Whitney Daniel G, Oliverio Andrea L, Kreschmer Jodi, Bolde Shannen, Hurvitz Edward A, Wong Ka Kit
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.
Front Med (Lausanne). 2024 Jun 12;11:1295104. doi: 10.3389/fmed.2024.1295104. eCollection 2024.
Despite the need, measuring glomerular filtration rate (mGFR) is not routinely performed for adults with cerebral palsy (CP), possibly due to unknown feasibility given the secondary complications of CP. This study aimed to assess the feasibility and reliability of mGFR and explore factors associated with eGFR-mGFR discordance among young adults with mild-to-moderate CP.
This single-center, cross-sectional study included 18- to 40-year-olds with CP gross motor function classification system (GMFCS) I-III. The participants were excluded if they were pregnant/lactating, had cognitive impairments, or had contraindications to mGFR. A routine clinical protocol for mGFR and eGFR was used. mGFR feasibility was assessed based on the number of participants who completed testing. mGFR reliability was assessed using the coefficient of variation (CV) across the four 30 min intervals. The association between age, sex, and GMFCS and the percentage of eGFR-mGFR discordance was assessed.
Of the 19 participants enrolled, 18 completed the testing [mean age (SD), 29.9 (7.4) years, = 10 female participants, = 10/3/5 for GMFCS I/II/III] and most ( = 15) of the participants had an mGFR >90 mL/min; 14 participants (77.8%) had a CV <20%, 2 had a CV between 20 and 25%, and 2 had a CV >50%. eGFR overestimated mGFR by a median (interquartile range) of approximately 17.5% (2-38%); the full range of mis-estimation was -20.5 to 174.3%. Increasing age and GMFCS levels exhibited notable, but weak-to-modest, associations with a larger eGFR-mGFR discordance.
Obtaining mGFR was feasible and reasonably reliable within this small sample. eGFR overestimated mGFR by a notable amount, which may be associated with patient-level factors.
尽管有必要，但对于成年脑瘫患者，肾小球滤过率（mGFR）的测量并未常规进行，这可能是由于考虑到脑瘫的继发并发症，其可行性尚不清楚。本研究旨在评估mGFR的可行性和可靠性，并探讨轻度至中度脑瘫青年成人中与估算肾小球滤过率（eGFR）-mGFR不一致相关的因素。
这项单中心横断面研究纳入了18至40岁、脑瘫粗大运动功能分级系统（GMFCS）为I-III级的患者。如果参与者怀孕/哺乳、有认知障碍或有mGFR检测的禁忌症，则将其排除。采用mGFR和eGFR的常规临床方案。根据完成检测的参与者数量评估mGFR的可行性。使用四个30分钟时间段内的变异系数（CV）评估mGFR的可靠性。评估年龄、性别和GMFCS与eGFR-mGFR不一致百分比之间的关联。
在纳入的19名参与者中，18名完成了检测[平均年龄（标准差），29.9（7.4）岁，女性参与者 = 10名，GMFCS I/II/III分别为10/3/5名]，大多数（ = 15名）参与者的mGFR>90 mL/分钟；14名参与者（77.8%）的CV<20%，2名参与者的CV在20%至25%之间，2名参与者的CV>50%。eGFR高估mGFR的中位数（四分位间距）约为17.5%（2% - 38%）；错误估计的全范围为-20.5%至174.3%。年龄增长和GMFCS水平与更大的eGFR-mGFR不一致表现出显著但微弱至中等程度的关联。
在这个小样本中，获得mGFR是可行且相当可靠的。eGFR显著高估了mGFR，这可能与患者层面的因素有关。
