种族在接受肾细胞癌切除术的大型、多种族患者队列中对未来肾小球滤过率方程的表现。
Performance of Future Glomerular Filtration Rate Equation by Race in a Large, Racially Diverse Patient Cohort Undergoing Nephrectomy for Renal Cell Carcinoma.
机构信息
Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
Department of Urology, Emory University School of Medicine, Atlanta, GA.
出版信息
Urology. 2024 Jan;183:147-156. doi: 10.1016/j.urology.2023.07.050. Epub 2023 Oct 16.
OBJECTIVE
To examine the performance of the Palacios et al [Aguilar Palacios D, Wilson B, Ascha M, et al. New baseline renal function after radical or partial nephrectomy: a simple and accurate predictive model. J Urol. 2021;205:1310-1320] post-nephrectomy future glomerular function rate (fGFR) equation in a diverse cohort using both the Chronic Kidney Disease Epidemiology (CKD-EPI) 2009 equation with race, used in the creation of the formula, as well as the CKD-EPI 2021 equation without race.
METHODS
Patients who underwent partial or radical nephrectomy for renal cell carcinoma from 2005-2021 were identified in our institutional database. Patients with creatinine values preoperatively and 3-12 months postoperatively were included. Correlation/bias/accuracy/precision of the fGFR equation (fGFR = 35+ [preoperative eGFR × 0.65] - 18 [if radical] - [age × 0.25] + 3 [if tumor >7 cm] - 2 [if diabetes]) with observed postoperative eGFR was determined by both the CKD-EPI-2021 and CKD-EPI 2009 equations.
RESULTS
A total of 1443 patients were analyzed. Seventy-one percent (1024) were White and 22.9% (331) were Black. Most underwent radical nephrectomy (60.3%). 40% T3-T4 renal cell carcinoma (RCC), with 14.8% of patients having M1 disease. Median observed vs predicted fGFR was 58.0 vs 58.7 mL/min/1.73 m for CKD-EPI 2021 and 56.0 vs 57.5 for CKD-EPI 2009. For the total cohort, the correlation/bias/accuracy/precision of the fGFR equation was 0.805/-0.5/81.7/7.9-9.0 for CKD-EPI 2021 and 0.809/-0.8/81.3/-8.1 to 8 for CKD-EPI 2009. In Black patients, fGFR equation demonstrated >75% accuracy with both CKD-EPI equations; however, accuracy was lower in black patients with the CKD-EPI2021 equation (76.1% vs 83.4%, P = .003).
CONCLUSION
The fGFR equation performed well in our large, diverse cohort, though accuracy was relatively lower when using CKD-EPI 2021 compared to CKD-EPI 2009.
目的
使用创建公式时使用的种族的慢性肾脏病流行病学（CKD-EPI）2009 方程以及没有种族的 CKD-EPI 2021 方程，在不同队列中检验 Palacios 等人的术后肾小球滤过率（fGFR）方程的性能[Aguilar Palacios D, Wilson B, Ascha M, 等。根治性或部分肾切除术后新的基础肾功能：一种简单而准确的预测模型。J Urol. 2021;205:1310-1320]。
方法
在我们的机构数据库中确定了 2005-2021 年因肾细胞癌接受部分或根治性肾切除术的患者。纳入术前和术后 3-12 个月有肌酐值的患者。通过 CKD-EPI-2021 和 CKD-EPI 2009 方程确定 fGFR 方程（fGFR=35+[术前 eGFR×0.65]-18[如果是根治性]–[年龄×0.25]+3[如果肿瘤>7cm]-2[如果糖尿病]）与观察到的术后 eGFR 的相关性/偏差/准确性/精度。
结果
共分析了 1443 名患者。71%（1024 人）为白人，22.9%（331 人）为黑人。大多数患者接受根治性肾切除术（60.3%）。40% T3-T4 肾细胞癌（RCC），14.8%的患者有 M1 期疾病。中位观察到的与预测的 fGFR 分别为 CKD-EPI 2021 为 58.0 vs 58.7mL/min/1.73m，CKD-EPI 2009 为 56.0 vs 57.5。对于整个队列，fGFR 方程的相关性/偏差/准确性/精度为 CKD-EPI 2021 为 0.805/-0.5/81.7/7.9-9.0，CKD-EPI 2009 为 0.809/-0.8/81.3/-8.1 至 8。在黑人患者中，两种 CKD-EPI 方程的 fGFR 方程的准确性均>75%；然而，在使用 CKD-EPI2021 方程时，黑人患者的准确性较低（76.1%比 83.4%，P=0.003）。
结论
fGFR 方程在我们的大型、多样化队列中表现良好，尽管与 CKD-EPI 2009 相比，使用 CKD-EPI 2021 时准确性相对较低。
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