Estimating glomerular filtration rate: comparison of the CKD-EPI and MDRD equations in a large UK cohort with particular emphasis on the effect of age
Estimating glomerular filtration rate: comparison of the CKD-EPI and MDRD equations in a large UK cohort with particular emphasis on the effect of age
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DOI：
10.1093/qjmed/hcr077
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发表时间：
2011-10-01
影响因子：
13.3
通讯作者：
Lamb, E. J.
中科院分区：
文献类型：
--
作者：
Carter, J. L.;Stevens, P. E.;Lamb, E. J.
背景资料：慢性肾脏病（CKD）-流行病学协作组（CKD-EPI）方程是为了解决肾脏病饮食改良（MDRD）方程在>60 mL/min/1.73 m2水平下低估肾小球滤过率（GFR）的问题而开发的。目的：评估CKD-EPI方程对英国大型成人人群GFR估计值的影响（n = 561400），特别是年龄的影响。设计：血清肌酐结果（ID-MS-对齐的酶测定）从1年期间的成人病理学数据库中提取方法：174448人的第一个可用肌酐结果用于估计GFR，使用方程和一致性评估。结果：CKD-EPI GFR中位数显著高于MDRD GFR中位数（82 vs. 76 mL/min/1.73 m2，P < 0.0001）。CKD-EPI和MDRD GFR之间的总体平均偏倚为5.0%，范围从18-29岁年龄组的13.0%降至90岁以上年龄组的-7.5%。尽管在所有年龄组中都具有统计学意义，但差异随着年龄的增长而缩小，并且GFR类别分配的一致性增加。根据CKD-EPI，经年龄调整的3-5期CKD人群患病率低于MDRD（4.4% vs.4.9%）。结论：CKD-EPI产生更高的GFR和更低的CKD估计值，特别是在18-59岁年龄组中，MDRD估计的GFRs为45-59 mL/min/1.73 m（2）（3A期）。然而，在年龄> 70岁时，方程之间的差异很小，并且在非常年长的CKD中，EPI实际上可能增加CKD患病率估计值。
Background: The chronic kidney disease (CKD)-Epidemiology Collaboration (CKD-EPI) equation was developed to address the underestimation of measured glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) equation at levels >60 mL/min/1.73 m(2).Aim: To assess the impact of the CKD-EPI equation on the estimation of GFR in a large adult UK population (n = 561 400), particularly looking at the effect of age.Design: Serum creatinine results (ID-MS-aligned enzymatic assay) were extracted from the pathology database during 1 year on adult (epsilon 18 years) patients from primary care.Methods: The first available creatinine result from 174 448 people was used to estimate GFR using both equations and agreement assessed.Results: Median CKD-EPI GFR was significantly higher than median MDRD GFR (82 vs. 76 mL/min/1.73 m(2), P < 0.0001). Overall mean bias between CKD-EPI and MDRD GFR was 5.0%, ranging from 13.0% in the 18-29 years age group down to -7.5% in those aged epsilon 90 years. Although statistically significant at all age groups the difference diminished with age and the agreement in GFR category assignment increased. Age-adjusted population prevalence of CKD Stages 3-5 was lower by CKD-EPI than by MDRD (4.4% vs. 4.9%).Conclusion: CKD-EPI produces higher GFR and lower CKD estimates, particularly among 18-59 year age groups with MDRD estimated GFRs of 45-59 mL/min/1.73 m(2) (Stage 3A). However, at ages > 70 years there is very little difference between the equations, and among the very elderly CKD-EPI may actually increase CKD prevalence estimates.