种族独立方程对评估肝病患者肾功能障碍时肾小球滤过率估计的影响。

Impact of race-independent equations on estimating glomerular filtration rate for the assessment of kidney dysfunction in liver disease.

机构信息

Department of Research and Development, Numares AG,, Am BioPark 9, 93053, Regensburg, Germany.

Department Néphrologie, Dialyse, Hypertension Et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Université Claude Bernard, Lyon 1, Lyon, France.

出版信息

BMC Nephrol. 2023 Mar 31;24(1):83. doi: 10.1186/s12882-023-03136-y.

DOI:10.1186/s12882-023-03136-y

PMID:37003973

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10064726/

Abstract

BACKGROUND

Altered hemodynamics in liver disease often results in overestimation of glomerular filtration rate (GFR) by creatinine-based GFR estimating (eGFR) equations. Recently, we have validated a novel eGFR equation based on serum myo-inositol, valine, and creatinine quantified by nuclear magnetic resonance spectroscopy in combination with cystatin C, age and sex (GFR). We hypothesized that GFR could improve chronic kidney disease (CKD) classification in the setting of liver disease.

RESULTS

We conducted a retrospective multicenter study in 205 patients with chronic liver disease (CLD), comparing the performance of GFR to that of validated CKD-EPI eGFR equations, including eGFRcr (based on creatinine) and eGFRcr-cys (based on both creatinine and cystatin C), using measured GFR as reference standard. GFR outperformed all other equations with a low overall median bias (-1 vs. -6 to 4 ml/min/1.73 m for the other equations; p < 0.05) and the lowest difference in bias between reduced and preserved liver function (-3 vs. -16 to -8 ml/min/1.73 m for other equations). Concordant classification by CKD stage was highest for GFR (59% vs. 48% to 53%) and less biased in estimating CKD severity compared to the other equations. GFR P30 accuracy (83%) was higher than that of eGFRcr (75%; p = 0.019) and comparable to that of eGFRcr-cys (86%; p = 0.578).

CONCLUSIONS

Addition of myo-inositol and valine to creatinine and cystatin C in GFR further improved GFR estimation in CLD patients and accurately stratified liver disease patients into CKD stages.

摘要

背景

肝脏疾病中的血流动力学改变通常会导致基于肌酐的肾小球滤过率（GFR）估计（eGFR）方程高估 GFR。最近，我们已经验证了一种基于血清肌醇、缬氨酸和肌酐的新型 eGFR 方程，该方程通过核磁共振光谱法与胱抑素 C、年龄和性别（GFR）相结合进行量化。我们假设 GFR 可以改善肝脏疾病患者的慢性肾脏病（CKD）分类。

结果

我们对 205 例慢性肝病（CLD）患者进行了回顾性多中心研究，将 GFR 与经过验证的 CKD-EPI eGFR 方程（包括基于肌酐的 eGFRcr 和基于肌酐和胱抑素 C 的 eGFRcr-cys）进行比较，以测量 GFR 为参考标准。GFR 的整体中位数偏差最低（-1 与其他方程的-6 至 4 ml/min/1.73 m；p < 0.05），并且在肝功能降低和保留之间的偏差最小（-3 与其他方程的-16 至-8 ml/min/1.73 m），优于所有其他方程。GFR 对 CKD 分期的一致性分类最高（59%比其他方程的 48%至 53%），并且与其他方程相比，对 CKD 严重程度的估计偏差更小。GFR P30 准确性（83%）高于 eGFRcr（75%；p = 0.019），与 eGFRcr-cys（86%；p = 0.578）相当。