Department of Pediatrics, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA.
Children's Hospital of Orange County, Orange, CA, USA.
Pediatr Nephrol. 2024 Jul;39(7):2177-2186. doi: 10.1007/s00467-024-06316-6. Epub 2024 Mar 1.
An accurate, rapid estimate of glomerular filtration rate (GFR) in kidney transplant patients affords early detection of transplant deterioration and timely intervention. This study compared the performance of serum creatinine (Cr) and cystatin C (CysC)-based GFR equations to measured GFR (mGFR) using iohexol among pediatric kidney transplant recipients.
CysC, Cr, and mGFR were obtained from 45 kidney transplant patients, 1-18 years old. Cr- and CysC-estimated GFR (eGFR) was compared against mGFR using the Cr-based (Bedside Schwartz, U25-Cr), CysC-based (Gentian CysC, CAPA, U25-CysC), and Cr-CysC combination (CKiD Cr-CysC, U25 Cr-CysC) equations in terms of bias, precision, and accuracy. Bland-Altman plots assessed the agreement between eGFR and mGFR. Secondary analyses evaluated the formulas in patients with biopsy-proven histological changes, and K/DOQI CKD staging.
Bias was small with Gentian CysC (0.1 ml/min/1.73 m); 88.9% and 37.8% of U25-CysC estimations were within 30% and 10% of mGFR, respectively. In subjects with histological changes on biopsy, Gentian CysC had a small bias and U25-CysC were more accurate-both with 83.3% of and 41.7% of estimates within 30% and 10% mGFR, respectively. Precision was better with U25-CysC, CKiD Cr-CysC, and U25 Cr-CysC. Bland-Altman plots showed the Bedside Schwartz, Gentian CysC, CAPA, and U25-CysC tend to overestimate GFR when > 100 ml/min/1.72 m. CAPA misclassified CKD stage the least (whole cohort 24.4%, histological changes on biopsy 33.3%).
In this small cohort, CysC-based equations with or without Cr may have better bias, precision, and accuracy in predicting GFR.
在肾移植患者中，准确、快速地估计肾小球滤过率（GFR）可早期发现移植功能恶化并及时进行干预。本研究比较了血清肌酐（Cr）和胱抑素 C（CysC）基于 GFR 方程与碘海醇测量 GFR（mGFR）在儿科肾移植受者中的表现。
45 名 1-18 岁的肾移植患者获得了 CysC、Cr 和 mGFR。使用基于 Cr 的（床边 Schwartz，U25-Cr）、基于 CysC 的（龙胆 CysC，CAPA，U25-CysC）和 Cr-CysC 组合（CKiD Cr-CysC，U25 Cr-CysC）方程，比较 Cr 基（Cr 基（Bedside Schwartz，U25-Cr））和 CysC 基（Gentian CysC，CAPA，U25-CysC）eGFR 与 mGFR 的偏差、精密度和准确性。Bland-Altman 图评估了 eGFR 与 mGFR 的一致性。二次分析评估了在有组织学变化的患者中的公式，以及 K/DOQI CKD 分期。
Gentian CysC 的偏差较小（0.1ml/min/1.73m）；U25-CysC 估计值的 88.9%和 37.8%分别在 mGFR 的 30%和 10%以内。在活检有组织学变化的患者中，Gentian CysC 的偏差较小，U25-CysC 的准确性更高，83.3%和 41.7%的估计值分别在 mGFR 的 30%和 10%以内。U25-CysC、CKiD Cr-CysC 和 U25 Cr-CysC 的精密度更好。Bland-Altman 图显示，Bedside Schwartz、Gentian CysC、CAPA 和 U25-CysC 当 GFR>100ml/min/1.72m 时，GFR 往往被高估。CAPA 对 CKD 分期的错误分类最少（整个队列 24.4%，活检有组织学变化 33.3%）。
在这个小队列中，基于 CysC 的方程与 Cr 或不与 Cr 结合可能具有更好的预测 GFR 的偏差、精密度和准确性。
