Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2024 May;68(5):619-625. doi: 10.1111/aas.14397. Epub 2024 Feb 27.
Renal dysfunction is a common complication after heart transplantation (Htx). Glomerular filtration rate (GFR) can be assessed by various estimating equations (eGFR). We evaluated the correlation, agreement, and accuracy between eGFR and mGFR and the ability of eGFR to track changes in mGFR early after Htx.
A single-center prospective observational study on 55 patients undergoing Htx. Serum creatinine and mGFR (plasma clearance of Cr-EDTA or iohexol) were measured preoperatively and on the fourth postoperative day. The accuracy of eGFR to predict true mGFR was calculated as the percentage of patients with an eGFR within 30% of mGFR (P30). The agreement between eGFR and mGFR was assessed according to Bland and Altman. A four-quadrant plot was made to evaluate the ability of eGFR to track changes in mGFR.
The accuracy of eGFR to assess mGFR was 52%. The bias was 11.2 ± 17.4 mL/min/1.72 m. The limits of agreement were -23.0 to 45.4 mL/min/1.72 m and the error 58%. The concordance rate between eGFR and mGFR was 72%.
eGFR underestimated mGFR and the agreement between eGFR and mGFR was low with an unacceptably large between-group error and low accuracy. Furthermore, the ability of eGFR to assess changes in mGFR, postoperatively, was poor. Thus, the use of estimating equations from serum creatinine will not adequately assess renal function early after major heart surgery. To gain adequate information on renal function early after Htx, GFR needs to be measured, not estimated.
肾功能障碍是心脏移植（Htx）后的常见并发症。肾小球滤过率（GFR）可以通过各种估算方程（eGFR）进行评估。我们评估了 eGFR 与 mGFR 之间的相关性、一致性和准确性，以及 eGFR 早期跟踪 Htx 后 mGFR 变化的能力。
对 55 例接受 Htx 的患者进行单中心前瞻性观察研究。术前和术后第 4 天测量血清肌酐和 mGFR（Cr-EDTA 或 iohexol 的血浆清除率）。eGFR 预测真实 mGFR 的准确性计算为 eGFR 与 mGFR 相差 30%以内的患者百分比（P30）。根据 Bland 和 Altman 评估 eGFR 与 mGFR 的一致性。制作四象限图评估 eGFR 跟踪 mGFR 变化的能力。
eGFR 评估 mGFR 的准确性为 52%。偏差为 11.2±17.4 mL/min/1.72 m。一致性界限为-23.0 至 45.4 mL/min/1.72 m，误差为 58%。eGFR 与 mGFR 的符合率为 72%。
eGFR 低估了 mGFR，eGFR 与 mGFR 之间的一致性较差，组间误差大且准确性低。此外，eGFR 评估术后 mGFR 变化的能力较差。因此，在重大心脏手术后早期，使用血清肌酐估算方程不能充分评估肾功能。为了在 Htx 后早期获得有关肾功能的充分信息，需要测量而不是估算 GFR。
