Peruzzo Stefania, Ottaviani Silvia, Tagliafico Luca, Muzyka Mariya, Ponzano Marta, Marelli Cristina, Signori Alessio, Nencioni Alessio, Monacelli Fiammetta
Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy.
Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
Front Med (Lausanne). 2024 Dec 4;11:1477500. doi: 10.3389/fmed.2024.1477500. eCollection 2024.
Age-related changes occurring in the kidney can lead to a reduction in Glomerular Filtration Rate (GFR); especially in older adults with multimorbidity and/or frailty, an accurate evaluation of kidney function is critical. For the estimation of GFR in patients over 70 years, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) is often used. However, validated equations exist for old-age populations like BIS1 (Berlin Initiative Study 1) and FAS (Full Age Spectrum). Here we aimed to compare the performance of CKD-EPI, MDRD (Modification of Diet in Renal Disease), BIS1, and FAS in assessing eGFR in a population of patients over 70, to evaluate which equations show the most accurate performance in our setting.
A total of 499 older adults were consecutively recruited in the Orthogeriatric ward and Oncogeriatrics clinic of IRCCS Polyclinic San Martino in Genoa Italy. eGFR was calculated using CKD-EPI, MDRD, BIS1, and FAS, calculating mean, median, standard deviation, and interquartile range. Bland-Altman graphs were used to evaluate how each equation performs with respect to the others and the concordance of the attribution of the KDIGO CKD stage was performed with Cohen's K constant and chi-squared test.
Patients' mean age was 82.6 years (± 7.44), and the mean creatinine value was 0.97 (± 0.71) mg/dl. The mean value of eGFR was 70 mL/min with CKD-EPI (± 20.6) and MDRD (± 25.7), 57 mL/min with BIS1 (± 16.7) and FAS (± 19.0), respectively. BIS1 and FAS estimated lower eGFR values than CKD-EPI and MDRD. As age increases, a steady decrease in filtrate value is observed with BIS1 and FAS. MDRD and CDK-EPI do not show the same trend. The performance of the equations at a fixed eGFR value of 30 mL/min is more linear for BIS1 and FAS compared with CKD-EPI and MDRD. Upon evaluation with chi-square, the attribution of KDIGO stage was statistically different among the various equations.
An appropriate assessment of renal function is of key clinical relevance to prevent adverse outcomes and risk of drug accumulation in older adults. Our study originally showed that in persons aged more than 70 years old BIS1 is the most accurate formula in calculating eGFR values when only serum creatinine is available.
肾脏发生的与年龄相关的变化可导致肾小球滤过率（GFR）降低；尤其是在患有多种疾病和/或身体虚弱的老年人中，准确评估肾功能至关重要。对于70岁以上患者的GFR估算，常使用CKD-EPI（慢性肾脏病流行病学协作组）公式。然而，也存在适用于老年人群的经过验证的公式，如BIS1（柏林倡议研究1）和FAS（全年龄谱）公式。我们旨在比较CKD-EPI、MDRD（肾脏病饮食改良）、BIS1和FAS在评估70岁以上患者群体估算肾小球滤过率（eGFR）方面的性能，以评估在我们的研究环境中哪些公式表现出最准确的性能。
在意大利热那亚IRCCS圣马蒂诺综合医院的老年骨科病房和肿瘤老年病诊所连续招募了499名老年人。使用CKD-EPI、MDRD、BIS1和FAS计算eGFR，计算均值、中位数、标准差和四分位间距。使用Bland-Altman图评估每个公式相对于其他公式的性能，并使用科恩K常数和卡方检验对KDIGO慢性肾脏病（CKD）分期的归因一致性进行分析。
患者的平均年龄为82.6岁（±7.44），平均肌酐值为0.97（±0.71）mg/dl。CKD-EPI计算的eGFR平均值为70 mL/min（±20.6），MDRD为（±25.7），BIS1为57 mL/min（±16.7），FAS为（±19.0）。BIS1和FAS估算的eGFR值低于CKD-EPI和MDRD。随着年龄的增加，BIS1和FAS观察到滤过值稳步下降。MDRD和CKD-EPI未显示出相同趋势。与CKD-EPI和MDRD相比，在固定eGFR值为30 mL/min时，BIS1和FAS公式的性能更呈线性。经卡方评估，不同公式之间KDIGO分期的归因在统计学上存在差异。
对肾功能进行适当评估对于预防老年人不良结局和药物蓄积风险具有关键的临床意义。我们的研究最初表明，在70岁以上的人群中，当仅可获得血清肌酐时，BIS1是计算eGFR值最准确的公式。
