[根据体表面积进行指数化会降低超重和肥胖人群的肾小球滤过率估计值并增加慢性肾脏病分期]

[Indexing to Body Surface Area Diminishes GFR Estimation and Increases Chronic Kidney Disease Staging in Overweight and Obese Population].

作者信息

Vega Jorge, Huidobro E Juan Pablo, Sepúlveda Rodrigo A

机构信息

Servicio de Medicina, Hospital Naval A. Nef, Viña del Mar, Chile.

Departamento de Nefrología, Escuela de Medicina, Facultad de Medicina, Universidad Católica de Chile, Santiago, Chile.

出版信息

Rev Med Chil. 2024 Jul;152(7):798-807. doi: 10.4067/s0034-98872024000700798.

DOI:10.4067/s0034-98872024000700798

PMID:39760549

Abstract

UNLABELLED

Glomerular filtration rate estimates are usually indexed to a standard body surface area (BSA) of 1.73 m2. This allows comparing values of individuals of different sizes but has the potential of affecting individuals with extremes BSA.

AIM

evaluating the differences in GFR estimates with or without indexing for BSA in a large cohort of ambulatory patients grouped by different body mass index (BMI) and how indexing affects CKD classification.

METHODS

demographic and anthropometric data of 390 patients evaluated with ambulatory 24-hour creatinine clearance were registered in an anonymous database. Patients were divided in 3 groups according to BMI (18-24.9; 25-29.9; >30 kg/m2). GFR was estimated using creatinine clearance (CrCl), CKD-EPI 2009 and 2021 equations, both indexed to a standardized BSA of 1.73 m2 and using the actual BSA of the patients. CKD classification was performed with and without indexing.

RESULTS

224 of 390 patients were men (57.4%). 103 (26.4%) had normal BMI (group 1), 193 (49.5%) BMI of 25-29.9 (group 2) and 94 (24.1%) had BMI of 30 or more kg/m2 (group 3). Mean CrCl was 67.9 +/- 32.7 ml/min. Indexed to a BSA of 1.73 m2 CrCl was 64.8 +/- 30.5 ml/min (difference of -3.1 ml/min) (p< 0.001). The difference between real and indexed CrCl was +2.2 ml/min, -2.9 ml/min y -9.3 ml/min in groups 1, 2 and 3, respectively. Real CrCl was significantly higher in group 3 compared to group 1. Indexed ClCr was similar between the 3 groups. GFR estimation using equations was over 2 mL/min higher when removing indexation for standard BSA. Group 1 had higher indexed GFR estimates than groups 2 and 3. However, when removing indexing the 3 groups had similar GFR estimates. Classification of CKD was significantly affected by removing indexing, with almost 20% of the patients changing CKD stage. Diagnosis of GFR <60 mL/min was less frequent when removing indexing.

CONCLUSION

Indexing to standard BSA lowers GFR estimation in overweight and obese patients, leading to a higher prevalence of GFR < 60 mL/min and CKD diagnosis.

摘要

未标注

肾小球滤过率估计值通常以1.73平方米的标准体表面积（BSA）为指标。这有助于比较不同体型个体的值，但可能会影响BSA极端的个体。

目的

评估在按不同体重指数（BMI）分组的一大群门诊患者中，有或无BSA指标时肾小球滤过率估计值的差异，以及指标如何影响慢性肾脏病（CKD）分类。

方法

将390例接受门诊24小时肌酐清除率评估患者的人口统计学和人体测量数据记录在一个匿名数据库中。患者根据BMI分为3组（18 - 24.9；25 - 29.9；>30 kg/m²）。使用肌酐清除率（CrCl）、CKD - EPI 2009和2021方程估计肾小球滤过率，既以1.73平方米的标准化BSA为指标，也使用患者的实际BSA。进行有或无指标时的CKD分类。

结果

390例患者中有224例为男性（57.4%）。103例（26.4%）BMI正常（第1组），193例（49.5%）BMI为25 - 29.9（第2组），94例（24.1%）BMI为30或更高kg/m²（第3组）。平均CrCl为67.9±32.7 ml/min。以1.73平方米的BSA为指标时，CrCl为64.8±30.5 ml/min（差异为 - 3.1 ml/min）（p<0.001）。第1、2和3组实际CrCl与指标化CrCl的差异分别为 + 2.2 ml/min、 - 2.9 ml/min和 - 9.3 ml/min。第3组的实际CrCl显著高于第1组。3组之间指标化的ClCr相似。去除标准BSA指标后，使用方程估计的肾小球滤过率高出2 mL/min以上。第1组的指标化肾小球滤过率估计值高于第2组和第3组。然而，去除指标后，3组的肾小球滤过率估计值相似。去除指标对CKD分类有显著影响，近20%的患者改变了CKD分期。去除指标时，肾小球滤过率<60 mL/min的诊断频率较低。