New Equations to Estimate GFR in Children with CKD
New Equations to Estimate GFR in Children with CKD
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DOI：
10.1681/asn.2008030287
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发表时间：
2009-03-01
影响因子：
13.6
通讯作者：
Furth, Susan L.
中科院分区：
文献类型：
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作者：
Schwartz, George J.;Munoz, Alvaro;Furth, Susan L.
Schwartz公式是在1970年代中期设计的，以估计儿童的GFR。最近的数据表明，该公式当前高估了通过iohexol的血浆消失测量的GFR，这可能是用于测量肌酐的方法变化的结果。在这里，我们使用来自慢性肾脏疾病（CKID）同伙的349名儿童（1至16岁）的基线访问中的数据来估算GFR。 iohexol-GFR（IGFR）中位数为41.3 ml/min，每1.73 m（2）（四分位间距32.0至51.7），中位血清肌酐中位数为1.3 mg/dl。我们进行了线性回归分析，评估了基于高度，血清肌酐，伴半尿素C，血尿素氮和性别的高度估计公式改进的精度，拟合良好和准确性。最好的方程式WASGFR（ml/min每1.73 m（2））= 39.1 [高度（M）/SCR（mg/dl）]（0,516）x [1.8/cystatin c（mg/l）]（0,294）[30 /bun（mg/dl）]（0,169）[1.099]（MALC）[高度（M）/1.4]（0.188）公式在IGFR的30％以内产生了87.7％的估计GFR，在10％以内45.6％。在随访1年后的168名CKID患者的测试集中，该公式与先前发表的儿童估计方程式进行了比较。此外，在CM中测得的高度为0.413*（高度/血清肌酐），可与估计的GFR公式提供良好的近似值。还需要对具有较高GFR的儿童的其他研究来验证这些公式以筛查所有儿童的CKD。
The Schwartz formula was devised in the mid-1970s to estimate GFR in children. Recent data suggest that this formula currently overestimates GFR as measured by plasma disappearance of iohexol, likely a result of a change in methods used to measure creatinine. Here, we developed equations to estimate GFR using data from the baseline visits of 349 children (aged 1 to 16 yr) in the Chronic Kidney Disease in Children (CKiD) cohort. Median iohexol-GFR (iGFR) was 41.3 ml/min per 1.73 m(2) (interquartile range 32.0 to 51.7), and median serum creatinine was 1.3 mg/dl. We performed linear regression analyses assessing precision, goodness of fit, and accuracy to develop improvements in the GFR estimating formula, which was based on height, serum creatinine, cystatin C, blood urea nitrogen, and gender. The best equation wasGFR(ml/min per 1.73 m(2)) = 39.1[height (m)/Scr (mg/dl)](0,516) x [1.8/cystatin C (mg/L)](0,294)[30/BUN (mg/dl)](0,169)[1.099](malc)[height (m)/1.4](0.188)This formula yielded 87.7% of estimated GFR within 30% of the iGFR, and 45.6% within 10%. In a test set of 168 CKiD patients at 1 yr of follow-up, this formula compared favorably with previously published estimating equations for children. Furthermore, with height measured in cm, a bedside calculation of 0.413*(height/serum creatinine), provides a good approximation to the estimated GFR formula. Additional studies of children with higher GFR are needed to validate these formulas for use in screening all children for CKD.