Fujii Ryosuke, Pattaro Cristian, Tsuboi Yoshiki, Ishihara Yuya, Melotti Roberto, Yamada Hiroya, Ando Yoshitaka, Ishikawa Hiroaki, Ohashi Koji, Hashimoto Shuji, Hamajima Nobuyuki, Barbieri Giulia, Ghasemi-Semeskandeh Dariush, Suzuki Koji
Institute for Biomedicine (affiliated to the University of Lübeck), Eurac Research, via Alessandro Volta 21, 39100 Bolzano/Bozen, Italy; Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192 Japan.
Institute for Biomedicine (affiliated to the University of Lübeck), Eurac Research, via Alessandro Volta 21, 39100 Bolzano/Bozen, Italy.
Clin Biochem. 2023 Jan;111:54-59. doi: 10.1016/j.clinbiochem.2022.10.011. Epub 2022 Nov 2.
Previous studies have proposed different formulas of estimating glomerular filtration rate (eGFR) among clinical patients. The comprehensive comparison of eGFR formulas is not well established in a Japanese population. We compared eGFR values and chronic kidney disease (CKD) classification of nine different eGFR in a Japanese general population sample.
We analyzed 469 Japanese community-dwelling adults (184 men) without any self-reported kidney disease. GFR estimated using the 4- and 6-parameter Modification of Diet in Renal Disease (MDRD) formulas (MDRD4 and MDRD6); the CKD-EPI formulas based on creatinine with (CKD-EPI-2009) and without race coefficient (CKD-EPI-2021), on cystatin C (CKD-EPI-Cys), on both (CKD-EPI-CreCys); the Japanese creatinine-based formula (JPN-Cre), cystatin C-based formula (JPN-Cys), and modified CKD-EPI formula (JPN-CKD-EPI). CKD stages were defined by KDIGO guidelines (eGFR < 60 ml/min/1.73 m).
eGFR (mean = 71.2; SD = 14.3) were much lower than eGFR (mean = 94.2; SD = 12.7), while eGFR (mean = 102.8; SD = 24.2) was comparable to the MDRD and CKD-EPI formulas. The difference between eGFR and eGFR showed a V-shaped distribution across eGFR levels, indicating complex errors between these formulas. We observed very low agreement in CKD classification between eGFR and the eGFR (kappa = 0.13; 95% confidence interval: 0.06, 0.23).
JPN-Cre was substantially different from the CKD-EPI formula without race term (CKD-EPI-2021), which means that it is impossible to recalibrate those with a simple coefficient. Although a comparison with measured GFR should be necessary, choice of the estimation method needs caution in clinical decision-making and academic research.
以往研究提出了临床患者中估算肾小球滤过率（eGFR）的不同公式。在日本人群中，eGFR公式的全面比较尚未充分确立。我们在一个日本普通人群样本中比较了9种不同eGFR的eGFR值和慢性肾脏病（CKD）分类。
我们分析了469名无任何自我报告肾脏疾病的日本社区居住成年人（184名男性）。使用4参数和6参数肾病饮食改良（MDRD）公式（MDRD4和MDRD6）估算GFR；基于肌酐且有（CKD-EPI-2009）和无种族系数（CKD-EPI-2021）的CKD-EPI公式、基于胱抑素C的（CKD-EPI-Cys）、基于两者的（CKD-EPI-CreCys）；基于肌酐的日本公式（JPN-Cre）、基于胱抑素C的公式（JPN-Cys）以及改良的CKD-EPI公式（JPN-CKD-EPI）。CKD分期根据KDIGO指南定义（eGFR < 60 ml/min/1.73 m²）。
JPN-Cre的eGFR（均值 = 71.2；标准差 = 14.3）远低于MDRD4的eGFR（均值 = 94.2；标准差 = 12.7），而JPN-CKD-EPI的eGFR（均值 = 102.8；标准差 = 24.2）与MDRD和CKD-EPI公式相当。JPN-Cre的eGFR与MDRD4的eGFR之间的差异在eGFR水平上呈V形分布，表明这些公式之间存在复杂的误差。我们观察到JPN-Cre的CKD分类与MDRD4的CKD分类之间的一致性非常低（kappa = 0.13；95%置信区间：0.06，0.23）。
JPN-Cre与无种族项的CKD-EPI公式（CKD-EPI-2021）有很大差异，这意味着不可能用一个简单系数对其进行重新校准。尽管有必要与测量的GFR进行比较，但在临床决策和学术研究中，估算方法的选择需要谨慎。
