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乌干达马萨卡地区转诊医院内科病房住院患者中，三种基于肌酐的方程评估的蛋白尿和估算肾小球滤过率降低与肾脏疾病患病率的比较：一项前瞻性研究。

Comparison of the prevalence of kidney disease by proteinuria and decreased estimated glomerular filtration rate determined using three creatinine-based equations among patients admitted on medical wards of Masaka Regional Referral Hospital in Uganda: a prospective study.

机构信息

Department of Medicine, Makerere University College of Health Sciences, P.O.BOX 7062, Kampala, Uganda.

Infectious Disease Research Collaboration, Kampala, Uganda.

出版信息

BMC Nephrol. 2022 Jul 7;23(1):242. doi: 10.1186/s12882-022-02865-w.

DOI:10.1186/s12882-022-02865-w

PMID:35799132

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9264612/

Abstract

BACKGROUND

Despite estimated glomerular filtration rate (eGFR) being the best marker for kidney function, there are no studies in sub-Saharan Africa comparing the performance of various equations used to determine eGFR. We compared prevalence of kidney disease determined by proteinuria of ≥ + 1 and or kidney disease improving global outcomes (KDIGO) eGFR criteria of < 60 ml/minute/1.73m determined using three creatinine-based equations among patients admitted on medical ward of Masaka Regional Referral Hospital.

METHODS

This was a prospective study conducted among adult patients admitted on medical wards between September 2020 to March 2021. Spot urine samples were collected to assess for proteinuria and blood samples were collected to assess serum creatinine levels. Kidney disease was defined as proteinuria of ≥ 1 + on spot urine dipstick and or KDIGO eGFR criteria of < 60 ml/minute/1.73m. Estimated glomerular filtration rate was calculated using three creatinine-based equations: a) Full Age Spectrum equation (FAS), b) chronic kidney disease-Epidemiology collaboration (CKD-EPI) 2021 equation, c) CKD EPI 2009 (without and with race factor) equation. CKD was determined after followed up at 90 days post enrollment to determine the chronicity of proteinuria of ≥ + 1 and or KDIGO eGFR criteria of < 60mls /minute/1.73m. We also compared prevalence of CKD determined by KDIGO eGFR criteria of < 60mls /minute/1.73m vs age adapted eGFR threshold criteria for defining CKD.

RESULTS

Among the 357 patients enrolled in the study, KDIGO eGFR criteria of < 60mls / minute determined using FAS and CKD-EPI 2009 without race factor equations and or proteinuria of ≥ + 1 showed the highest overall prevalence of kidney disease at 27.2%. Prevalence of confirmed CKD at 90 days was highest with proteinuria ≥ + 1 and or KDIGO eGFR criteria of < 60mls/min determined using CKD EPI 2009 without race factor Equation (15.1%).

CONCLUSIONS

Use of KDIGO eGFR criteria of < 60mls / minute /1.73m using FAS and CKD-EPI 2009 without race equations identifies the largest number of patients with CKD. Health care systems in sub-Saharan Africa should calculate eGFR using FAS equations or CKD-EPI 2009 without race equations during basic screening and management protocols.

摘要

背景

尽管估算肾小球滤过率（eGFR）是肾功能的最佳标志物，但在撒哈拉以南非洲地区，尚无比较用于确定 eGFR 的各种方程表现的研究。我们比较了使用三种基于肌酐的方程确定蛋白尿 ≥ +1 和/或肾脏病改善全球结局（KDIGO）eGFR 标准 < 60 ml/min/1.73m 在 Masaka 地区转诊医院内科病房住院的患者中肾脏疾病的患病率。

方法

这是一项前瞻性研究，于 2020 年 9 月至 2021 年 3 月期间在成年内科病房住院的患者中进行。采集尿液标本评估蛋白尿，采集血样评估血清肌酐水平。肾脏疾病定义为尿液点试纸蛋白尿 ≥ 1 + 和/或 KDIGO eGFR 标准 < 60 ml/min/1.73m。使用三种基于肌酐的方程计算估算肾小球滤过率：a）全年龄谱方程（FAS），b）慢性肾脏病-流行病学合作研究（CKD-EPI）2021 方程，c）CKD EPI 2009（无和有种族因素）方程。在纳入后 90 天进行随访以确定蛋白尿 ≥ 1 + 和/或 KDIGO eGFR 标准 < 60 ml/min/1.73m 的慢性肾脏病，确定慢性肾脏病。我们还比较了 KDIGO eGFR 标准 < 60 ml/min/1.73m 与年龄适应的 eGFR 阈值标准定义慢性肾脏病的患病率。

结果

在纳入的 357 名患者中，使用 FAS 和 CKD-EPI 2009 无种族因素方程以及蛋白尿 ≥ +1 确定的 KDIGO eGFR 标准 < 60 ml/min，总体肾脏疾病患病率最高，为 27.2%。在使用 CKD EPI 2009 无种族因素方程和蛋白尿 ≥ +1 和/或 KDIGO eGFR 标准 < 60 ml/min 确定的 90 天确诊慢性肾脏病的患病率最高（15.1%）。