Prediction of GFR in liver transplant candidates
Prediction of GFR in liver transplant candidates
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DOI：
10.1053/j.ajkd.2003.08.017
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发表时间：
2003-12-01
影响因子：
13.2
通讯作者：
Pergola, PE
中科院分区：
文献类型：
--
作者：
Skluzacek, PA;Szewc, RG;Pergola, PE
背景肝硬化患者肾功能经常受损，然而，肾小球滤过率（GFR）在这些患者中很难通过使用标准的临床标志物来估计。本研究的目的是比较根据125碘标记的碘酞酸盐（I-125-lothalamate）的肾清除率计算的GFR与血浆衰变技术、肾脏疾病饮食改良（MDRD）和Cockroft-Gault（CG）预测方程。研究方法：我们对肝硬化患者进行了一项横断面研究，这些患者正在接受肝移植评估（50% Child C级）; 89%有腹水或水肿，44%为55 +/- 2岁的男性。平均试验前血尿素氮水平为16 +/- 2 mg/dL（5.7 +/- 0.7 mmol/L）;血清肌酐，1.0 +/- 0.1 mg/dL（88 +/- 9 mumol/L;范围：0.6 - 1.7 mg/dL [53 - 150 mumol/L]）;血浆白蛋白：3.14 +/- 0.16 g/dL（31.4 +/- 1.6 g/L）;总胆红素，4.0 +/- 0.7 mg/dL（67 +/- 11.3 mumol/L）。通过同时测定I-125-洛他拉酯（Glofil-125; Cypros Pharmaceutical Corp，卡尔斯巴德，CA）的血浆和肾脏清除率以及MDRD和CG方程，测定肾功能。结果如下：I-125-碘酞酸盐肾清除率的GFR为58.2 +/- 5.1 mL/min/1.73 m（2），血浆衰减技术的GFR为76.7 +/- 7.2 mL/min/1.73 m（2）（+18.5 mL/min，或32%; P = 0.0004）。通过MDRD方程计算的GFR为76.9 +/- 7.8 mL/min/1.73 m（2）（+18.7 mL/min，或32%; P = 0.0004 vs肾氯酞酸盐; r（2）= 0.57）。CG公式计算的GFR准确度最低（+30.1 mL/min，或52%;与肾碘酞酸盐相比，P = 0.0001）。结论：目前临床上使用的CG和MDRD方程来估计肝硬化和容量过剩患者的肾功能，以及I-125-lothalamate血浆衰变技术是不准确的，因为它们高估了GFR。似乎不太可能开发出能够取代肝硬化患者GFR正式测量的准确可靠的公式。因此，我们得出结论，尽管额外的复杂性，肾清除技术应用于评估GFR准确地在肝硬化和腹水患者。
Background Kidney function frequently is impaired in patients with cirrhosis; however, glomerular filtration rate (GFR) is difficult to estimate in these patients by using standard clinical markers. The aim of our study is to compare GFR calculated from renal clearance of iodine 125-labeled iothalamate (I-125-lothalamate) with the plasma decay technique and the Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault (CG) prediction equations. Methods: We performed a cross-sectional study of patients with liver cirrhosis being evaluated for transplantation (50% Child's class C); 89% had ascites or edema and 44% were men aged 55 +/- 2 years. Average pretest blood urea nitrogen level was 16 +/- 2 mg/dL (5.7 +/- 0.7 mmol/L); serum creatinine, 1.0 +/- 0.1 mg/dL (88 +/- 9 mumol/L; range, 0.6 to 1.7 mg/dL [53 to 150 mumol/L]); plasma albumin, 3.14 +/- 0.16 g/dL (31.4 +/- 1.6 g/L); and total bilirubin, 4.0 +/- 0.7 mg/dL (67 +/- 11.3 mumol/L). Kidney function was measured by means of simultaneous plasma and renal clearance of I-125-lothala mate (Glofil-125; Cypros Pharmaceutical Corp, Carlsbad, CA) and the MDRD and CG equations. Results: GFRs were 58.2 +/- 5.1 mL/min/1.73 m(2) by renal clearance of I-125-iothalamate and 76.7 +/- 7.2 mL/min/1.73 m(2) by the plasma decay technique (+18.5 mL/min, or 32%; P = 0.0004). GFR by the MDRD equation was 76.9 +/- 7.8 mL/min/1.73 m(2) (+18.7 mL/min, or 32%; P = 0.0004 versus renal lothalamate; r(2) = 0.57). GFR by the CG equation was the least accurate (+30.1 mL/min, or 52%; P = 0.0001 versus renal iothalamate). Conclusion: The current clinically used CG and MDRD equations to estimate kidney function in patients with cirrhosis and volume excess and the I-125-lothalamate plasma decay technique are inaccurate because they overestimate GFR. It seems very unlikely that accurate and reliable formulas will be developed that are able to replace the formal measurement of GFR in patients with liver cirrhosis. Therefore, we conclude that despite the additional complexity, renal clearance techniques should be used to assess GFR accurately in patients with liver cirrhosis and ascites.