Escamilla-Cabrera Beatriz, Luis-Lima Sergio, Gallego-Valcarce Eduardo, Sánchez-Dorta Nuria Victoria, Negrín-Mena Natalia, Díaz-Martín Laura, Cruz-Perera Coriolano, Hernández-Valles Ana Monserrat, González-Rinne Federico, Rodríguez-Gamboa María José, Estupiñán-Torres Sara, Miquel-Rodríguez Rosa, Cobo-Caso María Ángeles, Delgado-Mallén Patricia, Fernández-Suárez Gema, González-Rinne Ana, Hernández-Barroso Grimanesa, González-Delgado Alejandra, Torres-Ramírez Armando, Jiménez-Sosa Alejandro, Ortiz Alberto, Gaspari Flavio, Hernández-Marrero Domingo, Porrini Esteban Luis
Nephrology Department, Complejo Hospitalario Universitario de Canarias, La Laguna, Spain.
Facultad de Medicina, Universidad de La Laguna, La Laguna, Spain.
Sci Rep. 2024 Mar 3;14(1):5219. doi: 10.1038/s41598-024-55022-8.
The error of estimated glomerular filtration rate (eGFR) and its consequences in predialysis are unknown. In this prospective multicentre study, 315 predialysis patients underwent measured GFR (mGFR) by the clearance of iohexol and eGFR by 52 formulas. Agreement between eGFR and mGFR was evaluated by concordance correlation coefficient (CCC), total deviation index (TDI) and coverage probability (CP). In a sub-analysis we assessed the impact of eGFR error on decision-making as (i) initiating dialysis, (ii) preparation for renal replacement therapy (RRT) and (iii) continuing clinical follow-up. For this sub-analysis, patients who started RRT due to clinical indications (uremia, fluid overload, etc.) were excluded. eGFR had scarce precision and accuracy in reflecting mGFR (average CCC 0.6, TDI 70% and cp 22%) both in creatinine- and cystatin-based formulas. Variations -larger than 10 ml/min- between mGFR and eGFR were frequent. The error of formulas would have suggested (a) premature preparation for RTT in 14% of stable patients evaluated by mGFR; (b) to continue clinical follow-up in 59% of subjects with indication for RTT preparation due to low GFRm and (c) to delay dialysis in all asymptomatic patients (n = 6) in whom RRT was indicated based on very low mGFR. The error of formulas in predialysis was frequent and large and may have consequences in clinical care.
估计肾小球滤过率（eGFR）的误差及其在透析前的后果尚不清楚。在这项前瞻性多中心研究中，315例透析前患者接受了碘海醇清除率测定的肾小球滤过率（mGFR）以及52种公式计算的eGFR。通过一致性相关系数（CCC）、总偏差指数（TDI）和覆盖概率（CP）评估eGFR与mGFR之间的一致性。在一项亚分析中，我们评估了eGFR误差对决策的影响，包括（i）开始透析、（ii）肾替代治疗（RRT）准备和（iii）继续临床随访。对于该亚分析，排除了因临床指征（尿毒症、液体超负荷等）开始RRT的患者。基于肌酐和胱抑素的公式在反映mGFR方面，eGFR的准确性和精确性都很差（平均CCC为0.6，TDI为70%，CP为22%）。mGFR和eGFR之间的差异大于10 ml/min的情况很常见。公式误差可能会导致：（a）在mGFR评估为稳定的患者中，14%过早进行RRT准备；（b）在59%因低GFRm有RRT准备指征的受试者中继续临床随访；（c）在所有基于极低mGFR有RRT指征的无症状患者（n = 6）中延迟透析。透析前公式误差很常见且较大，可能会对临床护理产生影响。
