Shen Yifeng, Cui Junhua, Yang Rong, Shao Wenqi, Yang Jing, Wang Beili, Pan Baishen, Zhu Jing, Guo Wei
Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Laboratory Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, Fujian, China.
Kidney Med. 2025 Jul 16;7(9):101068. doi: 10.1016/j.xkme.2025.101068. eCollection 2025 Sep.
RATIONALE & OBJECTIVE: The 2024 KDIGO guideline recommends the use of the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. We used the most widely applied 2009 CKD-EPI estimated glomerular filtration rate based on creatinine (eGFRcr) equation as a reference to compare the other 4 CKD-EPI eGFR equations in a large clinical population in China.
A cross-sectional analysis.
SETTING & PARTICIPANTS: Individuals with clinical encounters at Zhongshan Hospital, Fudan University, from July 1, 2017, to July 1, 2023, who had both creatinine (cr) and cystatin C (cys) tested.
Serum cr and serum cys.
This study compared the clinical effects of the 2012 CKD-EPI eGFR cr-cys and eGFRcys, 2021 CKD-EPI eGFRcr and eGFRcr-cys according to the 2009 CKD-EPI eGFRcr in a large clinical population in China.
The eGFR results were statistically evaluated according to sex, age, serum cys, and serum cr levels, and CKD stage.
The 2009 CKD-EPI eGFRcr had the overall result with a median of 74.9 mL/min/1.73m. The median of 2012 CKD-EPI eGFRcys and eGFRcr-cys were 67.6 and 72.2 mL/min/1.73m, respectively. The median of 2021 CKD-EPI eGFRcr and eGFRcr-cys were 79.5 and 75.0 mL/min/1.73 m, respectively. Compared with the 2009 CKD-EPI eGFRcr equation, the 2012 CKD-EPI eGFRcys equation had the greatest disagreement. The P and P were 84.2% and 39.5%, respectively. The extent of reclassification was 28.8% of participants had CKD stage worsening and 9.3% of participants had CKD stage improvement. The smallest difference with the 2009 CKD-EPI eGFRcr was observed in the 2021 CKD-EPI eGFRcr. The P was 100.0% and P was 99.5%. The extent of reclassification was 14.3% of participants had CKD stage improvement. The differences were similar between 2012 and 2021 CKD-EPI eGFRcr-cys equations when compared with the 2009 CKD-EPI eGFRcr equation.
Lack of measured GFR.
The 2021 and the 2009 CKD-EPI eGFRcr results appeared to have the best comparability, whereas the results of the 2012 CKD-EPI eGFRcys and the 2009 CKD-EPI eGFRcr showed the most obvious difference. The differences between eGFR equations should be considered when judging the CKD stage of patients.
2024年KDIGO指南推荐使用2021年慢性肾脏病流行病学协作组（CKD-EPI）方程。我们以应用最广泛的基于肌酐的2009年CKD-EPI估计肾小球滤过率（eGFRcr）方程作为参照，在中国的一个大型临床人群中比较其他4种CKD-EPI的eGFR方程。
横断面分析。
2017年7月1日至2023年7月1日在复旦大学附属中山医院有临床诊疗记录且检测了肌酐（cr）和胱抑素C（cys）的个体。
血清cr和血清cys。
本研究在中国的一个大型临床人群中，根据2009年CKD-EPI的eGFRcr比较了2012年CKD-EPI的eGFR cr-cys和eGFRcys、2021年CKD-EPI的eGFRcr和eGFRcr-cys的临床效果。
根据性别、年龄、血清cys、血清cr水平以及CKD分期对eGFR结果进行统计学评估。
2009年CKD-EPI的eGFRcr总体结果中位数为74.9 mL/min/1.73m²。2012年CKD-EPI的eGFRcys和eGFRcr-cys中位数分别为67.6和72.2 mL/min/1.73m²。2021年CKD-EPI的eGFRcr和eGFRcr-cys中位数分别为79.5和75.0 mL/min/1.73m²。与2009年CKD-EPI的eGFRcr方程相比，2012年CKD-EPI的eGFRcys方程差异最大。一致性百分比（P）和偏倚校正一致性百分比（P）分别为84.2%和39.5%。重新分类的程度为28.8%的参与者CKD分期恶化，9.3%的参与者CKD分期改善。与2009年CKD-EPI的eGFRcr差异最小的是2021年CKD-EPI的eGFRcr。P为100.0%，P为99.5%。重新分类的程度为14.3%的参与者CKD分期改善。与2009年CKD-EPI的eGFRcr方程相比，2012年和2021年CKD-EPI的eGFRcr-cys方程差异相似。
缺乏实测的GFR。
2021年和2009年CKD-EPI的eGFRcr结果可比性似乎最佳，而2012年CKD-EPI的eGFRcys与2009年CKD-EPI的eGFRcr结果差异最为明显。判断患者CKD分期时应考虑eGFR方程之间的差异。
