Comparing GFR Estimating Equations Using Cystatin C and Creatinine in Elderly Individuals
Comparing GFR Estimating Equations Using Cystatin C and Creatinine in Elderly Individuals
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DOI：
10.1681/asn.2014060607
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发表时间：
2015-08-01
影响因子：
13.6
通讯作者：
Inker, Lesley A.
中科院分区：
文献类型：
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作者：
Fan, Li;Levey, Andrew S.;Inker, Lesley A.
现行指南建议使用慢性肾脏病流行病学协作组（CKD-EPI）公式报告eGFR，除非其他公式更准确，并建议肌酐和胱抑素C（eGFRcr-cys）联合使用比单独使用eGFRcr或eGFRcys更准确。然而，老年人的首选方程和过滤标记物存在争议。在805名参加基于社区的年龄、基因/环境易感性（AGES）-雷克雅未克研究的成人中，我们使用碘海醇、标准化肌酐和胱抑素C的血浆清除率测量GFR（mGFR），并使用CKD-EPI、日本、柏林倡议研究（BIS）以及高加索和亚洲儿童和成人受试者（CAPA）方程测量eGFR。我们使用偏倚、精度和两种准确度指标评估方程性能。我们首先将日本、BIS和CAPA方程与CKD-EPI方程进行比较，以确定首选方程，然后使用首选方程将eGFRcr和eGFRcys与eGFRcr-cys进行比较。平均（SD）年龄为80.3（4.0）岁。GFR中位数（第25、75位）为64（52、73）ml/min/1.73 m2，GFR降低的患病率为39%（95%置信区间为35.8 ~ 42.5）。在24个与其他方程的比较中，CKD-EPI方程在9个方程中表现更好，在13个方程中表现相似，在2个方程中表现更差。使用CKD-EPI方程，eGFRcr-cys在四个指标上优于eGFRcr，在两个指标上优于eGFRcys，在两个指标上与eGFRcys相似。总之，无论是日本，BIS，或CAPA方程是上级CKD-EPI方程在这个队列的社区居住的老年人。使用CKD-EPI方程，eGFRcr-cys的表现优于eGFRcr或eGFRcys。
Current guidelines recommend reporting eGFR using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations unless other equations are more accurate, and recommend the combination of creatinine and cystatin C (eGFRcr-cys) as more accurate than either eGFRcr or eGFRcys alone. However, preferred equations and filtration markers in elderly individuals are debated. In 805 adults enrolled in the community-based Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study, we measured GFR (mGFR) using plasma clearance of iohexol, standardized creatinine and cystatin C, and eGFR using the CKD-EPI, Japanese, Berlin Initiative Study (BIS), and Caucasian and Asian pediatric and adult subjects (CAPA) equations. We evaluated equation performance using bias, precision, and two measures of accuracy. We first compared the Japanese, BIS, and CAPA equations with the CKD-EPI equations to determine the preferred equations, and then compared eGFRcr and eGFRcys with eGFRcr-cys using the preferred equations. Mean (SD) age was 80.3 (4.0) years. Median (25th, 75th) GFR was 64 (52, 73) ml/min per 1.73 m(2), and the prevalence of decreased GFR was 39% (95% confidence interval, 35.8 to 42.5). Among 24 comparisons with the other equations, CKD-EPI equations performed better in 9, similar in 13, and worse in 2. Using the CKD-EPI equations, eGFRcr-cys performed better than eGFRcr in four metrics, better than eGFRcys in two metrics, and similar to eGFRcys in two metrics. In conclusion, neither the Japanese, BIS, nor CAPA equations were superior to the CKD-EPI equations in this cohort of community-dwelling elderly individuals. Using the CKD-EPI equations, eGFRcr-cys performed better than eGFRcr or eGFRcys.