Predicting glomerular filtration rate in kidney transplantation:: Are the K/DOQI guidelines applicable?
Predicting glomerular filtration rate in kidney transplantation:: Are the K/DOQI guidelines applicable?
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DOI：
10.1111/j.1600-6143.2005.01070.x
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发表时间：
2005-11-01
影响因子：
8.8
通讯作者：
Berthoux, F
中科院分区：
文献类型：
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作者：
Mariat, C;Alamartine, E;Berthoux, F
肾脏疾病结局质量倡议（K/DOQI）指南介绍了基于肾功能水平的慢性肾脏疾病（CKD）分类。为了预测肾小球滤过率（GFR），他们特别推荐使用肾脏疾病饮食改良（MDRD）研究和Cockcroft-Gault（C-G）方程。由于这些估计的性能受到质疑，我们试图确定这些建议是否适用于肾移植。根据K/DOQI方法，我们比较了284例肾移植受者的476次菊粉清除率，用MDRD和C-G公式估算的GFR，虽然MDRD公式比C-G公式提供了更好的预测，但它们都没有达到K/DOQI标准所要求的准确性水平。至少25%的计算GFR给出了超过相应菊粉清除率值30%的预测。此外，当分类根据其预测的GFR，不到三分之二的移植患者原来被分配到正确的阶段CKD.We的结论是，在肾移植，C-G和MDRD研究方程的预测性能似乎是特别受损，可能会损害K/DOQI指南的有效性，如果在其目前的形式实施。
The kidney disease outcomes quality initiative (K/DOQI) guidelines introduced a classification of chronic kidney disease (CKD) based on the level of kidney function. In order to predict the glomerular filtration rate (GFR), they specifically recommended the use of the modification of diet in renal disease (MDRD) study and Cockcroft-Gault (C-G) equations.Since the performance of these estimates has been questioned, we sought to determine whether these recommendations might be applicable in renal transplantation.Following the K/DOQI methodology, we compared the GFR estimated by the MDRD and C-G equations with 476 inulin clearances performed in 284 renal transplant recipients.Even though the MDRD equations provided a better prediction than C-G formula, none of them reached the level of accuracy required by the K/DOQI standards. At least, 25% of the calculated GFR gave a prediction beyond 30% of the corresponding inulin clearance value. In addition, when classified according to their predicted GFR, less than two-thirds of the transplant patients turned out to be assigned to the correct stage of CKD.We conclude that, in renal transplantation, the predictive performance of both C-G and MDRD study equations appears to be particularly impaired and may potentially compromise the validity of the K/DOQI guidelines if implemented in their current form.