Choi Rihwa, Lee Sang Gon, Lee Eun Hee
Department of Laboratory Medicine, Green Cross Laboratories, Yongin 16924, Korea.
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
J Clin Med. 2022 Sep 11;11(18):5339. doi: 10.3390/jcm11185339.
We retrospectively reviewed the estimated glomerular filtration rates (eGFR) calculated by three equations: (1) Modification of Diet in Renal Disease Study (MDRD), (2) Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) using serum creatinine in 2009 (CKD-EPI 2009), and (3) CKD-EPI suggested in 2021 (CKD-EPI 2021), in an adult Korean population visiting local clinics and hospitals for health check-ups between 2019 and 2021 to investigate the effect of changes in the prevalence of chronic kidney diseases using those equations. During the study period, serum creatinine tests were performed on 442,566 subjects (205,236 men and 237,330 women). The overall prevalence rates of decreased eGFR (<60 mL/min/1.73 m2) at baseline measurement were as follows: 3.4% using MDRD, 2.8% using CKD-EPI 2009, and 2.1% using CKD-EPI 2021. The prevalence of decreased eGFR increased with age. Among 442,566 tests, specimens having simultaneously measured random urine dipstick tests for proteinuria represented 6.0% of the population, and the albumin-creatinine ratio (ACR) was 0.3%. The prevalence of specimens having both decreased eGFR and proteinuria was significantly different among equations (p < 0.05). Among the three equations, MDRD and CKD-EPI 2009 had a similar specimen prevalence of decreased eGFR and proteinuria (≥1+) using a dipstick test or albuminuria (urine ACR > 30 mg/g creatinine), while those based on CKD-EPI 2021 were about half of those based on MDRD and CKD-EPI 2009. Future studies are needed to clarify the clinical impact of the changes in the calculations for eGFR.
我们回顾性分析了通过三个公式计算的估计肾小球滤过率(eGFR):(1)肾脏疾病饮食改良研究(MDRD)公式;(2)慢性肾脏病流行病学协作组(CKD-EPI)2009年使用血清肌酐的公式(CKD-EPI 2009);(3)CKD-EPI 2021年建议的公式(CKD-EPI 2021)。研究对象为2019年至2021年间前往当地诊所和医院进行健康检查的成年韩国人群,旨在探讨使用这些公式计算慢性肾脏病患病率变化的影响。研究期间,对442,566名受试者(205,236名男性和237,330名女性)进行了血清肌酐检测。基线测量时eGFR降低(<60 mL/min/1.73 m²)的总体患病率如下:使用MDRD公式为3.4%,使用CKD-EPI 2009公式为2.8%,使用CKD-EPI 2021公式为2.1%。eGFR降低的患病率随年龄增长而增加。在442,566次检测中,同时进行随机尿试纸法蛋白尿检测的标本占人群的6.0%,白蛋白-肌酐比值(ACR)为0.3%。不同公式计算出的eGFR降低且伴有蛋白尿的标本患病率存在显著差异(p<0.05)。在这三个公式中,MDRD和CKD-EPI 2009使用试纸法检测或白蛋白尿(尿ACR>30 mg/g肌酐)时,eGFR降低且伴有蛋白尿(≥1+)的标本患病率相似,而基于CKD-EPI 2021的患病率约为基于MDRD和CKD-EPI 2009的一半。未来需要进一步研究以明确eGFR计算方法变化的临床影响。