A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation
A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation
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DOI：
10.7326/0003-4819-130-6-199903160-00002
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发表时间：
1999-03-16
影响因子：
39.2
通讯作者：
Roth, D
中科院分区：
文献类型：
--
作者：
Levey, AS;Bosch, JP;Roth, D
背景资料：血清肌酐浓度被广泛用作肾功能的指标，但该浓度受肾小球滤过率（GFR）以外的因素的影响。目的：建立一个从血清肌酐浓度和其他因素预测GFR的方程。设计：慢性肾病患者GFR、肌酐清除率、血清肌酐浓度以及人口统计学和临床特征的横断面研究。患者：1628例患者入组的基础阶段的饮食在肾脏疾病的改良（MDRD）研究，其中1070例被随机选择为训练样本，其余558例患者构成的验证sample.Methods：预测方程的逐步回归应用于训练样本。然后对该方程进行测试，并与验证样本中的其他预测方程进行比较。结果：为了简化对GFR的预测，该方程仅包括人口统计学变量和血清变量。与较低GFR相关的独立因素包括较高的血清肌酐浓度、年龄较大、女性、非黑人、较高的血清尿素氮水平和较低的血清白蛋白水平（所有因素均P <0.002）。多元回归模型解释了验证样本中GFR对数的90.3%方差。测量的肌酐清除率高估GFR 19%，Cockcroft-Gault公式预测的肌酐清除率高估GFR 16%。调整后，这种高估，肾小球滤过率的对数预测测得的肌酐清除率或Cockcroft-Gault公式的方差百分比分别为86.6%和84.2%.Conclusion：从MDRD研究开发的方程提供了一个更准确的估计肾小球滤过率在我们的研究组比测得的肌酐清除率或其他常用的方程。
Background: Serum creatinine concentration is widely used as an index of renal function, but this concentration is affected by factors other than glomerular filtration rate (GFR).Objective: To develop an equation to predict GFR from serum creatinine concentration and other factors.Design: Cross-sectional study of GFR, creatinine clearance, serum creatinine concentration, and demographic and clinical characteristics in patients with chronic renal disease.Patients: 1628 patients enrolled in the baseline period of the Modification of Diet in Renal Disease (MDRD) Study, of whom 1070 were randomly selected as the training sample; the remaining 558 patients constituted the validation sample.Methods: The prediction equation was developed by stepwise regression applied to the training sample. The equation was then tested and compared with other prediction equations in the validation sample.Results: To simplify prediction of GFR, the equation included only demographic and serum variables. Independent factors associated with a lower GFR included a higher serum creatinine concentration, older age, female sex, nonblack ethnicity, higher serum urea nitrogen levels, and lower serum albumin levels (P < 0.002 for all factors). The multiple regression model explained 90.3% of the variance in the logarithm of GFR in the validation sample. Measured creatinine clearance overestimated GFR by 19%, and creatinine clearance predicted by the Cockcroft-Gault formula overestimated GFR by 16%. After adjustment for this overestimation, the percentage of variance of the logarithm of GFR predicted by measured creatinine clearance or the Cockcroft-Gault formula was 86.6% and 84.2%, respectively.Conclusion: The equation developed from the MDRD Study provided a more accurate estimate of GFR in our study group than measured creatinine clearance or other commonly used equations.