使用欧洲肾脏功能协会和慢性肾脏病流行病学合作组公式对西澳大利亚社区人群进行估算肾小球滤过率常规报告的影响。

Impact of routine reporting of estimated glomerular filtration rate using the European Kidney Function Consortium and Chronic Kidney Disease Epidemiology Collaboration equations in a Western Australian community population.

机构信息

Curtin Institute for Computation, Curtin University, Perth, Western Australia, Australia.

Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.

出版信息

Nephrology (Carlton). 2022 Oct;27(10):823-833. doi: 10.1111/nep.14083. Epub 2022 Aug 15.

DOI:10.1111/nep.14083

PMID:36122908

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9804785/

Abstract

AIM

In 2020, the European Kidney Function Consortium (EKFC) published a new creatinine-based equation to estimate glomerular filtration rate (eGFR) to overcome known limitations in existing equations. The aim of this study is to model the potential impact on service referral and health expenditure of routine reporting of eGFR using the EKFC equation as compared to the CKD-EPI equation in a Western Australian population.

METHODS

eGFR was calculated for 760 614 patients with 2 368 234 creatinine results using the CKD-EPI and EKFC formulas. Patients were grouped into a CKD cohort if they had at least two eGFR results of <60 ml/min/1.73 m from tests at least 90 days apart. The impact of each equation on the reclassification of CKD stages, CKD cohort classification, the rate of change in eGFR and direct health costs were assessed.

RESULTS

About 90.66% of patients had a lower eGFR when calculated using the EKFC equation. About 12.6% of individuals were classified into a different CKD stage using the EKFC equation with 97.43% of these patients classified into a higher (more advanced) stage. There was a 25.9% increase in the number of patients identified as having CKD when calculated using the EKFC equation. Direct health costs also increased with the use of EKFC reporting.

CONCLUSION

Use of the EKFC equation will increase population prevalence of CKD and will result in a shift to higher stages of CKD. This has implications for monitoring and referral of patients within specialist services and has the potential to increase the need for multidisciplinary care.

摘要

目的

2020 年，欧洲肾脏功能联合会（EKFC）发布了一种新的基于肌酐的方程来估计肾小球滤过率（eGFR），以克服现有方程的已知局限性。本研究旨在通过在西澳大利亚人群中使用 EKFC 方程与 CKD-EPI 方程常规报告 eGFR，模拟其对服务转介和健康支出的潜在影响。

方法

使用 CKD-EPI 和 EKFC 公式计算了 760614 例患者的 2368234 次肌酐结果的 eGFR。如果患者至少有两次 eGFR 结果<60ml/min/1.73m，且两次检测至少相隔 90 天，则将其归入 CKD 队列。评估了每个方程对 CKD 分期的重新分类、CKD 队列分类、eGFR 变化率和直接健康成本的影响。

结果

使用 EKFC 方程计算时，约 90.66%的患者 eGFR 较低。约 12.6%的个体使用 EKFC 方程被分类为不同的 CKD 分期，其中 97.43%的患者被分类为更高（更晚期）的分期。使用 EKFC 方程计算时，被确定患有 CKD 的患者人数增加了 25.9%。使用 EKFC 报告还增加了直接健康成本。