Selistre Luciano, de Souza Vandréa, Nicola Carla, Juillard Laurent, Lemoine Sandrine, Derain-Dubourg Laurence
Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Néphrologie Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Lyon, France.
CAPES, Coordenação de Aperfeiçoamento do Pessoal de Nível Superior, Brasilia, Brazil.
Clin Kidney J. 2023 May 26;16(8):1298-1306. doi: 10.1093/ckj/sfad050. eCollection 2023 Aug.
Creatinine-based equations such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) are recommended for estimating glomerular filtration rate (eGFR) in clinical practice, but have reduced performance in advanced stages of chronic kidney disease. However, only rarely studies have evaluated the performance of eGFR by measuring the average of the urinary clearances of creatinine and urea (mCl) compared with the eGFR equations.
This cross-sectional study evaluated the usefulness of mCl in a population of 855 participants who performed a GFR measurement by urinary inulin clearance. The performance of mCl was compared with those of CKD-EPI 2009 and CKD-EPI 2021, considering three criteria: bias, precision and accuracy.
In the whole sample, the mCl performed similarly to CKD-EPI equations (2009 and 2021) [precision: 11.5 (95% CI 10.5; 12.5) vs 19.0 (95% CI 17.2; 20.1) and 19.1 (95% CI 17.4; 20.4), and accuracy P: 97.0 (95% CI 95.8; 98.0) vs 82.0 (95% CI 79.2; 84.4) and 77.2 (95% CI 74.5; 80.0)]. The CKD-EPI equations (2009 and 2021) had the best performance when mGFR was >60 mL/min/1.73 m. In contrast, the mCl performed better than others with lowest mGFR values, more noticeable when mGFR was <60 mL/min/1.73 m.
The study described the best performance of mCl at GFR levels below 60 mL/min/1.73 m and a satisfactory result in the overall cohort. The findings point to a role of this tool, especially for estimating GFR in chronic kidney disease patients in developing countries, when reference measurement of GFR is not available.
在临床实践中，推荐使用基于肌酐的方程，如慢性肾脏病流行病学协作组（CKD-EPI）方程来估算肾小球滤过率（eGFR），但在慢性肾脏病晚期其性能会下降。然而，仅有极少数研究通过测量肌酐和尿素的尿清除率平均值（mCl）来评估eGFR的性能，并与eGFR方程进行比较。
这项横断面研究评估了mCl在855名通过菊粉清除率测量肾小球滤过率的参与者中的有效性。将mCl的性能与CKD-EPI 2009和CKD-EPI 2021的性能进行比较，考虑三个标准：偏差、精密度和准确性。
在整个样本中，mCl的表现与CKD-EPI方程（2009年和2021年）相似[精密度：11.5（95%CI 10.5；12.5）对19.0（95%CI 17.2；20.1）和19.1（95%CI 17.4；20.4），准确性P：97.0（95%CI 95.8；98.0）对82.0（95%CI 79.2；84.4）和77.2（95%CI 74.5；80.0）]。当mGFR>60 mL/min/1.73 m²时，CKD-EPI方程（2009年和2021年）表现最佳。相反，当mGFR值最低时，mCl的表现优于其他方法，当mGFR<60 mL/min/1.73 m²时更为明显。
该研究描述了mCl在肾小球滤过率低于60 mL/min/×1.73 m²时的最佳性能，以及在整个队列中的满意结果。研究结果表明该工具具有一定作用，特别是在无法进行肾小球滤过率参考测量时，用于估算发展中国家慢性肾脏病患者的肾小球滤过率。
