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[JAMA Intern Med在线发表]: 基于肌酐的公式评估65岁以上成年人肾小球滤过率的诊断准确性
2019年06月29日 时讯速递, 进展交流 暂无评论

Original Investigation April 29, 2019

Diagnostic Performance of Creatinine-Based Equations for Estimating Glomerular Filtration Rate in Adults 65 Years and Older

Luciano da Silva Selistre, Dener L. Rech, Vandréa de Souza, et al

JAMA Intern Med. Published online April 29, 2019. doi:10.1001/jamainternmed.2019.0223

Abstract

Importance 背景

Estimating glomerular filtration rate (GFR) is useful in many clinical conditions. However, very few studies have evaluated the performance of GFR-estimating equations in older adults at various degrees of kidney impairment.

在很多临床情况下,估测肾小球滤过率(GFR)非常有用。然而,很少有研究评价GFR估测公式用于不同程度肾脏功能异常的老年人的准确性。

Objective 目的

To determine the performance of plasma-creatinine-based equations Chronic Kidney Disease–Epidemiology Collaboration (CKD-EPI), Lund-Malmö Revised, (LMR), full age spectrum (FAS), and Berlin Initiative Study (BIS) 1 in older adults across a broad spectrum of GFRs.

确定基于血浆肌酐公式包括CKD-EP、LMR、FAS和BIS 1用于很宽GFR范围的老年人的准确性。

Design, Setting, and Participants 试验设计、场景和研究对象

Single-center cross-sectional study performed in France including 2247 participants aged 65 to 90 years who underwent inulin GFR measurements from July 1, 2003, to July 30, 2017, for suspected or established renal dysfunction, for renal risk, before kidney donation, or after kidney transplant.

在法国进行的单中心横断面研究,2003年7月1日至2017年7月30日间纳入2247名年龄在65岁至90岁的患者,患者因疑似或明确的肾功能不全、肾脏风险评估,捐献肾脏前或肾脏移植后接受菊酚GFR测定。

Main Outcomes and Measures 主要预后指标

The main outcome measure was GRF measured by inulin clearance. Equation performance criteria considered bias (difference between estimated and measured GFR), precision (interquartile range of the median difference), and accuracy P30 (percentage of estimated GFRs lying between [measured GFR – 30% of measured GFR] and [measured GFR + 30% of measured GFR]).

主要预后指标为根据菊酚清除率测定的GFR。公式准确性标准包括偏倚(估计与测定GFR的差值)、精确度(中位数差异的四分位区间)及准确度P30(估计GFR在测定GFR+/-30%测定GFR区间内的百分比)。

Results 结果

The mean (SD) age of the 2247 participants was 71.5 (5) years and 1192 (53.0%) were male. The difference in median (95% CI) bias was significant between CKD-EPI vs LMR (−4.0 [–4.0 to –3.5 mL/min/1.73 m2P < .001]) and CKD-EPI vs FAS (–2.0 [–3.5 to –2.5] mL/min/1.73 m2P < .001) but not significant between CKD-EPI vs BIS 1 (0.0 [–1.5 to 0.5], P = .07, Mood test). In patients aged 65 to 74 years with measured GFR<45 mL/min/1.73 m2, the difference in median P30 (95% CI) was not significant between CKD-EPI vs LMR (P = .08) and CKD-EPI vs FAS (P = .48) but significant vs BIS 1 (P = .004, McNemar test). In subjects 75 years and older, with measured GFR less than 45 mL/min/1.73 m2, LMR and BIS 1 were more accurate than CKD-EPI and FAS (P30 = 74.5 [70.0-79.5] and 73.0 [68.0-78.0] vs 69.0 [64.5-74.0] and 69.0 [65.5-72.0]). In all patients, despite small statistical differences, the performance of CKD-EPI equation was not clinically different from that of LMR, FAS, or BIS 1.

2247名患者平均(SD)年龄为71.5 (5)岁,1192名(53.0%)患者为女性。CKD-EPI 与 LMR之间偏倚的中位数(95% CI)差异显著(−4.0 [–4.0 to –3.5 mL/min/1.73 m2P < .001]),CKD-EPI 与 FAS间的偏倚也有显著差异 (–2.0 [–3.5 to –2.5] mL/min/1.73 m2P < .001) ,但CKD-EPI 与 BIS 1之间无差异 (0.0 [–1.5 to 0.5], P = .07, Mood test)。对于年龄65至74岁且测定GFR<45 mL/min/1.73 m2的患者,CKD-EPI 与 LMR 间P30 中位数(95% CI)的差异并不显著(P = .08),CKD-EPI 与 FAS间差异也不显著 (P = .48),但与BIS 1之间存在显著差异 (P = .004, McNemar test)。对于75岁以上且测定GFR < 45 mL/min/1.73 m2的患者,LMR 与 BIS 1 较CKD-EPI 和 FAS 更加准确 (P30 = 74.5 [70.0-79.5] and 73.0 [68.0-78.0] vs 69.0 [64.5-74.0] and 69.0 [65.5-72.0])。对于所有患者,尽管存在很小的统计学差异,但CKD-EPI公式的准确性与LMR, FAS, 或 BIS 1无临床显著差异。

Conclusions and Relevance 结论与意义

In a referral group of patients 65 years and older who had GFR estimated using CDK-EPI, LMR, BIS 1, and FAS equations, a comparison with renal inulin clearance found that none of the equations had a superior diagnostic performance. Each had limitations regarding accuracy.

对于65岁以上患者,采用CDK-EPI, LMR, BIS 1 和 FAS 公式估测GFR,与菊酚清除率进行比较,结果发现,上述公式中没有一个诊断准确性更好。每个公式的准确性都具有局限性。

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