量化肾小球滤过率估计的个体水平误差：一项横断面研究。
Quantifying Individual-Level Inaccuracy in Glomerular Filtration Rate Estimation : A Cross-Sectional Study.
机构信息
Division of Nephrology, Department of Medicine, Department of Physiology, and Department of Population Health, Bower School of Population Health, The University of Mississippi Medical Center, Jackson, Mississippi (T.S.).
Department of Data Science, Bower School of Population Health, The University of Mississippi Medical Center, Jackson, Mississippi (X.Z., S.T.L.).
出版信息
Ann Intern Med. 2022 Aug;175(8):1073-1082. doi: 10.7326/M22-0610. Epub 2022 Jul 5.
BACKGROUND
Although the population-level differences between estimated glomerular filtration rate (eGFR) and measured glomerular filtration rate (mGFR) are well recognized, the magnitude and potential clinical implications of individual-level differences are unknown.
OBJECTIVE
To quantify the magnitude and consequences of the individual-level differences between mGFRs and eGFRs.
DESIGN
Cross-sectional study.
SETTING
Four U.S. community-based epidemiologic cohort studies with mGFR.
PATIENTS
3223 participants in 4 studies.
MEASUREMENTS
The GFRs were measured using urinary iothalamate and plasma iohexol clearance; the eGFR was calculated from serum creatinine concentration alone (eGFR) and with cystatin C. All GFR results are presented as mL/min/1.73 m.
RESULTS
The participants' mean age was 59 years; 32% were Black, 55% were women, and the mean mGFR was 68. The population-level differences between mGFR and eGFR were small; the median difference (mGFR - eGFR) was -0.6 (95% CI, -1.2 to -0.2); however, the individual-level differences were large. At an eGFR of 60, 50% of mGFRs ranged from 52 to 67, 80% from 45 to 76, and 95% from 36 to 87. At an eGFR of 30, 50% of mGFRs ranged from 27 to 38, 80% from 23 to 44, and 95% from 17 to 54. Substantial disagreement in chronic kidney disease staging by mGFR and eGFR was present. Among those with eGFR of 45 to 59, 36% had mGFR greater than 60 whereas 20% had mGFR less than 45; among those with eGFR of 15 to 29, 30% had mGFR greater than 30 and 5% had mGFR less than 15. The eGFR based on cystatin C did not provide substantial improvement.
LIMITATION
Single measurement of mGFR and serum markers without short-term replicates.
CONCLUSION
A substantial individual-level discrepancy exists between the mGFR and the eGFR. Laboratories reporting eGFR should consider including the extent of this uncertainty to avoid misinterpretation of eGFR as an mGFR replacement.
PRIMARY FUNDING SOURCE
National Institutes of Health.
背景
虽然估算肾小球滤过率（eGFR）和实测肾小球滤过率（mGFR）之间的人群水平差异已得到充分认识，但个体水平差异的程度和潜在临床意义尚不清楚。
目的
量化 mGFR 和 eGFR 个体水平差异的程度和后果。
设计
横断面研究。
地点
四项基于美国社区的具有 mGFR 的流行病学队列研究。
患者
四项研究中的 3223 名参与者。
测量
使用尿碘海醇和血浆 iohexol 清除率测量 GFR；通过血清肌酐浓度（eGFR）和胱抑素 C 计算 eGFR。所有 GFR 结果均以 mL/min/1.73 m 表示。
结果
参与者的平均年龄为 59 岁；32%为黑人，55%为女性，平均 mGFR 为 68。mGFR 和 eGFR 之间的人群水平差异较小；中位数差异（mGFR-eGFR）为-0.6（95%CI，-1.2 至-0.2）；然而，个体水平差异较大。在 eGFR 为 60 的情况下，50%的 mGFR 范围在 52 到 67，80%的 mGFR 范围在 45 到 76，95%的 mGFR 范围在 36 到 87。在 eGFR 为 30 的情况下，50%的 mGFR 范围在 27 到 38，80%的 mGFR 范围在 23 到 44，95%的 mGFR 范围在 17 到 54。mGFR 和 eGFR 慢性肾脏病分期存在显著差异。在 eGFR 为 45 到 59 的人群中，有 36%的 mGFR 大于 60，而有 20%的 mGFR 小于 45；在 eGFR 为 15 到 29 的人群中，有 30%的 mGFR 大于 30，而有 5%的 mGFR 小于 15。基于胱抑素 C 的 eGFR 并不能提供实质性的改善。
局限性
mGFR 和血清标志物的单次测量，没有短期重复。
结论
mGFR 和 eGFR 之间存在显著的个体水平差异。报告 eGFR 的实验室应考虑包括这种不确定性的程度，以避免将 eGFR 错误地解释为 mGFR 的替代品。
主要资金来源
美国国立卫生研究院。
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