Validation of the Toronto formula to predict progression in IgA nephropathy
Validation of the Toronto formula to predict progression in IgA nephropathy
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DOI：
10.1159/000145458
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发表时间：
2008-01-01
影响因子：
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通讯作者：
Geddes, Colin C.
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文献类型：
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作者：
Mackinnon, Bruce;Fraser, Emily P.;Geddes, Colin C.
背景/目的：预测 IgA 肾病 (IgAN) 的结果很困难。多伦多公式使用随访前 2 年的平均动脉血压和蛋白尿 (MAP(0-2)、UP0-2) 来预测随后估计肌酐清除率 (eCrCl) 的斜率。我们的目的是在苏格兰队列中验证多伦多公式，并测试以下假设：在随访的前 2 年中添加斜率 eCrCl (eCrCl(0-2)) 将提高类似多变量模型的预测效用。方法：纳入来自我们中心的经活检证实 IgAN 的成年人 (n=169) 并进行至少 2 年随访（中位时间 129.4 个月）。使用临床数据计算MAP（0-2）、UP0-2、斜率eCrCl（0-2）和预测斜率eCrCl（使用多伦多公式）。结果：使用多伦多公式预测斜率eCrCl与实际斜率eCrCl之间存在显着相关性（R-2=0.21；p < 0.001）。该公式预测 75% 受试者的实际病情进展速度在 4 毫升/分钟/年之内，以最高的准确度预测病情恶化最快的患者。我们队列中创建的多元线性回归模型使用与多伦多公式相同的自变量来预测总体斜率 eCrCl，其 R-2 为 0.22 (p < 0.001)，添加斜率 CrCl0-2 仅将其增加至 0.25。结论：多伦多公式在欧洲人群中有效，可用于识别未来肾功能恶化高风险的患者。将斜率 eCrCl(0-2) 添加到包含 MAP(0-2) 和 UP0-2 的预测模型中似乎不会改善 eCrCl 整体斜率的预测。版权所有 (c) 2008 S. Karger AG，巴塞尔。
Background/Aim: Predicting outcome in IgA nephropathy (IgAN) is difficult. The Toronto formula uses average mean arterial blood pressure and proteinuria during the first 2 years of follow-up (MAP(0-2), UP0-2) to predict the subsequent slope of estimated creatinine clearance (eCrCl). We aimed to validate the Toronto formula in a Scottish cohort and test the hypothesis that adding the slope eCrCl over the first 2 years of follow-up (eCrCl(0-2)) would improve the predictive utility of a similar multivariate model.Methods: Adults from our centre with biopsy-proven IgAN (n=169) and at least 2 years of follow-up ( median 129.4 months) were included. Clinical data were used to calculate MAP(0-2), UP0-2, slope eCrCl(0-2) and predicted slope eCrCl ( using the Toronto formula).Results: There was a significant correlation between predicted slope eCrCl using the Toronto formula and actual slope eCrCl (R-2=0.21; p < 0.001). The formula predicted the actual rate of progression to within 4 ml/min/year in 75% of subjects, predicting patients with the most rapid deterioration with the greatest accuracy. The multivariate linear regression model created in our cohort using the same independent variables as the Toronto formula to predict the overall slope eCrCl had an R-2 of 0.22 (p < 0.001) and adding the slope CrCl0-2 only increased this to 0.25.Conclusions: The Toronto formula is valid in a European population and useful for identifying patients at high risk of future deterioration in renal function. Adding slope eCrCl(0-2) to a predictive model containing MAP(0-2), and UP0-2 does not appear to improve prediction of the overall slope of eCrCl. Copyright (c) 2008 S. Karger AG, Basel.