Weidmann Lukas, Laux Catherine, Castrezana Lopez Kai, Harmacek Dusan, George Britta, von Moos Seraina, Schachtner Thomas
Department of Nephrology, University Hospital of Zurich, Zurich, Switzerland.
Department of Nephrology, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
Clin Kidney J. 2024 Aug 20;17(11):sfae253. doi: 10.1093/ckj/sfae253. eCollection 2024 Nov.
Previous studies show heterogeneity when applying estimated glomerular filtration (eGFR) equations to kidney transplant recipients (KTRs). However, research on the impact of transplantation-related characteristics on eGFR equations using creatinine (eGFRcr) compared to cystatin C (eGFRcys) is scarce.
We conducted a comprehensive analysis with three eGFRcr equations (Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009, European Kidney Function Consortium (EKFC) 2021, kidney recipient specific-glomerular filtration rate KRS-GFR) 2023), comparing them to two eGFRcys (CKD-EPI 2012 and EKFC 2023) in 596 KTRs. Bland-Altman plots demonstrated relative differences according to different eGFR-stages. Multivariable logistic regression identified transplantation-related characteristics independently associated with smaller or greater differences between eGFRcr and eGFRcys equations.
94.3% of the cohort were White individuals. Median eGFR differed as much as 9 ml/min/1.73 m between equations. The median relative differences (Q2) were greater (more negative) when comparing the eGFRcr equations to eGFRcys CKD-EPI 2012, than when comparing them to eGFRcys EKFC 2023 ( < .001). Better average eGFR was associated with smaller mean relative differences in all comparisons but eGFRcr CKD-EPI 2009 with eGFR EKFC 2023 and eGFRcr EKFC 2021 with eGFRcys EKFC 2023. Living kidney donation and belatacept use were independent factors associated with a smaller difference (≥Q3) between eGFRcr and eGFRcys equations, while prednisone use or higher HbA1c were independently associated with a greater difference (≤Q1) between equations.
Different eGFR-stages, donor, or recipient characteristics, along with immunosuppression such as belatacept or prednisone, contribute to differences between eGFRcr and eGFRcys. These effects need to be considered in the clinical management of KTRs.
先前的研究表明，将估算肾小球滤过率（eGFR）方程应用于肾移植受者（KTR）时存在异质性。然而，与胱抑素C（eGFRcys）相比，关于移植相关特征对使用肌酐的eGFR方程（eGFRcr）影响的研究较少。
我们使用三个eGFRcr方程（慢性肾脏病流行病学协作组（CKD-EPI）2009、欧洲肾功能联盟（EKFC）2021、肾移植受者特异性肾小球滤过率KRS-GFR 2023）进行了综合分析，并将其与596名KTR中的两个eGFRcys方程（CKD-EPI 2012和EKFC 2023）进行比较。布兰德-奥特曼图展示了不同eGFR阶段的相对差异。多变量逻辑回归确定了与eGFRcr和eGFRcys方程之间较小或较大差异独立相关的移植相关特征。
该队列中94.3%为白人个体。各方程之间的eGFR中位数差异高达9 ml/min/1.73 m²。与将eGFRcr方程与eGFRcys EKFC 2023进行比较时相比，将eGFRcr方程与eGFRcys CKD-EPI 2012进行比较时，中位数相对差异（Q2）更大（更负）（P <.001）。在所有比较中，除了eGFRcr CKD-EPI 2009与eGFR EKFC 2023以及eGFRcr EKFC 2021与eGFRcys EKFC 2023的比较外，更好的平均eGFR与较小的平均相对差异相关。活体肾捐赠和使用贝拉西普是与eGFRcr和eGFRcys方程之间较小差异（≥Q3）独立相关的因素，而使用泼尼松或更高的糖化血红蛋白与方程之间较大差异（≤Q1）独立相关。
不同的eGFR阶段、供体或受体特征，以及诸如贝拉西普或泼尼松等免疫抑制因素，导致了eGFRcr和eGFRcys之间的差异。在KTR的临床管理中需要考虑这些影响。
