肾小球滤过率评估公式的比较

肾小球滤过率(GFR)是评价肾功能的重要指标,也是慢性肾脏病(CKD)分期的重要依据。使用公式评估GFR方法简便,已被广泛应用,其中Cockcroft-Gault(CG)公式和MDRD公式最为常用,CKD-EPI、改良MDRD公式、瑞金公式及基于胱抑素C的公式等次之,通过比较其偏差、精确度、准确性等指标发现,CG公式更适用于健康人群,但在肾功能不全患者适用性较差,且受体重影响明显;MDRD公式适用于肾功能不全患者,但在GFR水平较高时可靠性较差;CKD-EPI克服了MDRD公式在GFR较高时会低估真实值的缺点;改良MDRD公式和瑞金公式则更适用于中国人;而基于胱抑素C的公式在疾病早期有较好适用性。因此,尚需进一步改进或者发掘更好地评估GFR的公式。     

肾小球滤过率评估公式在糖尿病患者中的适用性分析

目的评价常用的肾小球滤过率评估公式在我国2型糖尿病患者中的临床适用性。方法选择住院的2型糖尿病患者163例,将^99mTc—DTPA肾动态显像测定肾小球滤过率作为参考值（Standard GFR,sGFR）,用简化MDRD、Cockcroft—Gauh（CG）、CKD—EPI公式计算GFR评估值,将不同公式估测的GFR与GFR参考值（sGFR）进行比较。结果（1）简化MDRD与CKD—EPI公式均高估患者GFR水平,但CKD—EPI评估值偏离程度小于简化MDRD公式;（2）当sGFR≥60ml／min时,C—G公式评估值明显低于sGFR,当sGFR〈60ml／min时,C—G公式评估值明显高于sGFR,与简化MDRD与CKD—EPI公式相比,C—G公式偏离程度较小;（3）CKD—EPI公式评估值在慢性肾脏病Ⅰ、Ⅱ期的患者中与sGFR符合度高,而在慢性肾脏病Ⅲ～Ⅴ期的患者中,C—G公式与sGFR符合度较高。结论CKD—EPI与C—G公式评估糖尿病患者GFR优于简化MDRD公式,其中CKD—EPI公式适用于CKDⅠ～Ⅱ患者,而C—G公式适用于慢性肾脏病Ⅲ～Ⅴ期患者。     

Lack of effect of IGF-I on the glomerular filtration rate in non-diabetic patients with advanced chronic kidney disease

Recombinant human insulin-like growth factor I (rhIGF-I) acutely increases the glomerular filtration rate (GFR) in human volunteers and patients with advanced chronic kidney disease (CKD). However, on chronic administration, rhIGF-I induces tolerance to its renal effects attributed to a fall in serum IGF-binding protein 3 (IGFBP-3) enhancing its systemic clearance. Tolerance may be avoided by the use of an intermittent dosage regimen of rhIGF-I. A randomised, double-blind, placebo-controlled study was undertaken in non-diabetic patients with advanced CKD to establish whether intermittent subcutaneous injections of rhIGF-I (50 μg/kg, four days/week) could increase GFR over a 24 week period and thereby have the potential to delay the onset of renal replacement therapy. Twenty-seven patients were randomised into rhIGF-I/placebo groups using a 2:1 treatment ratio. GFR was determined by inulin clearance. RhIGF-I therapy produced a sustained increase serum total and free IGF-I elevating IGFBP-1 without decreasing IGFBP-3. Inulin clearance however, was not increased after either four weeks or over the 24 week observation period. Only 4/18 rhIGF-I treated patients compared to 6/9 placebo patients completed the study, the major reason being the requirement for dialysis. Compared with healthy volunteers, advanced CKD patients had elevated serum levels of IGFBP-1, IGFBP-2, tumour necrosis factor-alpha and asymmetric dimethylarginine, all factors proposed to mediate IGF-I resistance. In conclusion, although intermittent rhIGF-I therapy elevated serum total IGF-I and prevented any fall in serum IGFBP-3, it failed to increase GFR in non-diabetic patients with advanced CKD. The lack of efficacy was attributed to the presence of renal IGF-I resistance in CKD.     

Comparison of four equations for estimation of glomerular filtration rate in predicting cardiovascular events and subclinical vascular disease in patients with type-2 diabetes

AimsChronic kidney disease (CKD), defined by a low glomerular filtration rate (GFR), is a predictor of cardiovascular disease in patients with type-2 diabetes (T2D). We aimed to compare four GFR equations in predicting future cardiovascular events in T2D and the presence of subclinical vascular disease.MethodsFour equations were used to estimate GFR in asymptomatic T2D patients consulting our centre for cardiovascular assessment. Follow-up was performed to collect cardiovascular events. Cox proportional hazard ratio (HR) was used to build and compare prediction models, and the incremental value of the addition of GFR with any of the 4 formulas was evaluated. The ability to triage patients with and without CVD events according to GFR were assessed by comparing the receiver operator characteristics (ROC) curves with the 4 models.ResultsAmong 829 asymptomatic T2D patients, the CKD prevalence was 20.2% for Modification of Diet in Renal Disease (MDRD), 17.3% for Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), 20.7% for Lund-Malmö Revised (LMR) and 21.4% for Full Age Spectrum (FAS). All the estimated GFRs were well correlated from one formula to another, with stronger agreement to define CKD (GFR <60 mL/min/1.73 m²) between MDRD and CKD-EPI, and between LMR and FAS. The 5-year incidence of cardiovascular events was 8% (n = 63). After adjustment on covariables, CKD was significantly associated with cardiovascular events when defined by MDRD (HR = 2.04; 1.15–3.60) and CKD-EPI (HR = 1.90; 1.05–3.41) but missed statistical significance when using LMR (HR = 1.74; 0.97–3.14) or FAS (HR = 1.71; 0.94–3.14). Only the prediction models including MDRD and CKD-EPI provided a significant incremental information to the predictive model without GFR, but the area under the ROC curves were similar with the 4 models: 0.60 [0.54–0.68] for MDRD, 0.61 [0.49–0.65] for CKD-EPI and 0.62 [0.55–0.69] for LMR and FAS, without any significant difference among formulas.ConclusionIn asymptomatic T2D patients, MDRD and CKD-EPI may be preferable when more specificity is desired (stronger association between GFR and CVD events), while LMR and FAS appear more sensitive by including a higher number of patients with GFR <60 mL/min/1.73 m².     

Difference between CKD-EPI and MDRD equations in calculating glomerular filtration rate in patients with cirrhosis

AIM:To evaluate the difference between the performance of the (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations in cirrhotic patients. METHODS: From Jan 2004 to Oct 2008, 4127 cirrhotic patients were reviewed. Patients with incomplete data with respect to renal function were excluded; thus, a total of 3791 patients were included in the study. The glomerular filtration rate (GFR) was estimated by the 4-variable MDRD (MDRD-4), 6-variable MDRD (MDRD-6), and CKD-EPI equations.RESULTS:When ser...     

肌酐清除率和MDRD方程评估肾小球滤过率的比较

目的比较MDRD方程和内生肌酐清除率(Ccr)评估肾小球滤过率(GFR)的适用性。方法选择2年来我院175例慢性肾脏病(CKD)患者,测得双血浆法99mTcDTPA血浆清除率(tGFR),CockcroftGault(CG)方程、体表面积标准化的Ccr、MDRD方程7、简化MDRD方程估计GFR(分别用eGFR2、eGFR3、eGFR7、eGFRa表示),以tGFR为参考值,将估计的eGFR进行比较。结果eGFR7、eGFRa与tGFR偏差最小,eGFR2、eGFR3与tGFR偏差较大,各方程估计GFR的准确性基本相当。结论MDRD方程7、简化MDRD方程估计eGFR的精确度、偏差均好于24小时Ccr,但与GFR参考值之间仍存在显著差异,若应用于临床,有必要对其进行适当修正。     

肾小球滤过率评估方程对老年慢性肾脏病患者适用性的评价

目的 评价肾小球滤过率(GFR)评估方程在老年慢性肾脏病(CKD)患者的适用性.方法 选择老年CKD患者103例,采用Cockcroft-Gauh(CG)方程、MDRD1方程、简化MDRD方程、Jelliffe1973(JE73)方程、Mawer(MA)方程、Hull(HU)方程、Jellife1971(JE71)方程、血肌酐倒数公式,Gate(GA)方程、Bjornsson(BJ)方程,分别预测GFR值,与""Tc DTPA肾动态显像检测的GFR(sGFR)进行比较. 结果 Bland-Ahman分析显示,CG方程、BJ方程和HU方程估计的GFR与sGFR的一致性较好,但所有各方程估计的GFR与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,JE方程和CG方程估测的GFR与X轴的斜率较其他方程更接近0,MDRD1方程较其他方程有较小的偏差;在所有方程中,BJ方程、JE方程和CG方程GFR符合率较高.在CKD的不同分期中,BJ方程、CG方程和JE方程具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,如果直接应用目前临床常用的GFR评估方程预测老年CKD患者的GFR,可能会产生明显的偏差.J方程和HU方程估计的GFR与sGFR的一致性较好,但所有各方程估计的GFR与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,JE方程和CG方程估测的GFR与X轴的斜率较其他方程更接近0,MDRD1方程较其他方程有较小的偏差;在所有方程中,BJ方程、JE方程和CG方程GFR符合率较高.在CKD的不同分期中,BJ方程、CG方程和JE方程具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,如果直接应用目前临床常用的GFR评估方程预测老年CKD患者的GFR,可能会产     

五种肾小球滤过率评估方程在良性小动脉肾硬化症中的应用

目的比较经体表面积校正后Cockcroft-Gault(CG)、美国肾脏病膳食改良实验(modification of diet inrenal disease,MDRD)、美国简化MDRD、中国MDRD、中国简化MDRD方程在良性小动脉肾硬化症患者中预测肾小球滤过率(glomerular filtration rate,GFR)的适用性。方法选取2010年2月至2011年11月在广东省人民医院确诊为良性小动脉肾硬化症的患者140例为研究对象,以双血浆法99mTc-DTPA血浆清除率为GFR参考值,将各方程的估算GFR与双血浆法所测的结果进行对比分析。结果双血浆法所测的GFR值为(39.3±22.3)mL.min-1.1.73 m-2。校正后CG、MDRD、美国简化MDRD方程均低估(-6.90、-3.48、-2.59 mL.min-1.1.73m-2)实际GFR,而中国MDRD、中国简化MDRD方程均高估(4.07、5.96 mL.min-1.1.73 m-2)实际GFR;MDRD方程偏离度(363.16任意单位)明显小于其他方程(876.24、1 267.12、483.82、1 516.90任意单位),并且精密度、30%准确性明显优于中国MDRD、中国简化MDRD方程,差异有统计学意义(P<0.05)。结论以上各估算GFR方程对良性小动脉肾硬化症患者适用性均欠佳,鉴于MDRD方程偏离度、精密度、准确性的优越性,选用MDRD方程可能更加合适。     

肾小球滤过率估算公式的发展改进及应用

肾小球滤过率(GFR)的准确评估对慢性肾脏病(CKD)的诊断、分期及判断预后均具有重大意义.由于实际GFR测定较为复杂,临床上常需依赖各种公式对GFR进行间接的估算.在过去的三十多年里,相继有多个用于GFR评估的公式问世.成人常用的GFR估算公式有Cockcroft-Gault公式、MDRD公式、CKD-EPI公式及其相应的改良公式.CKD-EPI公式可弥补MDRD公式在GFR较高时精确度不高的缺陷,因而被新的指南所推荐.此外,还有一些基于胱抑素CysC的GFR估算公式.本文对上述公式的发展沿革及各自的特点和影响因素作一综述.     

公式估算的肾小球滤过率在糖尿病人群中的应用

糖尿病已逐渐成为慢性肾脏疾病(CKD)的主导病因,美国流行病学调查显示自2001年起,每年接受透析治疗的患者绝大多数(＞40%)患有糖尿病.越来越多的临床医师认识到,在该人群中进行CKD分期的重要性.美国糖尿病协会最新指南推荐在该人群中应用Cockcroft-Gault公式和肾脏疾病饮食改良系列公式(MDRD).现有研究肯定了公式估算的肾小球滤过率在糖尿病肾病筛查中的价值,同时也有许多研究分析了其与糖尿病相关危险因素之间的关系.但目前尚未确立最合适的估算糖尿病人群肾小球滤过率的公式,此外其结合其他指标后的实际应用价值也需要大量循证医学资料加以证实.     

Comparison of prediction equations to estimate glomerular filtration rate in Chinese patients with chronic kidney disease

Aim: We sought to evaluate the applicability of formulae based on serum creatinine (SC) levels in Chinese patients with chronic kidney disease (CKD). Materials and methods: Three hundred and twenty‐seven patients with CKD who had undergone ^99mTc‐DTPA glomerular filtration rate (GFR) estimation were enrolled. The Cockcroft–Gault equation, SC‐reciprocal equation, Gate equation, Hull equation, Jelliffe‐1973 equation, Jelliffe‐1971 equation, Mawer equation, Bjornsson equation, reexpressed 6‐variable MDRD equation and reexpressed 4‐variable MDRD equation were compared. Using the ^99mTc‐DTPA GFR as the standard GFR (sGFR), the accuracy of estimated GFR was compared with sGFR in various stages of CKD. Results: Median per cents of the absolute difference ranged from 28.16% to 39.39%, accuracy with a deviation less than 30% ranging from 39.4% to 53.5%, accuracy with a deviation less than 50% ranging from 63.0% to 80.7%. None of the equations had accuracy up to the 70% level with a deviation less than 30% from sGFR. Bland–Altman analysis demonstrated that mean difference ranged from ?2.42 to 16.39 mL/min/1.73 m², whereas precision ranged from 82.66 to 106.15 mL/min/1.73 m². However, the agreement limits of all the equations exceeded the prior acceptable tolerances defined as 60 mL/min/1.73 m². Linear regression showed that the slopes of regression line ranged from 0.37 to 0.54 and intercepts ranged from ?12.10 to 3.86. When the overall performance as well as bias and accuracy were compared in different stages of CKD, GFR estimated by Jelliffe‐1973 equation, Cockcroft–Gault equation and Bjornsson equation showed promising results. Conclusion: When SC was measured by the enzymatic method, GFR estimation equations showed great bias in Chinese CKD patients. At present, the Jelliffe‐1973 equation and Cockcroft–Gault equation may be more accurate in the Chinese ethnic group.     

高龄慢性肾脏病患者肾小球滤过率估算公式比较

目的研究常用的肾小球滤过率估算公式在老龄慢性肾脏病(CKD)患者中的适用性。方法以同位素显像法测定的患者肾小球滤过率为标准,评价常用的肾小球滤过率估算公式用于334例高龄CKD患者的精确度和准确度。结果目前最常用的CG和MDRD系列公式在估算高龄CKD患者肾小球滤过率时均无法达到临床需要的估算效能。经过数据转换,可以改善这些公式的精确度和准确度。结论在以常用的肾小球滤过率公式评价高龄CKD患者肾功能时需审慎,建议个体化选用公式,适当数据转换,必要时直接测定肾小球滤过率或内生肌酐清除率。     

Estimating glomerular filtration rate preoperatively for patients undergoing hepatectomy

AIM： To compare creatinine clearance （Ccr） with estimated glomerular filtration rate （eGFR） in preoperative renal function tests in patients undergoing hepatectomy.METHODS： The records of 197 patients undergoing hepatectomy between August 2006 and August 2008 were studied, and preoperative Ccr, a three-variable equation for eGFR （eGFR3） and a five-variable equation for eGFR （eGFR5） were calculated. Abnormal values were defined as Ccr 〈 50 mL/min, eGFR3 and eGFR5 〈 60 mL/min per 1.73 m2. The maximum increases in the postoperative serum creatinine （post Cr） level and postoperative rate of increase in the serum Cr level （post Cr rate） were compared.RESULTS： There were 37 patients （18.8%） with abnormal Ccr, 31 （15.7%） with abnormal eGFR3, and 40 （20.3%） with abnormal eGFR5. Although there were no significant differences in the post Cr rate between patients with normal and abnormal Ccr, eGFR3 and eGFR5 values, the post Cr level was significantly higher in patients with eGFR3 and eGFR5 abnormality than in normal patients （P 〈 0.0001）. Post Cr level tended to be higher in patients with Ccr abnormality （P = 0.0936 and P = 0.0875, respectively）.CONCLUSION： eGFR5 and the simpler eGFR3, rather than Ccr, are recommended as a preoperative renal function test in patients undergoing hepatectomy.     

临床常用肾小球滤过率评估方程在2型糖尿病患者中的效能比较

目的评价目前临床常用的肾小球滤过率（GFR）评估方程在2型糖尿病患者中的准确性和适用性。方法入选2007年10月至2010年12月在广州中山大学附属第三医院肾内科及内分泌科住院的2型糖尿病患者224例,其中男133例,女91例,平均年龄（60±13）岁。测定血清肌酐和胱抑素C水平,以体表面积标化的锝-二乙三胺五乙酸（^99mTcDTPA）测得的GFR（sGFR）为标准,采用肾脏病膳食改良试验方程（MDRD）、中国方程、Cockcroft—Gault方程、慢性肾脏病流行病合作组方程（EPI方程）、瑞金方程、慢性肾脏病流行病合作组胱抑素方程（EPI—Cysl方程及EPI-Cys2方程）以及MacIsaac胱抑素方程估测GFR值。应用Bland—Altman分析、线性相关分析及受试者工作特征曲线进行数据统计。结果（1）Bland—Altman分析显示,EPI—Cysl方程、EPI—Cys2方程及MacIsaac胱抑素方程估测的GFR与sGFR的一致性最好,所有方程估测的GFR与sGFR的一致性限度均超过预定的界值;EPI．Cysl方程、EPI—Cys2方程及MacIsaac胱抑素方程与x轴的斜率分别为0．168、0．183、0．186;MacIsaac胱抑素方程与Y轴的截距最小。（2）胱抑素C推导的3个方程偏差较小,30％符合率达60％以上,50％符合率达85％;EPI．Cysl方程和EPI-Cys2方程低估GFR,血肌酐推导的5个方程高估GFR。（3）诊断慢性肾病的效能方面,EPI—Cysl方程及EPI-Cys2方程的准确性和敏感度较高（分别为88％和94％）,MacIsaac胱抑素方程和瑞金方程的截点值分别为62．4、64．9ml·min-1·1．73m-1,与原分割点（60ml·min-1·1．73m-2）吻合度较高。结论8个GFR方程估算的GFR均存在不同程度的误差,胱抑素C推导方程总体效能高于血肌酐推导方程,瑞金方程在血肌酐推导方程中效能较高。在今后广泛用于临床前,所有方程仍需进一步进行校正。     

Renal changes and estimation of glomerular filtration rate using different equations in morbidly obese Egyptian patients

Background and aimsObesity is a worldwide pandemic with multiple consequences including kidney affection. This study aimed to assess the effects of obesity on renal functions and to detect the most reliable formula of estimated glomerular filtration rate (eGFR) in morbidly obese patients.MethodsA cross-sectional, observational study was conducted on 82 morbidly obese patients. Anthropometric measurements were done for all patients and body adiposity (BAI) and visceral adiposity (VAI) indices were calculated after assessment of abdominal fat tissue analysis by computerized tomography (CT). Serum creatinine was incorporated into six different formulae of eGFR, then eGFR was compared with the 24-h measured creatinine clearance (CL_cr) values.ResultsThe mean body mass index was 55.8 ± 9.5 kg/m². Proteinuria and glomerular hyperfiltration (CL_cr > 130 ml/min/1.73 m²) were detected in 68.3% and 91.5% of the patients, respectively. Cockcroft–Gault formula using total (CCG-TBW-eGFR) and adjusted body water (CCG-AjBW-eGFR) had the nearest values to measured CL_Cr. These two formulae had a moderate reliability and the lowest percentage of error (30% and 23%, respectively). Visceral and total abdominal fat tissue surface area and volume assessed by CT were directly correlated to the 24-h urinary protein excretion (r = 0.32, 0.24, 0.37 and 0.34, respectively; p = 0.02, 0.03, 0.004 and 0.002, respectively).ConclusionsGlomerular hyperfiltration and proteinuria are highly prevalent in morbidly obese patients. There is no ideal formula for GFR estimation in morbidly obese patients, however, TBW and AjBW incorporated into the Cockcroft–Gault can be helpful in those patients.