南亚慢性肾脏病人群中 EKFC、巴基斯坦 CKD-EPI 和 2021 年无种族 CKD-EPI 肌酐方程的比较：来自巴基斯坦慢性肾脏病社区队列的研究。
Comparison of EKFC, Pakistani CKD-EPI and 2021 Race-Free CKD-EPI creatinine equations in South Asian CKD population: A study from Pakistani CKD community cohort.
机构信息
Faculty of Pharmaceutical Sciences, University of Central Punjab, Lahore, Punjab, Pakistan.
Department of Medicinal Chemistry, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden.
出版信息
PLoS One. 2024 Mar 21;19(3):e0300428. doi: 10.1371/journal.pone.0300428. eCollection 2024.
INTRODUCTION
South Asian individuals possess a high risk of chronic kidney disease. There is a need to study, evaluate, and compare the newly suggested glomerular filtration rate (eGFR) equations for accurate CKD diagnosis, staging, and drug dosing. This study aimed to (1) evaluate the European Kidney Function Consortium (EKFC), Pakistani CKD-EPI, and 2021 Race-Free CKD-EPI creatinine equation in the South Asian population with CKD and (2) to examine the expected implications on both CKD classification as well as End Stage Renal Disease (ESRD) prevalence across these equations in South Asian population.
METHODS
We carried out a cross-sectional investigation on 385 participants, a CKD cohort ≥ 18 years, at Allama Iqbal Medical College, Jinnah Hospital, Lahore. Serum creatinine was measured by Jaffe's method and rGFR was measured by inulin clearance.
RESULTS
Pakistani CKD-EPI has a lower median difference at -1.33 ml/min/1.73m2 elevated precision (IQR) at 2.33 (-2.36, -0.03) and higher P30 value at 89.35% than 2021 CKD-EPI and EKFC equations. The mean difference (ml/min/1.73m2), 95% agreement limits (ml/min/1.73m2) of CKD-EPI PK: -1.18, -6.14, 2021 CKD-EPI: -5.98, -13.24 and EKFC: -5.62, -13.01 (P <0.001). These equations highly correlated to rGFR (P <0.001). An upward re-classification in GFR categories was shown by 2021 CKD-EPI and EKFC compared to the Pakistani CKD-EPI equation. However, there was an exception regarding the G5 category, where an elevated count of 217 (56.36%) was shown for CKD-EPI PK. The prevalence of ESRD was seen in entire age groups and prevailed among females more than in males overall equations.
CONCLUSIONS
Pakistani CKD-EPI exhibited outstanding performance, while 2021 CKD-EPI and EKFC demonstrated poor performances and could not show an adequate advantage for both CKD classification and prevalence of ESRD compared to Pakistani CKD-EPI. Therefore, Pakistani CKD-EPI appears optimal for this region and warrants future validation in other South Asian countries. In contrast, suitable measures must be implemented in Pakistani laboratories.
简介
南亚个体患慢性肾脏病的风险较高。需要研究、评估和比较新提出的肾小球滤过率（eGFR）方程，以准确诊断、分期和调整药物剂量。本研究旨在：（1）评估在患有慢性肾脏病的南亚人群中使用欧洲肾脏功能协会（EKFC）、巴基斯坦 CKD-EPI 和 2021 年 Race-Free CKD-EPI 肌酐方程；（2）研究这些方程在南亚人群中对慢性肾脏病分类和终末期肾病（ESRD）患病率的预期影响。
方法
我们在拉合尔的 Allama Iqbal 医学院 Jinnah 医院进行了一项横断面研究，纳入了 385 名年龄≥18 岁的慢性肾脏病患者。血清肌酐采用 Jaffe 法测量，rGFR 采用菊粉清除率法测量。
结果
巴基斯坦 CKD-EPI 的中位数差异较低，为-1.33ml/min/1.73m2，精度较高（IQR）为 2.33（-2.36，-0.03），P30 值较高，为 89.35%，而 2021 年 CKD-EPI 和 EKFC 方程的中位数差异分别为-5.98ml/min/1.73m2 和-5.62ml/min/1.73m2。PK 型 CKD-EPI 的平均差异（ml/min/1.73m2）、95%一致性界限（ml/min/1.73m2）分别为-1.18、-6.14，2021 年 CKD-EPI 为-5.98、-13.24，EKFC 为-5.62、-13.01（P<0.001）。这些方程与 rGFR 高度相关（P<0.001）。与巴基斯坦 CKD-EPI 方程相比，2021 年 CKD-EPI 和 EKFC 方程的 GFR 分类显示出向上的再分类。然而，在 G5 类别中存在一个例外，PK 型 CKD-EPI 的 G5 类别计数为 217（56.36%），明显升高。整个年龄组都存在 ESRD 患病率，女性的患病率总体上高于男性。
结论
巴基斯坦 CKD-EPI 表现出色，而 2021 年 CKD-EPI 和 EKFC 表现不佳，与巴基斯坦 CKD-EPI 相比，无法在慢性肾脏病分类和 ESRD 患病率方面显示出足够的优势。因此，巴基斯坦 CKD-EPI 似乎是该地区的最佳选择，需要在其他南亚国家进一步验证。相比之下，巴基斯坦实验室必须采取适当的措施。
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