CKD-EPI方程对基于简化MDRD方程的慢性肾脏病患者分期的影响

目的 研究CKD-EPI方程对基于简化MDRD方程的慢性肾脏病（CKD）患者分期的影响。 方法 选择2008年6月至2009年9月在我院肾内科就诊的CKD患者450例,分别用简化MDRD方程和CKD-EPI方程估测GFR（eGFR）。用Bland-Altman曲线对二方程计算的eGFR进行一致性检验。根据eGFR对CKD患者分期,对基于不同方程的CKD患者的分期情况进行Kappa检验。 结果 简化MDRD方程和CKD-EPI方程估测eGFR的一致性好,但CKD-EPI-eGFR较MDRD-eGFR平均高出约2.4 ml·（min）-1·（1.73 m2）-1。简化MDRD方程和CKD-EPI方程在CKD1、2、3A、3B、4 和5期符合率分别为97.10%（n=67）,80.77%（n=105）,60.86%（n=48）,87.69%（n=57）,90.38%（n=47）和98.18%（n=54）。Kappa检验提示2方程对CKD患者分期的一致性极好[Kappa值0.913（95%CI：0.881~0.945）]。然而,若依据CKD-EPI方程结果,仍须将由简化MDRD方程分类至60～89 ml·（min）-1·（1.73 m2）-1及45～59 ml·（min）-1·（1.73 m2）-1两组中的19.23%（n=25）及39.24%（n=31）的患者进行再次分类,且均被归为更高eGFR等级。 结论 CKD-EPI方程可“上调”基于简化MDRD方程的CKD 2期～3A期患者的分期等级,纠正了简化MDRD方程对CKD的过度诊断。     

中国肾小球滤过率评估方程在慢性肾脏病患者的应用评价

目的 评价现有在中国人群基础上开发的肾小球滤过率(GFR)评估方程在慢性肾脏病(CKD)患者的适用性。 方法 选择327例CKD患者,用中国方程、瑞金方程分别预测GFR值,与体表面积标准化99mTc-DTPA测的GFR（sGFR）进行比较。 结果 Bland-Altman分析显示瑞金方程估计的GFR和sGFR的一致性最好,但所有方程估计的GFR和sGFR的一致性限度均超过事先规定的专业界值。线性回归结果显示,瑞金方程和MDRD-1方程估测的GFR与X轴的斜率较其他方程更小。在所有方程中,瑞金方程估测GFR 15%符合率、30%符合率和50%符合率均最高,但瑞金方程估测GFR 30%符合率依然低于70%。在CKD的不同分期中,瑞金方程估测GFR 15%符合率、30%符合率和50%符合率均较高。 结论 当血肌酐的测定方法为酶法时,如果直接应用目前在中国人群基础上开发出的GFR评估方程预测GFR,可能会产生明显的偏差。有必要进行更大规模试验,进一步评估和验证中国方程和瑞金方程在中国人群的适用性。     

CKD-EPI方程对基于简化MDRD方程的慢性肾脏病患者分期的影响

Objective To compare the estimated CFR (eCFR) values using the new chronic kidney disease epidemiology collaboration (CKD-EPI) equation with those from the abbreviated MDRD equation in a Chinese cohort with chronic kidney disease (CKD) and to analyze the impact of the new CKD-EPI equation on the staging of CKD. Methods A total of 450 Chinese patients (239 female and 211 male) with CKD were enrolled. eCFRs obtained by the CKD-EPI equation and the abbreviated MDRD equation were compared with the Bland and Altaian method. The agreement between two equations in CKD staging was assessed by Kappa test. Results Mean eGFR was 2.4 ml ·(min)-1 ·( 1.73 m2)-1 higher with the CKD-EPI equation as compared to the abbreviated MDRD equation. The percentage of CKD staging concordance between equations for stage 1, 2, 3A, 3B, 4, and 5 was 97.10% (n=67), 80.77% (n=105), 6 0.86% (n= 48), 87.69%(n=57), 90.38% (n=47) and 98.18% (n=54) respectively. Kappa index was 0.913 (95%C/: 0.881-0.945). The CKD-EPI equation reclassified 19.23% (n=25) and 39.24% (n=31) of patients with CKD stage 2 and 3A,upward to a higher eCFR category. Conclusions The new CKD-EPI equation reclassifies a number of patients to higher CKD stages, especially those classified as CKD stage 2 or 3A by the abbreviated MDRD equation.     

CKD-EPI方程对基于简化MDRD方程的慢性肾脏病患者分期的影响

Objective To compare the estimated CFR (eCFR) values using the new chronic kidney disease epidemiology collaboration (CKD-EPI) equation with those from the abbreviated MDRD equation in a Chinese cohort with chronic kidney disease (CKD) and to analyze the impact of the new CKD-EPI equation on the staging of CKD. Methods A total of 450 Chinese patients (239 female and 211 male) with CKD were enrolled. eCFRs obtained by the CKD-EPI equation and the abbreviated MDRD equation were compared with the Bland and Altaian method. The agreement between two equations in CKD staging was assessed by Kappa test. Results Mean eGFR was 2.4 ml ·(min)-1 ·( 1.73 m2)-1 higher with the CKD-EPI equation as compared to the abbreviated MDRD equation. The percentage of CKD staging concordance between equations for stage 1, 2, 3A, 3B, 4, and 5 was 97.10% (n=67), 80.77% (n=105), 6 0.86% (n= 48), 87.69%(n=57), 90.38% (n=47) and 98.18% (n=54) respectively. Kappa index was 0.913 (95%C/: 0.881-0.945). The CKD-EPI equation reclassified 19.23% (n=25) and 39.24% (n=31) of patients with CKD stage 2 and 3A,upward to a higher eCFR category. Conclusions The new CKD-EPI equation reclassifies a number of patients to higher CKD stages, especially those classified as CKD stage 2 or 3A by the abbreviated MDRD equation.     

不同肾小球滤过率评估方程在慢性肾脏病患者中适用性的比较

目的：比较肾脏病膳食改良试验（MDRD）和Cock—croft—Gault（cG）方程以及国内的两个校正MDRD方程对慢性肾脏病（CKD）患者预测肾小球滤过率（GFR）的适用性。方法：选择2006年--2008年646例非透析CKD患者,用简化MDRD和CG公式以及两个国内校正公式（MDRD1、MDRD2）计算估测GFR（eGFR）,并进行相关性、偏离度、精密度的比较,以及比较不同CKD分期估测GFR的准确性、偏差中位数。结果：（1）MDRD1方程不论在精密度、偏离度、绝对偏差方面都明显优于其他的方程。（2）MDRD1方程的30％和50％准确率上明显高于其他方程（P〈0．05）。（3）CG明显低估了GFR,MI）RD和MDRD2在Ⅳ期低估了GFR,在Ⅱ、Ⅲ期高估了GFR,MDRD1在Ⅲ期高估了GFR。结论：经过校正的MDRD1方程明显优于CG、简化MDRD、MDRD2方程。     

CKD—EPI方程在慢性肾脏病患者中的适用性

目的探讨慢性。肾脏病流行病学合作研究（CKD-EPI）方程对评估中国人肾小球滤过率（GFR）的适用性。方法选择CKD患者42例,对其以CKD-EPI方程估算GFR（eGFR）与BSA标准化的99mTc-DTPA肾动态显像法测定的GFR（sGFR）进行比较。结果eGFR与sGFR呈正相关（r=0．868,P〈0．01）;eGFR的15％、30％及50％符合率分别是23．8％、40．5％和64．3％,eGFR与sGFR平均偏差5．46ml／min。结论CKD-EPI方程可广泛应用于评估CKD患者GFR,但仍然存在偏差,需进行大规模试验并根据CKD不同分期进行适用性研究。     

肾小球滤过率评估方程在中国糖尿病合并慢性肾脏病患者中的适用性评价

目的探讨临床上使用广泛的慢性肾脏病流行病学协助组(CKD-EPI)肾小球滤过率(GFR)评估方程、改良肾脏病膳食改良试验(MDRD)方程与近年来针对中国人开发的Feng方程、针对中国糖尿病患者改良的CKD-EPI_(糖尿病)方程在中国糖尿病合并慢性肾脏病(CKD)患者中的适用性,进而为临床中准确估测糖尿病合并CKD患者GFR提供更精确的依据。方法选取2型糖尿病合并CKD患者160名。收集患者性别、年龄、身高、体质量、血肌酐(Scr)及胱抑素C(Cys C)。以~(99m)Tc-DTPA肾动态显像法测定的GFR作为参考GFR(rGFR)。使用中国改良MDRD方程、CKD-EPI_(Scr)方程、CKD-EPI_(Cys C)方程、CKD-EPI_(Scr-Cys C)方程、CKD-EPI_(糖尿病)方程、Feng_(Cys C)方程及Feng_(Scr-Cys C)方程对估算GFR(eGFR)进行计算。采用Pearson相关性分析及κ检验比较各方程eGFR与rGFR之间的相关性及分期一致性,并使用Bland-Altman分析法比较各方程eGFR与rGFR的一致性限度。各方程eGFR之间的比较使用偏倚、精确度、10%准确率、30%准确率、50%准确率。定义GFR60 mL·min~(-1)·(1.73 m~2)~(-1)为肾功能不全的诊断标准,通过ROC曲线比较各方程诊断肾功能不全的效能。根据rGFR将患者分为A组(CKD 4～5期)、B组(CKD 3期)、C组(CKD 1～2期),比较不同分组中各方程的适用性。结果在各方程eGFR之间的比较中,CKD-EPI_(糖尿病)方程偏倚最小,与Feng_(Cys C)方程、Feng_(Scr-Cys C)方程比较差异有统计学意义(P0.05);精确度最高,与改良MDRD方程、CKD-EPI_(Cys C)方程比较差异有统计学意义(P0.05)。在7种方程的准确率比较中,CKD-EPI_(糖尿病)方程10%、30%准确率均最高,与简化MDRD方程、CKD-EPI_(Scr)方程、CKD-EPI_(Cys C)方程比较差异均有统计学意义(P0.05)。Bland-Altman分析显示CKD-EPI_(糖尿病)方程一致性限度最佳。在A组患者中,CKD-EPI_(Cys C)方程eGFR与rGFR均值比较差异无统计学意义,偏倚最小,50%、30%准确率最高。B组患者与总体患者类似,CKD-EPI_(糖尿病)方程偏倚最小,精确度最高,10%、30%、50%准确率均最高。结论在7种方程的比较中,CKD-EPI_(糖尿病)方程eGFR与rGFR拟合度最佳。在不同分组的比较中,CKD 4～5期患者CKD-EPI_(Cys C)方程eGFR与rGFR拟合度最佳,CKD 3期患者CKD-EPI_(糖尿病)方程eGFR与rGFR拟合度最佳,可分别用于估测糖尿病合并CKD不同分组患者的GFR。     

CKD—EPI方程在我国慢性肾脏病不同分期中的应用

目的探讨慢性肾脏病流行病学合作研究（CKD-EPI）方程在中国人CKD的不同分期评估肾小球滤过率（GFR）的适用性。方法选择我院肾内科CKD患者98例。将CKl2vEPI方程估算的GFR值用体表面积（BSA）标准化得出估算GFR（eGFR）,与BsA标准化的肾动态显像法（^99Tc-DTPA）检测的GFR（sGFR）用K／DOOI指南推荐的方法进行比较。结果相关性分析得出eGFR与sGFR呈正相关（r=0．847,P〈0．01）;eGFR的15％、30％及50％符合率分别是31．6N、59．2％和85．7％,eGFR估计值与sGFR平均偏差2．56ml／min。CKD各期偏差均无统计学意义,在CKD2～5期,偏差较小;CKD1期,偏差略大,偏差值为（13．22±22．41）,但偏差无统计学意义（P〉0．05）。结论CKD-EPI方程可广泛应用于我国CKD各期患者评估GFR,具有较小的偏差,较高的准确性。CKD-EPI方程在评估较高的GFR时,可能存在矫枉过正,高估GFR。     

中国肾小球滤过率评估方程在慢性肾小球肾炎患者的适用性评价

目的：评价现有在中国人群基础上开发的肾小球滤过率（GFR）评估方程在慢性肾小球肾炎患者的适用性。方法：选择143例慢性肾小球肾炎患者,用中国方程、瑞金方程、MDRD1方程和简化MDRD方程,分别计算GFR值,与^99mTc—DTPA测的GFR（sGFR）进行比较。结果：Bland—Altman分析显示MDRD1方程和瑞金方程估计的GFR和sGFR的一致性较好,但所有各方程估计的GFR和出FR的一致性限度均超过事先规定的专业界值。线性回归结果显示,MDRD1方程和瑞金方程估测的GFR与X轴的斜率较其他方程更接近0。在所有方程中,MDRD1方程和中国9方程偏差较小,瑞金方程估测GFR30％符合率和50％符合率均最高,但瑞金方程估测GFR30％符合率依然低于70％。在慢性肾脏病不同分期中,瑞金方程和MDRD1方程较其他方程有较小的偏差和更优的准确性。结论：当血肌酐的测定方法为酶法时,如直接应用现有在中国人群基础上开发的肾小球滤过率评估方程评估慢性肾小球肾炎患者肾功能,可能会产生明显的偏差。     

Cockcraft-Gault方程改良前后对慢性肾脏病的适用性比较

目的:探讨Cockcraft -Gault方程改良前后在我国华北地区慢性肾脏病患者中的适用性。方法:选择近1年来经99mTc -DTPA肾动态γ照相检查的患者共10 0例,分别用改良前后的Cockcraft-Gault方程计算肾小球滤过率(GFR) ,并进行体表面积标准化,将方程GFR计算值与99mTc -DTPA肾动态γ照相法GFR测量值进行比较。结果:Cockcraft -Gault方程改良前后计算的GFR与测量值的偏差和绝对偏差的中位数、落入测量值±15 %、±30 %和±5 0 %范围内的病例百分数有显著的统计学差异,改良后的Cockcraft -Gault方程偏离测量值的程度较高,与测量值的符合率低。结论:改良后的Cockcraft-Gault方程计算GFR与99mTc -DTPA肾动态γ照相法GFR测量值的偏差较大,同样不适合我国华北地区的慢性肾脏病患者。     

Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease

Background

Accurate estimation of the glomerular filtration rate (GFR) is crucial for the detection of chronic kidney disease (CKD). In clinical practice, GFR is estimated from serum creatinine using the Modification of Diet in Renal Disease (MDRD) study equation or the Cockcroft-Gault (CG) equation instead of the time-consuming method of measured clearance for exogenous markers such as inulin. In the present study, the equations originally developed for a Caucasian population were tested in Japanese CKD patients, and modified with the Japanese coefficient determined by the data.

Methods

The abbreviated MDRD study and CG equations were tested in 248 Japanese CKD patients and compared with measured inulin clearance (Cin) and estimated GFR (eGFR). The Japanese coefficient was determined by minimizing the sum of squared errors between eGFR and Cin. Serum creatinine values of the enzyme method in the present study were calibrated to values of the noncompensated Jaffé method by adding 0.207?mg/dl, because the original MDRD study equation was determined by the data for serum creatinine values measured by the noncompensated Jaffé method. The abbreviated MDRD study equation modified with the Japanese coefficient was validated in another set of 269 CKD patients.

Results

There was a significant discrepancy between measured Cin and eGFR by the 1.0 × MDRD or CG equations. The MDRD study equation modified with the Japanese coefficient (0.881 × MDRD) determined for Japanese CKD patients yielded lower mean difference and higher accuracy for GFR estimation. In particular, in Cin 30–59?ml/min per 1.73?m², the mean difference was significantly smaller with the 0.881 × MDRD equation than that with the 1.0 × MDRD study equation (1.9 vs 7.9?ml/min per 1.73?m²; P P 2, the accuracy was significantly higher, with 85% vs 69% of the points deviating within 50% (P P 2.

Conclusions

Although the Japanese coefficient improves the accuracy of GFR estimation of the original MDRD study equation, a new equation is needed for more accurate estimation of GFR in Japanese patients with CKD stages 3 and 4.     

Performance of the Cockcroft-Gault and MDRD equations in adult Nigerians with chronic kidney disease

Background  Estimation of the glomerular filtration rate (GFR) is required in the assessment of patients with chronic kidney disease (CKD) in order to provide information regarding the functional status of the kidneys. Current guidelines advocate the use of prediction equations, such as the Cockcroft-Gault (CG) formula and the Modification of Diet in Renal Disease (MDRD) study-derived equations, over clearance of endogenous creatinine (Ccr) in achieving this aim. We were interested in knowing the accuracy of these equations in predicting the GFR in adult Nigerians with CKD. Methods  We conducted a review of records of patients who were evaluated for CKD at the Nephrology Clinic of the Jos University Teaching Hospital between 2001 and 2003. We compared the CG and MDRD equations against the Ccr in predicting the GFR in 130 patients (88 males and 42 females) with CKD. Results  The means ± standard deviation (SD) for the measured and predicted GFR by the CG and MDRD equations were similar (17.6 ± 25.8 ml/min, 19.9 ± 24.0 ml/min and 21.5 ± 28.2 ml/min, respectively; analysis of variance [ANOVA], F = 0.68, P = 0.5). The mean difference between CG and Ccr was −2.2 ± 14.8 ml/min, with discordance at Ccr values >25 ml/min. The mean difference between MDRD and Ccr was −3.9 ± 18.1 ml/min, with discordance at Ccr values >40 ml/min. Conclusion  The CG and MDRD equations provide reliable alternatives to measured Ccr in the estimation of the GFR in Nigerian patients with CKD.     

Comparison of different equations for estimated glomerular filtration rate in patients with chronic kidney disease

Objective To compare different equations for estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD). Methods Hospitalized patients with CKD from the nephrology department of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) were recruited between December 2014 and May 2015. The calculations of eGFR and 24 h creatinine clearance rate (Ccr) were accomplished in three days after admission. The eGFRs were calculated separately using the 24 h creatinine clearance rate adjusted by the standard body surface area (Ccr_BSA), Cockcroft-Gault equation adjusted by the standard body surface area (eCcr_BSA), CKD-EPI creatinine equation (EPI_Cr), CKD-EPI cystatin C equation (EPI_CysC), CKD-EPI creatinine-cystatin C equation (EPI_Cr_CysC), simplified MDRD (MDRD) and China MDRD equations. The EPI_Cr_CysC equation was used as the standard and the precision and accuracy of the other six equations were compared and analyzed. Results A total of 403 CKD participants were enrolled in the study, with 228 male patients and a mean age of (54.9±18.4) years. The main primary diseases were chronic glomerulonephritis (43.7%) and diabetic nephropathy (13.2%). The median concentration of serum creatinine and cystatin C were 117.5 (69.7, 242.4) μmol/L and 1.80 (1.13, 3.31) mg/L, respectively. The median values of Ccr_BSA, eCcr_BSA, MDRD, China MDRD, EPI_Cr, EPI_CysC and EPI_Cr_CysC equations were 50.8 (21.1, 96.2), 51.9 (23.3, 93.2), 53.6 (23.0, 97.4), 52.2 (22.4, 94.1), 53.2 (22.1, 97.3), 35.1 (15.4, 67.0) and 49.1 (22.8, 82.3) ml?min-1?(1.73 m2)-1, respectively. There was well agreement among MDRD, China MDRD and EPI_Cr equations, while there were large differences between equations derived from CysC (EPI_Cr_CysC and EPI_CysC) and equations derived only from creatinine (EPI_Cr, MDRD, China MDRD, eCcr_BSA, Ccr_BSA equations). Compared with EPI_Cr_CysC equation (the reference equation), EPI_Cr equation showed the highest accuracy [percentage of other eGFR equation calculations that were ＞30% of the reference equation calculations (1-P30), 30.8%] while Ccr_BSA equation showed the lowest (1-P30, 42.4%). EPI_CysC equation showed the highest precision [inter-quartile range (IQR) of the difference, 11.7 ml?min-1?(1.73 m2)-1] while Ccr_BSA equation showed the lowest [IQR of the difference, 22.8 ml?min-1?(1.73 m2)-1]. Conclusions The agreement among equations derived only from creatinine is better; while it exhibits some differences between equations with cystatin C and equations derived only from creatinine. The accuracy of EPI_Cr equation is second only to EPI_Cr_CysC equation and it is currently the most suitable eGFR equation for clinical popularization of renal glomerular function assessment.     

Cystatin C相关方程在计算慢性肾脏病肾小球滤过率的对照研究

目的 评价血清半胱氨酸蛋白酶抑制剂C（Cystatin C，CysC）相关方程在不同病因引起慢性肾脏病（CKD）患者的肾小球滤过率（GFR）计算中的临床应用价值。方法选择CKD患者255例，运用MDRD方程（mGFR）、MDRD简化方程（rnGFR）、Hoek方程（hGFR）、2006年中华医学会肾脏病学分会推荐的方程（c-cGFR1，c-cGFR2）计算GFR，与^99m-二乙撑三胺五乙酸（^99m TcDT-PA）肾动态显像测得的。肾小球滤过率（sGFR）进行比较。结果在分期比较中，各方程估算的GFR和sGFR相关性一般，CysC相关方程能更敏感反应GFR；在不同病因分组中，各方程估算的GFR和sGFR均明显相关，特别是c-cGFR2。结论在CysC相关方程中，以2006中华公式2计算的c-cG-FR2与sGFR相关性及一致性最好，并且在糖尿病肾脏病组中，各方程相关系数优于其他组别，有必要进一步大规模临床研究证明其应用价值。     

Validation of the EKFC equation for glomerular filtration rate estimation and comparison with the Asian-modified CKD-EPI equation in Chinese chronic kidney disease patients in an external study

ObjectivesThe aim of this study is to determine whether new European Kidney Function Consortium (EKFC) equation is more applicable than Asian-modified CKD-EPI equation in clinical practice, having a higher accuracy in estimating GFR in our external CKD population.MethodsWe calculated estimated GFR_EKFC and GFR_CKD-EPI independently using the EKFC and Asian-modified CKD-EPI formulas, respectively. The clinical diagnostic performance of the two equations was assessed and compared by median bias, precision, accuracy (P₃₀) and so on, using ^99mTc-DTPA dual plasma sample clearance method as a reference method for GFR measurement (mGFR). The equation that met the following targets was superior: (1) median bias within ± 3 mL/min/1.73 m²; (2) P₃₀ > 75%; and (3) better precision and 95% limits of agreement in Bland–Altman analysis.ResultsTotally, 160 CKD patients were recruited in our external cohort. GFR_EKFC was highly related to mGFR, with a regression equation of GFR_EKFC=mGFR × 0.87 + 5.27. Compared with the Asian-modified CKD-EPI equation, EKFC equation demonstrated a wider median bias (–1.64 vs. 0.84 mL/min/1.73 m², p < 0.01) that was within 3 mL/min/1.73 m² and not clinically meaningful. Furthermore, the precision (12.69 vs. 12.72 mL/min/1.73 m², p = 0.42), 95% limits of agreement in Bland–Altman analysis (42.4 vs. 44.4 mL/min/1.73 m²) and incorrect reclassification index of the two target equations were almost identical. Although, EKFC equation had a slightly better P₃₀ (80.0% vs. 74.4%, p = 0.01).ConclusionsThe overall performance of EKFC equation is acceptable. There is no clinically meaningful difference in the performance of the Asian-modified CKD-EPI and EKFC equations within the limits imposed by the small sample size.