The Clinician and Estimation of Glomerular Filtration Rate by Creatinine-based Formulas: Current Limitations and Quo Vadis
The Clinician and Estimation of Glomerular Filtration Rate by Creatinine-based Formulas: Current Limitations and Quo Vadis
复制标题
DOI：
10.2215/cjn.09241010
复制
发表时间：
2011-04-01
影响因子：
9.8
通讯作者：
Schueck, Otto
中科院分区：
文献类型：
--
作者：
Botev, Rossini;Mallie, Jean-Pierre;Schueck, Otto
GFR在慢性肾脏疾病结局质量倡议临床实践指南（K/DOQI-CKD）中具有重要的诊断和分期作用。在成人中最广泛使用的血清肌酐估算GFR （eGFR）的公式是Cockcroft-Gault （CG）和肾脏疾病研究（MDRD）中的饮食调整。最近，一个新的慢性肾脏疾病流行病学协作方程被开发出来。文献回顾显示，CG和MDRD公式分别正确地将受试者分配到实际的K/DOQI-CKD分类的GFR组（由测量的GFR （mGFR）确定）中，分别只有64%和62%。这表明，在美国2630万成年人CKD患病率的估计基础上，大约1000万（38%）受试者可能被错误分类。本综述的目的是帮助临床医生了解在日常实践中使用eGFR的局限性。我们还精心mGFR标记之间的差异等问题后,肾小球滤过率(GFR)调整身体表面积的有效性在某些人群,边界的有限的数据正常mGFR根据年龄,性别,种族,需要校准血清肌酐的宽光谱测量,缺乏实际的表皮生长因子受体的价值高于60毫升/每分钟1.73米(2)和参考正常mGFR临床实验室的报告,以及eGFR的绩效评估公式。在我们能够在日常肾脏学实践中可靠地确定健康和疾病之前，必须克服几个陷阱，以保持执业医学的第一规则：原始无损伤。中华临床医学杂志，2011,31(6):937-950。doi: 10.2215 / CJN.09241010
The GFR has a paramount diagnostic and staging role in the Kidney Disease Outcome Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease (K/DOQI-CKD). The most widely used serum creatinine-based formulas in adults for estimated GFR (eGFR) are the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease Study (MDRD). Recently, a new Chronic Kidney Disease Epidemiology Collaboration equation has been developed. Review of the literature revealed that CG and MDRD formulas correctly assigned overall only 64% and 62%, respectively, of the subjects to their actual K/DOQI-CKD classification's GFR groups as determined by measured GFR (mGFR). This suggests that approximately 10 million (38%) subjects may have been misclassified on the basis of estimated CKD prevalence of 26.3 million adults in the United States. The purpose of this review is to help the clinician understand the limitations of using eGFR in daily practice. We also elaborate upon issues such as the differences among markers of mGFR, the validity of adjusting GFR for body surface area in certain populations, the limited data on boundaries for normal mGFR according to age, gender, and race, the need for calibration of a wide spectrum of serum creatinine measurements, the lack of actual eGFR value above 60 ml/min per 1.73 m(2) and reference for normal mGFR in the clinical laboratories' reports, and the performance evaluation of the eGFR formulas. Several pitfalls have to be overcome before we can reliably determine health and disease in daily nephrology practice to preserve the first rule of practicing medicine: primum non nocere. Clin J Am Soc Nephrol 6: 937-950, 2011. doi: 10.2215/CJN.09241010