Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi.
Department of Medicine, Division of Nephrology, Houston Methodist, Houston, Texas.
Curr Opin Nephrol Hypertens. 2023 Jan 1;32(1):89-97. doi: 10.1097/MNH.0000000000000854. Epub 2022 Nov 11.
Glomerular filtration rate (GFR) is the best index for kidney function and estimated GFR (eGFR) calculated from endogenous filtration markers like serum creatinine and cystatin C is widely used in clinical practice for chronic kidney disease diagnosis and prognostication. We sought to review the evolution of GFR estimating equations, nuances of eGFR interpretation, and utility of eGFR in drug dosing.
The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) serum creatinine eGFR equation was recently updated to exclude the race variable and the CKD-EPI creatinine-cystatin C equation demonstrated the highest reliability. Although calculated creatinine clearance by Cockcroft Gault has been traditionally used for drug dosing, the use of eGFR is slowly being adapted by the Food and Drug Administration for pharmacokinetic studies. However, the individual-level accuracy of eGFR using the CKD-EPI 2021 equations remained low, with the distribution of measured GFR at a given eGFR value spanning several CKD stages.
Although current methods of estimating GFR have improved in population measures of reliability, all have significant individual-level inaccuracies that can be an issue when clinical decision-making is contingent on the actual level of GFR. Modern methods of GFR measurements should be made widely available to enhance individualized patient decision-making.
肾小球滤过率（GFR）是肾功能的最佳指标，内源性滤过标志物（如血清肌酐和胱抑素 C）计算出的估算肾小球滤过率（eGFR）广泛应用于慢性肾脏病的诊断和预后。我们旨在综述 GFR 估算方程的发展、eGFR 解释的细微差别，以及 eGFR 在药物剂量调整中的应用。
慢性肾脏病流行病学合作（CKD-EPI）血清肌酐 eGFR 方程最近进行了更新，删除了种族变量，并且 CKD-EPI 肌酐-胱抑素 C 方程表现出最高的可靠性。虽然 Cockcroft-Gault 计算的肌酐清除率传统上用于药物剂量调整，但食品和药物管理局正在逐步将 eGFR 用于药代动力学研究。然而，使用 CKD-EPI 2021 方程的 eGFR 个体水平准确性仍然较低，在给定的 eGFR 值下，测量的 GFR 分布跨越了几个 CKD 阶段。
虽然目前估算 GFR 的方法在人群可靠性测量方面有所改进，但所有方法在个体水平上都存在显著的不准确性，这在临床决策取决于实际 GFR 水平时可能会成为一个问题。应该广泛提供现代 GFR 测量方法，以增强个体化患者决策。
