CDK-EPI equation may be the most proper formula based on creatinine in determining glomerular filtration rate in Chinese patients with chronic kidney disease
CDK-EPI equation may be the most proper formula based on creatinine in determining glomerular filtration rate in Chinese patients with chronic kidney disease
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DOI：
10.1007/s11255-012-0325-7
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发表时间：
2013-08-01
影响因子：
2
通讯作者：
Pan, Li-Ping
中科院分区：
文献类型：
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作者：
Xie, Peng;Huang, Jian-Min;Pan, Li-Ping
比较慢性肾脏病流行病学协作组（CDK-EPI）公式、24小时肌酐清除率（24 hCCr）、Cockroft-Gault（C-G）公式、简化的肾脏病饮食改良（aMDRD）公式、改良的肾脏病饮食改良（mMDRD）方程测定中国慢性肾脏病（CKD）患者的肾小球滤过率（GFR）本研究共纳入154例CKD患者，其中154例为慢性肾脏病（CKD）患者，154例为慢性肾脏病（CKD）患者。采用双血浆采样法（rGFR）测定的Tc-99 m-DTPA血浆清除率作为参比标准。同时用5种方法估算GFR：（1）CDK-EPI方程（eGFR 1）;（2）24 hCCr（eGFR 2）;（3）C-G公式（eGFR 3）;（4）简化MDRD方程（eGFR 4）;（5）mMDRD方程（eGFR 5）。检测CKD的相关性、回归、偏倚、精密度、准确度、一致性限和受试者工作特征（ROC）的比较（GFR截断值为60 mLmin（-1）1.73 m（-2））进行分析，以确定最合适的方法。CDK-EPI方程的相关系数最高（r（eGFR 1）= 0.922，P < 0.001）。Bland-Altman分析表明，CDK-EPI方程的一致性限为-25.5至30.3 mL min（-1）1.73 m（-2），这是测试方程中的最小范围。CDK-EPI方程的精密度最好（14.24 mL min（-1）1.73 m（-2））。ROC曲线显示在检测CKD方面的最佳性能。CDK-EPI方程、24 hCCr方程和mMDRD方程在± 30%范围内的准确率分别为72.08、69.48和70.13%，差异无统计学意义（P > 0.05）。但CDK-EPI方程的准确性最高（P < 0.05）。CDK-EPI方程的偏倚和准确性与其他4个方程相比无统计学差异，但在相关性、准确性、一致性限和检出CKD方面，CDK-EPI方程优于其他4个基于肌酐的方程，且具有简便、省时、经济的特点。因此，我们强烈建议CDK-EPI方程是测定中国CKD患者GFR的最合适方法，可在临床上普遍应用。
To compare the performance of the Chronic Kidney Disease Epidemiology Collaboration (CDK-EPI) equation, the 24-h creatinine clearance rate (24hCCr), Cockroft-Gault (C-G) formula, the abbreviated Modification of Diet in Renal Disease (aMDRD) equation, the modified Modification of Diet in Renal Disease (mMDRD) equation in determining glomerular filtration rate (GFR) in Chinese patients with chronic kidney disease (CKD) and detect the most proper method to measure GFR in clinical practice.One hundred and fifty-four patients with CKD were enrolled in the present study. Tc-99m-diethylene triamine pentaacetic acid (Tc-99m-DTPA) plasma clearance method measured by dual plasma sampling method (rGFR) was considered as the reference standard. GFR was estimated simultaneously using five methods: (1) CDK-EPI equation (eGFR1); (2) 24hCCr (eGFR2); (3) C-G formula (eGFR3); (4) abbreviated MDRD equation (eGFR4); (5) mMDRD equation (eGFR5). The comparison of correlation, regression, bias, precision, accuracy, limit of agreement, and receiver-operating characteristics (ROC) for detecting CKD (with a GFR cutoff of 60 mL min(-1) 1.73 m(-2)) among the methods was analyzed to identify the most suitable method.All the equations correlated well with rGFR, and the correlation coefficient of CDK-EPI equation was the highest (r(eGFR1) = 0.922, P < 0.001). The Bland-Altman analysis showed that the limit of agreement for CDK-EPI equation was -25.5 to 30.3 mL min(-1) 1.73 m(-2), which was the least range among the tested equations. The CDK-EPI equation represented the best capability in precision (14.24 mL min(-1) 1.73 m(-2)). The ROC curve showed the best performance in detecting CKD. The accuracy within +/- 30 % of CDK-EPI equation, 24hCCr, and mMDRD equation was 72.08, 69.48, and 70.13 %, respectively, and no statistical significant difference was found (P > 0.05). However, CDK-EPI equation had the highest accuracy when compared with the other two equations (P < 0.05). And its performance on bias showed no statistically significant difference compared with other four equations.Although its bias and accuracy did not overmatch the other four equations in our patient group, the CDK-EPI equation outperformed the other equations based on creatinine in correlation, precision, limit of agreement, and detecting CKD, and it is very simple, time-saving, and cost-effective. So we recommend intensely that the CDK-EPI equation is the most suitable method in determining GFR in Chinese patients with CKD and can be applied generally in clinical practice.