基于胱抑素C的估算肾小球滤过率的公式，不纳入种族和性别因素。
Cystatin C-Based Equation to Estimate GFR without the Inclusion of Race and Sex.
作者信息
Pottel Hans, Björk Jonas, Rule Andrew D, Ebert Natalie, Eriksen Björn O, Dubourg Laurence, Vidal-Petiot Emmanuelle, Grubb Anders, Hansson Magnus, Lamb Edmund J, Littmann Karin, Mariat Christophe, Melsom Toralf, Schaeffner Elke, Sundin Per-Ola, Åkesson Anna, Larsson Anders, Cavalier Etienne, Bukabau Justine B, Sumaili Ernest K, Yayo Eric, Monnet Dagui, Flamant Martin, Nyman Ulf, Delanaye Pierre
机构信息
From the Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk (H.P.), and the Departments of Clinical Chemistry (E.C.) and Nephrology-Dialysis-Transplantation (P.D.), University of Liège, Centre Hospitalier Universitaire du Sart-Tilman, Liège - all in Belgium; the Division of Occupational and Environmental Medicine, Lund University (J.B., A.Å.), Clinical Studies Sweden, Forum South (J.B., A.Å.), and the Department of Clinical Chemistry (A.G.), Skåne University Hospital, Lund, the Function Area Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital Huddinge, and Department of Laboratory Medicine, Stockholm (M.H.), the Division of Clinical Chemistry, Huddinge (K.L.), the Department of Geriatrics, School Department of Laboratory Medicine, Karolinska Institutet of Medical Sciences, Örebro University, Örebro (P.-O.S.), the Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala (A.L.), and the Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö (U.N.) - all in Sweden; the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (A.D.R.); Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany (N.E., E.S.); the Section of Nephrology, University Hospital of North Norway and Metabolic and Renal Research Group, Universitetet i Tromsø the Arctic University of Norway, Tromsø, Norway (B.O.E., T.M.); Service de Néphrologie, Dialyse, Hypertension et Explorations Fonctionnelles Rénales, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon (L.D.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and Université de Paris, INSERM Unité 1149 (E.V.-P.), and AP-HP, Bichat Hospital, and Université de Paris, Unité Mixte de Recherche S1138, Cordeliers Research Center (M.F.), Paris, Service de Néphrologie, Dialyse et Transplantations Rénales, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne (C.M.), and the Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes (P.D.) - all in France; Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom (E.J.L.); the Renal Unit, Department of Internal Medicine, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo (J.B.B., E.K.S.); and the Département de Biochimie, Unité de Formation et de Recherche Sciences Pharmaceutiques et Biologiques, Université Felix Houphouët Boigny, Abidjan, Ivory Coast (E.Y., D.M.).
出版信息
N Engl J Med. 2023 Jan 26;388(4):333-343. doi: 10.1056/NEJMoa2203769.
BACKGROUND
The accuracy of estimation of kidney function with the use of routine metabolic tests, such as measurement of the serum creatinine level, has been controversial. The European Kidney Function Consortium (EKFC) developed a creatinine-based equation (EKFC eGFRcr) to estimate the glomerular filtration rate (GFR) with a rescaled serum creatinine level (i.e., the serum creatinine level is divided by the median serum creatinine level among healthy persons to control for variation related to differences in age, sex, or race). Whether a cystatin C-based EKFC equation would increase the accuracy of estimated GFR is unknown.
METHODS
We used data from patients in Sweden to estimate the rescaling factor for the cystatin C level in adults. We then replaced rescaled serum creatinine in the EKFC eGFRcr equation with rescaled cystatin C, and we validated the resulting EKFC eGFRcys equation in cohorts of White patients and Black patients in Europe, the United States, and Africa, according to measured GFR, levels of serum creatinine and cystatin C, age, and sex.
RESULTS
On the basis of data from 227,643 patients in Sweden, the rescaling factor for cystatin C was estimated at 0.83 for men and women younger than 50 years of age and 0.83 + 0.005 × (age - 50) for those 50 years of age or older. The EKFC eGFRcys equation was unbiased, had accuracy that was similar to that of the EKFC eGFRcr equation in both White patients and Black patients (11,231 patients from Europe, 1093 from the United States, and 508 from Africa), and was more accurate than the Chronic Kidney Disease Epidemiology Collaboration eGFRcys equation recommended by Kidney Disease: Improving Global Outcomes. The arithmetic mean of EKFC eGFRcr and EKFC eGFRcys further improved the accuracy of estimated GFR over estimates from either biomarker equation alone.
CONCLUSIONS
The EKFC eGFRcys equation had the same mathematical form as the EKFC eGFRcr equation, but it had a scaling factor for cystatin C that did not differ according to race or sex. In cohorts from Europe, the United States, and Africa, this equation improved the accuracy of GFR assessment over that of commonly used equations. (Funded by the Swedish Research Council.).
背景
使用常规代谢测试（如测量血清肌酐水平）来评估肾功能的准确性一直存在争议。欧洲肾功能联盟（EKFC）开发了一种基于肌酐的方程（EKFC eGFRcr），通过重新标度血清肌酐水平（即将血清肌酐水平除以健康人群的血清肌酐水平中位数，以控制与年龄、性别或种族差异相关的变化）来估计肾小球滤过率（GFR）。基于胱抑素C的EKFC方程是否会提高估计GFR的准确性尚不清楚。
方法
我们使用瑞典患者的数据来估计成人胱抑素C水平的重新标度因子。然后，我们用重新标度的胱抑素C取代EKFC eGFRcr方程中的重新标度血清肌酐，并根据测量的GFR、血清肌酐和胱抑素C水平、年龄和性别，在欧洲、美国和非洲的白人患者和黑人患者队列中验证所得的EKFC eGFRcys方程。
结果
根据瑞典227,643名患者的数据，50岁及以下男性和女性的胱抑素C重新标度因子估计为0.83，50岁及以上者为0.83 + 0.005×（年龄 - 50）。EKFC eGFRcys方程无偏差，在白人患者和黑人患者（来自欧洲的11,231名患者、来自美国的1093名患者和来自非洲的508名患者）中的准确性与EKFC eGFRcr方程相似，并且比《改善全球肾脏病预后》推荐的慢性肾脏病流行病学协作组eGFRcys方程更准确。EKFC eGFRcr和EKFC eGFRcys的算术平均值比单独使用任何一种生物标志物方程的估计值进一步提高了估计GFR的准确性。
结论
EKFC eGFRcys方程与EKFC eGFRcr方程具有相同的数学形式，但它对胱抑素C有一个不随种族或性别而变化的标度因子。在来自欧洲、美国和非洲的队列中，该方程比常用方程提高了GFR评估的准确性。（由瑞典研究理事会资助。）
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