Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease.
Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease.
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DOI：
10.1007/s10157-006-0453-4
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发表时间：
2007-03-01
影响因子：
2.3
通讯作者：
Matsuo, Seiichi
中科院分区：
文献类型：
--
作者：
Imai, Enyu;Horio, Masaru;Matsuo, Seiichi
背景：准确估计肾小球滤过率（GFR）对于检测慢性肾脏病（CKD）至关重要。在临床实践中，GFR是使用肾脏疾病饮食改良（MDRD）研究方程或Cockcroft-Gault（CG）方程根据血清肌酐估计的，而不是耗时的外源性标志物（如菊粉）清除率测量方法。在本研究中，最初开发的高加索人口的方程进行了测试，在日本CKD患者，并修改与日本系数确定的data.METHODS：的缩写MDRD研究和CG方程进行了测试，在248例日本CKD患者，并与测定菊粉清除率（Cin）和估计GFR（eGFR）。通过最小化eGFR和Cin之间的平方误差之和确定日本系数。本研究中酶法的血清肌酐值通过添加0.207 mg/dl校准为非补偿Jaffe法的值，因为原始MDRD研究方程是由非补偿Jaffe法测量的血清肌酐值数据确定的。结果：用1.0xMDRD或CG公式计算的Cin与eGFR之间存在显著性差异，用1.0xMDRD或CG公式计算的Cin与eGFR之间存在显著性差异。使用日本CKD患者确定的日本系数（0.881xMDRD）修改的MDRD研究方程，GFR估计的平均差较低，准确度较高。特别是在Cin 30-59 ml/min/1.73 m2时，0.881xMDRD方程的平均差异显著小于1.0xMDRD研究方程每1.73 m（2）分别为1.9和7.9 ml/min;准确性显著高于对照组，分别有60%和39%的点偏差在15%以内，97%和87%的点偏差在50%以内（均P < 0.01）。不同数据集的验证显示，eGFR和Cin之间的相关性与0.881xMDRD方程比与1.0xMDRD研究方程更好。在Cin小于60 ml/min/1.73 m2时，准确性明显较高，分别有85%和69%的点偏离50%（P < 0.01）。平均差异也显著较小（P < 0.01）。然而，在Cin超过60 ml/min/1.73 m2的范围内，0.881xMDRD方程计算的GFR值仍被低估。结论：尽管日本系数提高了原始MDRD研究方程GFR估计的准确性，但需要一个新的方程来更准确地估计日本CKD 3期和4期患者的GFR。
BACKGROUND: Accurate estimation of the glomerular filtration rate (GFR) is crucial for the detection of chronic kidney disease (CKD). In clinical practice, GFR is estimated from serum creatinine using the Modification of Diet in Renal Disease (MDRD) study equation or the Cockcroft-Gault (CG) equation instead of the time-consuming method of measured clearance for exogenous markers such as inulin. In the present study, the equations originally developed for a Caucasian population were tested in Japanese CKD patients, and modified with the Japanese coefficient determined by the data.METHODS: The abbreviated MDRD study and CG equations were tested in 248 Japanese CKD patients and compared with measured inulin clearance (Cin) and estimated GFR (eGFR). The Japanese coefficient was determined by minimizing the sum of squared errors between eGFR and Cin. Serum creatinine values of the enzyme method in the present study were calibrated to values of the noncompensated Jaffe method by adding 0.207 mg/dl, because the original MDRD study equation was determined by the data for serum creatinine values measured by the noncompensated Jaffe method. The abbreviated MDRD study equation modified with the Japanese coefficient was validated in another set of 269 CKD patients.RESULTS: There was a significant discrepancy between measured Cin and eGFR by the 1.0xMDRD or CG equations. The MDRD study equation modified with the Japanese coefficient (0.881xMDRD) determined for Japanese CKD patients yielded lower mean difference and higher accuracy for GFR estimation. In particular, in Cin 30-59 ml/min per 1.73 m(2), the mean difference was significantly smaller with the 0.881xMDRD equation than that with the 1.0xMDRD study equation (1.9 vs 7.9 ml/min per 1.73 m(2); P < 0.01), and the accuracy was significantly higher, with 60% vs 39% of the points deviating within 15%, and 97% vs 87% of points within 50%, respectively (both P < 0.01). Validation with the different data set showed the correlation between eGFR and Cin was better with the 0.881xMDRD equation than with the 1.0xMDRD study equation. In Cin less than 60 ml/min per 1.73 m(2), the accuracy was significantly higher, with 85% vs 69% of the points deviating within 50% (P < 0.01), respectively. The mean difference was also significantly smaller (P < 0.01). However, GFR values calculated by the 0.881xMDRD equation were still underestimated in the range of Cin over 60 ml/min per 1.73 m(2).CONCLUSIONS: Although the Japanese coefficient improves the accuracy of GFR estimation of the original MDRD study equation, a new equation is needed for more accurate estimation of GFR in Japanese patients with CKD stages 3 and 4.