Delanaye Pierre, Masson Ingrid, Maillard Nicolas, Pottel Hans, Mariat Christophe
Department of Nephrology-Dialysis-Transplantation, University de Liège, CHU Sart Tilman, Liège, Belgium.
Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France.
Transplantation. 2022 Dec 1;106(12):2443-2447. doi: 10.1097/TP.0000000000004234. Epub 2022 Aug 2.
Whether the new chronic kidney disease-epidemiology (CKD-EPI) equation without the race variable remains accurate enough for glomerular filtration rate (GFR) estimation in non-US kidney transplant recipients (KTRs) is unclear. We sought to compare the predictive performance between this equation and the classical CKD-EPI equation in a French cohort of KTRs. We also evaluated the performance of the European Kidney Function Consortium (EKFC) equation, an estimate that has proved very accurate in nontransplant patients and that does not include race variable.
We retrospectively selected 489 KTRs for whom GFR was measured by inulin clearance. Performances of GFR equations were compared according to median bias, imprecision, and accuracy within 30% (P30) and 20% (P20). Differences in P20/P30 were tested using the exact McNemar test.
Although the 4 equations exhibited a similar level of imprecision, the bias of the new CKD-EPI equation was +5.5 (4.0; 6.6) mL/min/1.73 m², much higher than the bias of the classical CKD-EPI, EKFC, and Modified Diet in Renal Diseases (MDRD) equation (2.4 [1.7;3.5], 2.2 [1.1;3.1], and -0.5 [-1.5; 1.0] mL/min/1.73 m², respectively). The new CKD-EPI equation was significantly less accurate with a P30 of 68.3% as compared with 74.2%, 75.3%, and 77.1% for the classical CKD-EPI, EKFC, and MDRD equation, respectively. The EKFC equation outperformed both versions of the CKD-EPI equation in terms of P20.
The new CKD-EPI equation is suboptimal for the care and follow-up of European transplanted patients. The EKFC equation shows at least a similar performance to the MDRD and the classical CKD-EPI equation. Further validation of the EKFC equation in KTRs from a diverse ethnic background is needed.
对于非美国肾移植受者（KTR），不包含种族变量的新慢性肾脏病流行病学（CKD-EPI）方程在估算肾小球滤过率（GFR）时是否仍足够准确尚不清楚。我们试图比较该方程与经典CKD-EPI方程在一组法国KTR中的预测性能。我们还评估了欧洲肾功能联盟（EKFC）方程的性能，该估算方法在非移植患者中已被证明非常准确且不包含种族变量。
我们回顾性选择了489例通过菊粉清除率测量GFR的KTR。根据中位数偏差、不精密度以及30%（P30）和20%（P20）范围内的准确性比较GFR方程的性能。使用精确的McNemar检验测试P20/P30的差异。
尽管这4个方程表现出相似程度的不精密度，但新CKD-EPI方程的偏差为+5.5（4.0；6.6）mL/min/1.73 m²，远高于经典CKD-EPI、EKFC和肾脏病膳食改良（MDRD）方程的偏差（分别为2.4 [1.7；3.5]、2.2 [1.1；3.1]和 -0.5 [-1.5；1.0] mL/min/1.73 m²）。新CKD-EPI方程的准确性明显较低，P30为68.3%，而经典CKD-EPI、EKFC和MDRD方程的P30分别为74.2%、75.3%和77.1%。在P20方面，EKFC方程优于两种版本的CKD-EPI方程。
新CKD-EPI方程对于欧洲移植患者的护理和随访并非最优。EKFC方程显示出至少与MDRD方程和经典CKD-EPI方程相似的性能。需要在不同种族背景的KTR中进一步验证EKFC方程。
