Measured GFR Does Not Outperform Estimated GFR in Predicting CKD-related Complications
Measured GFR Does Not Outperform Estimated GFR in Predicting CKD-related Complications
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DOI：
10.1681/asn.2010101077
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发表时间：
2011-10-01
影响因子：
13.6
通讯作者：
Feldman, Harold
中科院分区：
文献类型：
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作者：
Hsu, Chi-yuan;Propert, Kathleen;Feldman, Harold
尽管许多人认为使用碘酞酸 (iGFR) 等标记物测量肾小球滤过率 (GFR) 优于方程估计 GFR (eGFR)，但这些方法均具有明显的缺点。由于医生经常使用肾功能来指导各种 CKD 相关并发症的筛查，因此比较 iGFR 和 eGFR 临床实用性的一种方法是确定它们与 CKD 相关合并症的关联强度。使用慢性肾功能不全队列 (CRIC) 研究中的 1214 名参与者，我们确定了 CKD 已知并发症和 iGFR、根据血清肌酐估计的 eGFR (eGFR_Cr) 和根据胱抑素 C 估计的 eGFR (eGFR_cysC) 之间的横断面关联。我们发现，没有一项肾功能指标与 CKD 并发症密切相关，并且相关性的相对强度根据感兴趣的结果而变化。例如，对于贫血和血红蛋白浓度结果，iGFR 表现出比 eGFR_Cr 和 eGFR_cysC 更好的辨别能力；然而，对于高磷血症和磷水平的结果，eGFR_Cr 和 eGFR_cysC 都表现出比 iGFR 更好的辨别能力。 iGFR 和 eGFR 与高钾血症/钾水平以及代谢性酸中毒/碳酸氢盐水平的相关性相似。总之，在解释 CKD 相关合并症时，碘酞酸盐测量的 GFR 并不总是优于基于方程的 GFR 估计。这些结果对 iGFR 是衡量肾功能的“金标准”这一传统观点提出了质疑。
Although many assume that measurement of glomerular filtration rate (GFR) using a marker such as iothalamate (iGFR) is superior to equation-estimated GFR (eGFR), each of these methods has distinct disadvantages. Because physicians often use renal function to guide the screening for various CKD-associated complications, one method to compare the clinical utility of iGFR and eGFR is to determine the strength of their association with CKD-associated comorbidities. Using a subset of 1214 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study, we determined the cross-sectional associations between known complications of CKD and iGFR, eGFR estimated from serum creatinine (eGFR_Cr), and eGFR estimated from cystatin C (eGFR_cysC). We found that none of the measures of renal function strongly associated with CKD complications and that the relative strengths of associations varied according to the outcome of interest. For example, iGFR demonstrated better discrimination than eGFR_Cr and eGFR_cysC for outcomes of anemia and hemoglobin concentration; however, both eGFR_Cr and eGFR_cysC demonstrated better discrimination than iGFR for outcomes of hyperphosphatemia and phosphorus level. iGFR and eGFR had similar strengths of association with hyperkalemia/potassium level and with metabolic acidosis/bicarbonate level. In conclusion, iothalamate measurement of GFR is not consistently superior to equation-based estimations of GFR in explaining CKD-related comorbidities. These results raise questions regarding the conventional view that iGFR is the "gold standard" measure of kidney function.