Lower serum albumin level is associated with higher fractional excretion of creatinine
Lower serum albumin level is associated with higher fractional excretion of creatinine
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DOI：
10.1007/s10157-013-0841-5
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发表时间：
2014-06-01
影响因子：
2.3
通讯作者：
Matsuo, Seiichi
中科院分区：
文献类型：
--
作者：
Horio, Masaru;Imai, Enyu;Matsuo, Seiichi
由于肌酐的肾小管分泌，肌酐清除率 (Ccr) 高估了肾小球滤过率 (GFR)。众所周知，肌酐 (FE-Cr) 的排泄分数随着 GFR 的降低而增加。先前也报道了血清白蛋白水平与肌酐的肾小管分泌的关联。 FE-Cr 的改变可能会影响基于血清肌酐的 GFR 估计方程的性能。因此，我们分析了影响 FE-Cr 的因素，并比较了按血清白蛋白水平分层的受试者中 GFR 方程的性能。纳入了 757 名日本受试者。 GFR 通过菊粉肾清除率来测量。同时测量 GFR 和 Ccr。 FE-Cr 计算为 Ccr 与 GFR 的比率。进行多变量分析来评估影响FE-Cr的因素。以年龄、性别、GFR、体重指数（BMI）、体重、身高和血清白蛋白水平作为参数进行分析。根据血清肌酐 (Eq-cr)、血清胱抑素 C (Eq-cys) 和包括血清白蛋白 (Eq-5var) 在内的 5 个变量，通过日本 GFR 方程计算估计 GFR。血清白蛋白 < 3.0、3.0-3.9 和千分之 4.0 g/dl 的受试者的 FE-Cr 为 1.63 +/- A 0.48、1.53 +/- A分别为 0.55 和 1.40 +/- A 0.36。血清白蛋白 < 3.0 或 3.0-3.9 g/dl 的受试者的 FE-Cr 值显着高于血清白蛋白千分之 4.0 g/dl 的受试者的值。多变量分析显示，GFR (p < 0.0001) 和血清白蛋白水平 (p = 0.004) 是影响 FE-Cr 的独立参数。血清白蛋白 < 3.0 g/dl 的受试者中 Eq-cr、Eq-cys 和 Eq-5var 的偏差分别为 -9.5 +/- A 17.5、-0.7 +/- A 17.1 和 -0.6 +/- A 14.8 ml/min/1.73 m(2)。与 Eq-cys 或 Eq-5var 相比，Eq-cr 显着高估了 GFR。血清白蛋白为千分之4.0 g/dl的受试者的偏差分别为6.4 +/- A 18.8、2.0 +/- A 18.1和3.0 +/- A 18.3 ml/min/1.73 m(2)。与Eq-cys或Eq-5var相比，Eq-cr显着低估了GFR。GFR和血清白蛋白水平是影响FE-Cr的独立参数。 FE-Cr随血清白蛋白水平的变化可能是基于血清肌酐的GFR方程出现偏差的原因之一。
Creatinine clearance (Ccr) overestimates glomerular filtration rate (GFR) due to the tubular secretion of creatinine. It is known that fractional excretion of creatinine (FE-Cr) increases with decreasing GFR. Association of serum albumin level with the tubular secretion of creatinine was also reported previously. Alteration of FE-Cr may affect the performance of GFR estimating equations based on serum creatinine. Therefore, we analyzed the factors influencing FE-Cr and compared the performance of GFR equations in subjects stratified by serum albumin levels.Seven hundred and fifty-seven Japanese subjects were included. GFR was measured by inulin renal clearance. GFR and Ccr were measured simultaneously. FE-Cr was calculated as the ratio of Ccr to GFR. Multivariate analysis was performed to evaluate the factors influencing FE-Cr. Age, gender, GFR, body mass index (BMI), body weight, height and serum albumin level were analyzed as the parameters. Estimated GFR was calculated by Japanese GFR equations based on serum creatinine (Eq-cr), serum cystatin C (Eq-cys) and 5 variables including serum albumin (Eq-5var).FE-Cr in subjects with serum albumin < 3.0, 3.0-3.9 and a parts per thousand yen4.0 g/dl were 1.63 +/- A 0.48, 1.53 +/- A 0.55, and 1.40 +/- A 0.36, respectively. FE-Cr in subjects with serum albumin < 3.0 or 3.0-3.9 g/dl were significantly higher than the value in subjects with serum albumin a parts per thousand yen4.0 g/dl. Multivariate analysis showed that GFR (p < 0.0001) and serum albumin level (p = 0.004) were independent parameters affecting FE-Cr. Biases of Eq-cr, Eq-cys and Eq-5var in subjects with serum albumin < 3.0 g/dl were -9.5 +/- A 17.5, -0.7 +/- A 17.1 and -0.6 +/- A 14.8 ml/min/1.73 m(2), respectively. Eq-cr significantly overestimated GFR compared with Eq-cys or Eq-5var. Biases in subjects with serum albumin a parts per thousand yen4.0 g/dl were 6.4 +/- A 18.8, 2.0 +/- A 18.1 and 3.0 +/- A 18.3 ml/min/1.73 m(2), respectively. Eq-cr significantly underestimated GFR compared with Eq-cys or Eq-5var.GFR and serum albumin level were independent parameters affecting FE-Cr. Alteration of FE-Cr according to the serum albumin levels may be one of the reasons of the bias of GFR equation based on serum creatinine.