Delanaye Pierre, Cavalier Etienne, Pottel Hans, Stehlé Thomas
Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium.
Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France.
Clin Kidney J. 2023 Mar 15;16(9):1375-1383. doi: 10.1093/ckj/sfad039. eCollection 2023 Sep.
Glomerular filtration rate (GFR) is estimated in clinical practice from equations based on the serum concentration of endogenous biomarkers and demographic data. The 2009 creatinine-based Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) was recommended worldwide until 2021, when it was recalibrated to remove the African-American race factor. The CKD-EPI and CKD-EPI equations overestimate GFR of adults aged 18-30 years, with a strong overestimation in estimated GFR (eGFR) at age 18 years. CKD-EPI does not perform better than CKD-EPI in US population, overestimating GFR in non-Black subjects, and underestimating it in Black subjects with the same magnitude. CKD-EPI performed worse than the CKD-EPI in White Europeans, and provides no or limited performance gains in Black European and Black African populations. The European Kidney Function Consortium (EKFC) equation, which incorporates median normal value of serum creatinine in healthy population, overcomes the limitations of the CKD-EPI equations: it provides a continuity of eGFR at the transition between pediatric and adult care, and performs reasonably well in diverse populations, assuming dedicated scaling of serum creatinine (Q) values is used. The new EKFC equation based on cystatin C (EKFC) shares the same mathematical construction, namely, it incorporates the median cystatin C value in the general population, which is independent of sex and ethnicity. EKFC is therefore a sex-free and race-free equation, which performs better than the CKD-EPI equation based on cystatin C. Despite advances in the field of GFR estimation, no equation is perfectly accurate, and GFR measurement by exogenous tracer clearance is still required in specific populations and/or specific clinical situations.
在临床实践中，肾小球滤过率（GFR）是根据基于内源性生物标志物血清浓度和人口统计学数据的公式来估算的。基于肌酐的2009年慢性肾脏病流行病学协作组公式（CKD-EPI）在2021年重新校准以去除非裔美国人种族因素之前，一直是全球推荐使用的公式。CKD-EPI和CKD-EPI公式高估了18至30岁成年人的GFR，在18岁时对估算肾小球滤过率（eGFR）有强烈的高估。在美国人群中，CKD-EPI的表现并不优于CKD-EPI，在非黑人受试者中高估GFR，而在黑人受试者中低估程度相同。在欧洲白人中，CKD-EPI的表现比CKD-EPI更差，在欧洲黑人和非洲黑人人群中没有或仅有有限的性能提升。欧洲肾功能联盟（EKFC）公式纳入了健康人群血清肌酐的中位数正常值，克服了CKD-EPI公式的局限性：它在儿科和成人护理过渡阶段提供了eGFR的连续性，并且在不同人群中表现良好，前提是使用血清肌酐（Q）值的专用缩放。基于胱抑素C的新EKFC公式（EKFC）具有相同的数学结构，即它纳入了一般人群中的胱抑素C中位数，该中位数与性别和种族无关。因此，EKFC是一个无性别和无种族的公式，其表现优于基于胱抑素C的CKD-EPI公式。尽管在GFR估算领域取得了进展，但没有一个公式是完全准确的，在特定人群和/或特定临床情况下，仍需要通过外源性示踪剂清除来测量GFR。
