An alternative formula to the Cockcroft-Gault and the modification of diet in renal diseases formulas in predicting GFR in individuals with type 1 diabetes
An alternative formula to the Cockcroft-Gault and the modification of diet in renal diseases formulas in predicting GFR in individuals with type 1 diabetes
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DOI：
10.1681/asn.2004080692
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发表时间：
2005-04-01
影响因子：
13.6
通讯作者：
Thomas, W
中科院分区：
文献类型：
--
作者：
Ibrahim, H;Mondress, M;Thomas, W
目前，慢性肾病呈上升趋势，不仅导致终末期肾病（ESRD），需要透析或移植，而且还会增加心血管疾病的风险。 GFR 的测量是评估肾功能的金标准，它既昂贵又麻烦。目前有几种基于血清肌酐的预测公式用于估计 GFR，但尚未在大量糖尿病患者中得到验证。两种常用公式的性能，即肾病饮食改良 (MDRD) 研究公式的 GFR 和肌酸酐清除率的 Cockcroft-Gault 估计值，在糖尿病控制和并发症试验 (DCCT) 的 1286 名 1 型糖尿病患者中，与通过碘酞酸盐肾脏清除率测量的 GFR 进行了比较。这些公式的性能通过计算偏差、精度和准确度进行评估。与 MDRD 患者不同，DCCT 参与者的血清肌酐正常，并且肌酐排泄量比原始队列 Cockcroft Gault 中的受试者稍低，这导致当这些公式应用于 DCCT 受试者时，GFR 的估计存在偏差且高度可变。 MDRD 大大低估了碘酞酸盐 GFR，而当碘酞酸盐 GFR < 120 ml/min 每 1.73 m(2) 时，Cockcroft Gault 公式会低估它，而当碘酞酸盐 GFR > 130 ml/min 每 1.73 m(2) 时，Cockcroft Gault 公式会高估它。总体而言，只有三分之一的公式估计值在碘酞酸盐 GFR 的 +/- 10% 范围内。通过低估 GFR，这些公式可能会标志着肾功能的早期下降。将 MDRD 公式重新拟合到 DCCT 数据中，可以根据血清肌酐更准确、更公正地预测 GFR；测量 GFR 10% 范围内的估计百分比增加至 56%。然而，估计值仍然存在很大差异。
Chronic kidney disease is currently on the rise and not only leads to ESRD necessitating dialysis or transplantation but also increases cardiovascular disease risk. Measurement of the GFR, the gold standard for assessing kidney function, is expensive and cumbersome. Several prediction formulas that are based on serum creatinine ate currently used to estimate the GFR, but none has been validated in a large cohort of individuals with diabetes. The performance of two commonly used formulas, the abbreviated Modification of Diet in Renal Disease (MDRD) study formula for the GFR and the Cockcroft-Gault estimate of creatinine clearance, were examined against GFR measured by the renal clearance of iothalamate in 1286 individuals with type 1 diabetes from the Diabetes Control and Complications Trial (DCCT). The performance of these formulas was assessed by computing bias, precision, and accuracy. The DCCT participants had normal serum creatinine, unlike the MDRD patients, and somewhat lower creatinine excretion than subjects in the original cohort Cockcroft Gault, which led to biased and highly variable estimates of GFR when these formulas were applied to the DCCT subjects. The MDRD substantially underestimated iothalamate GFR, whereas the Cockcroft Gault formula underestimated it when it was < 120 ml/min per 1.73 m(2) and overestimated it when iothalamate GFR was > 130 ml/min per 1.73 m(2). Overall, only one third of the formula's estimates were within +/- 10% of iothalamate GFR. By underestimating GFR, these formulas were likely to flag early declines in kidney function. Refitting the MDRD formula to the DCCT data gave a more accurate and unbiased prediction of GFR from serum creatinine; percentage of estimate within 10% of measured GFR increased to 56%. A substantial variability in the estimates, however, remained.