Determination of the best method to estimate glomerular filtration rate from serum creatinine in adult patients with sickle cell disease: a prospective observational cohort study
Determination of the best method to estimate glomerular filtration rate from serum creatinine in adult patients with sickle cell disease: a prospective observational cohort study
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DOI：
10.1186/1471-2369-13-83
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发表时间：
2012-08-06
期刊：
影响因子：
2.3
通讯作者：
Courbebaisse, Marie
中科院分区：
文献类型：
--
作者：
Arlet, Jean-Benoit;Ribeil, Jean-Antoine;Courbebaisse, Marie
背景：镰状细胞病（SCD）导致组织缺氧，导致慢性器官功能障碍，包括SCD相关肾病。我们研究的目的是确定最佳方程估计肾小球滤过率（GFR）在SCD成人patients.Methods：我们进行了一项前瞻性观察队列研究。自2007年以来，在两个医疗部门随访的所有处于稳定状态的成人SCD患者都使用碘海醇血浆清除率（金标准）测量了其GFR。检验了Cockcroft-Gault、MDRD-v4、CKP-EPI以及最后未校正种族的MDRD和CKD-EPI方程，以根据血清肌酐估计GFR。估计GFRs进行了比较，测量GFRs根据图形Bland和Altman方法。结果：64名SCD患者（16名男性，中位年龄27.5岁[范围18.0-67.5]，41与SS基因型进行了研究。他们是撒哈拉以南非洲和法属西印度群岛的本地人，主要是瘦（体重指数中位数：22 kg/m（2）[16-33]）。在53.1%的患者中检测到高滤过（定义为测量的GFR > 110 mL/min/1.73 m2）。高滤过患者的尿白蛋白/肌酐比值高于GFR正常患者（4.05 mg/mmol [0.14-60] vs 0.4 mg/mmol [0.7-81]，p = 0.01）。CKD-EPI方程在没有种族调整的情况下具有最低的偏倚和最高的精度。使用CKP-EPI方程估计GFR和测量GFR之间的差异随着GFR值的增加而降低，而Cockcroft-Gault和MDRD-v4 equations.Conclusions：我们证实，SCD患者有很高的肾小球高滤过率，这是经常与微量白蛋白尿或大量白蛋白尿。在非美国黑人SCD患者中，从血清肌酐估计GFR的最佳方法是CKD-EPI方程，无需校正种族。该公式对于估计高GFR值（包括肾小球高滤过）特别准确，因此应推荐用于筛查SCD肾病高风险的SCD成人患者。
Background: Sickle cell disease (SCD) leads to tissue hypoxia resulting in chronic organ dysfunction including SCD associated nephropathy. The goal of our study was to determine the best equation to estimate glomerular filtration rate (GFR) in SCD adult patients.Methods: We conducted a prospective observational cohort study. Since 2007, all adult SCD patients in steady state, followed in two medical departments, have had their GFR measured using iohexol plasma clearance (gold standard). The Cockcroft-Gault, MDRD-v4, CKP-EPI and finally, MDRD and CKD-EPI equations without adjustment for ethnicity were tested to estimate GFR from serum creatinine. Estimated GFRs were compared to measured GFRs according to the graphical Bland and Altman method.Results: Sixty-four SCD patients (16 men, median age 27.5 years [range 18.0-67.5], 41 with SS-genotype were studied. They were Sub-Saharan Africa and French West Indies natives and predominantly lean (median body mass index: 22 kg/m(2) [16-33]). Hyperfiltration (defined as measured GFR > 110 mL/min/1.73 m(2)) was detected in 53.1% of patients. Urinary albumin/creatinine ratio was higher in patients with hyperfiltration than in patients with normal GFR (4.05 mg/mmol [0.14-60] versus 0.4 mg/mmol [0.7-81], p = 0.01). The CKD-EPI equation without adjustment for ethnicity had both the lowest bias and the greatest precision. Differences between estimated GFRs using the CKP-EPI equation and measured GFRs decreased with increasing GFR values, whereas it increased with the Cockcroft-Gault and MDRD-v4 equations.Conclusions: We confirm that SCD patients have a high rate of glomerular hyperfiltration, which is frequently associated with microalbuminuria or macroalbuminuria. In non-Afro-American SCD patients, the best method for estimating GFR from serum creatinine is the CKD-EPI equation without adjustment for ethnicity. This equation is particularly accurate to estimate high GFR values, including glomerular hyperfiltration, and thus should be recommended to screen SCD adult patients at high risk for SCD nephropathy.