured or estimated glomerular filtration rate is not reliable renal functional markers in these patients compared to other patient groups. In the present study, four original equations are designed and tested for screening chronic kidney disease (CKD) and chronic kidney insufficiency (CKI) in stable cirrhotic patients.
MATERIAL & METHOD: estimated GFR (CKD-EPI creatinine and cystatin equations) were recorded in 175 adult stable patients suffering from cirrhosis, and these patients were classified as presenting or not CKD and CKI after evaluation by two independent nephrologists. Based on these data, the variables with the significant discriminating capability to identify CKD and CKI (based on creatinine and cystatin) were detected by applying the Student's t-test for two independent groups, later confirmed by the lambda test of Wilks, in order to obtain the renal function equations.
CKD equation (creatinine) = 7.094238-0.043104 × CKD-EPI creatinine - 0.057537 × haematocrit. CKD equation (cystatin) = 8.375074-0.117218 × CKD-EPI cystatin. CKI equation (creatinine) = 0.428389-0.043214 × CKD-EPI creatinine +0.183051 × Child-Pugh score + 0.050162 × age (in years). CKI equation (cystatin) = 9.169579-0.139319 × CKD-EPI cystatin.
Simple and reliable equations have been obtained for screening chronic kidney disease and chronic kidney insufficiency in cirrhotic patients.
肝硬化患者可发生急性肾损伤（AKI）和慢性肾脏病（CKD）。因此，肾功能评估对肝硬化患者至关重要。然而，与其他患者群体相比，血清肌酐和尿素水平以及测量或估算的肾小球滤过率在这些患者中并非可靠的肾功能标志物。在本研究中，设计并测试了四个原始方程，用于筛查稳定期肝硬化患者的慢性肾脏病（CKD）和慢性肾功能不全（CKI）。
记录了175例成年稳定期肝硬化患者的估算肾小球滤过率（CKD-EPI肌酐和胱抑素方程），并由两名独立的肾脏科医生评估后，将这些患者分类为患有或未患有CKD和CKI。基于这些数据，通过对两个独立组应用Student t检验检测出对识别CKD和CKI具有显著区分能力的变量（基于肌酐和胱抑素），随后通过Wilks的lambda检验进行确认，以获得肾功能方程。
CKD方程（肌酐）=7.094238 - 0.043104×CKD-EPI肌酐 - 0.057537×血细胞比容。CKD方程（胱抑素）=8.375074 - 0.117218×CKD-EPI胱抑素。CKI方程（肌酐）=0.428389 - 0.043214×CKD-EPI肌酐 + 0.183051×Child-Pugh评分 + 0.050162×年龄（岁）。CKI方程（胱抑素）=9.169579 - 0.139319×CKD-EPI胱抑素。
已获得用于筛查肝硬化患者慢性肾脏病和慢性肾功能不全的简单可靠方程。
