A comparison between 2017 FAS and 2012 CKD-EPI equations: a multi-center validation study in Chinese adult population
A comparison between 2017 FAS and 2012 CKD-EPI equations: a multi-center validation study in Chinese adult population
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2017年FAS与2012年CKD-EPI方程的比较：中国成年人群的多中心验证研究
DOI：
10.1007/s11255-018-1997-4
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发表时间：
2019-01-01
影响因子：
2
通讯作者：
Zhao, Weihong
中科院分区：
文献类型：
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作者：
Yong, Zhenzhu;Li, Fen;Zhao, Weihong
背景最近的指南建议使用估计的肾小球滤过率(EGFR)来评估肾功能。2017年有两个已报道的全年龄谱(FAS)方程，这两个方程基于有或没有伴随血清肌酐水平的血清胱抑素C浓度(FASCr-Cysor FASCys)。我们比较了新的Fas方程和2012年CKD-EPI(CKD-EPI和CKD-EPICr-Cys)方程在中国受试者中的适用性。比较4个方程计算的EGFR和rGFR的偏倚(EGFR-rGFR)、精密度(四分位差值范围[IQR])和准确度(EGFR占rGFR的比例在rGFR的30%以内[P30])。具体而言，参考rGFR(67.33亿毫升/分/1.73百万米~2)，CKD-EPICys、CKD-EPICR-Cys、FASCys和FASCR-周期估算的GFR分别为56.46百万/分/1.73百万、62.79百万/分/1.73百万、56.45百万/分/1.73百万和61.04百万/分/1.73百万~2，ROCAUC0.944、0.954、0.943和0.953。与FASCr-Cys的偏差、精确度、P30和均方根误差分别为2.87亿/分/1.73百万米~2、19.01百万毫升/分/1.73百万米~2、74.16%和17.84亿毫升/分/1.73百万米~2，表明− -Cys比其他公式更准确，对肾小球滤过率分期的诊断一致性也更高。在rGFR <； 60min/m in/1.73m~2亚组中，FASCR-循环法效果最好。在老年人中，与FASCys、CKD-EPICR-Cys和CKD-EPICys相比，FASCr-Cys的偏差相对较小(− 8.09vs.− 9.63，− 7.52，− 11.04，P<； 0.05)，最精确(15.18vs.16.32，15.22，16.63)，最准确，P30与其他方程有统计学差异，并达到理想的 >值；结论在中国人群中， -EPICR-循环法的效果优于CKD-EPICR-循环法，尤其是老年人。然而，在一项大规模研究中对FAS方程进行进一步修改可能更适合中国人，特别是老年人。
BackgroundThe recent guidelines recommend using the estimated glomerular filtration rate (eGFR) to evaluate renal function. There are two reported full-age-spectrum (FAS) equations in 2017, which are based on serum cystatin C concentrations with or without accompanying serum creatinine level (FASCr–Cysor FASCys). We compared the performance and assessed the applicability of the new FAS equation with the 2012 CKD-EPI (CKD-EPICysand CKD-EPICr–Cys) equation in Chinese subjects.MethodsA total of 1184 patients, mean aged 55.06 year who underwent99mTc-DTPA GFR measurements (rGFR) from four hospitals were enrolled. The bias (eGFR-rGFR), precision (interquartile range of difference [IQR]), and accuracy (the proportion of eGFR within 30% of rGFR [P30]) of eGFR and rGFR calculated by four equations were compared.ResultsGenerally, the equation based on the combination of Cys and Scr performed superior to that on the basis of Cys alone, either the CKD-EPICr–Cysor the FASCr–Cys. Detailedly, referred to rGFR (67.33 ml/min/1.73 m2), the CKD-EPICys, CKD-EPICr–Cys, FASCys, and the FASCr–Cysestimated GFR 56.46 ml/min/1.73 m2, 62.79 ml/min/1.73 m2, 56.45 ml/min/1.73 m2, and 61.04 ml/min/1.73 m2, gave ROCAUC0.944, 0.954, 0.943, and 0.953, respectively. Another comparison as to bias, precision, P30, and RMSE with FASCr–Cyswere − 2.87 ml/min/1.73 m2, 19.01 ml/min/1.73 m2, 74.16%, and 17.84 ml/min/1.73 m2showed that FASCr–Cysperformed approximately more accurate than other equations, as well as the diagnostic consistency of GFR staging. In the rGFR < 60 ml/min/1.73 m2subgroup, the FASCr–Cysequation showed the best performance. In older subjects, compared with FASCys, CKD-EPICr–Cys, and CKD-EPICys, the FASCr–Cysequation had relatively less bias (− 8.09 vs. − 9.63, − 7.52, − 11.04,P< 0.05), most precise (15.18 vs. 16.32, 15.22, 16.63), and most accuracy, P30was statistically different from the other equations, and achieved a ideal value > 70%.ConclusionThe performance of the FASCr–Cysequation is better than that of the CKD-EPICr–Cysequation in the Chinese population, particularly in the elderly. Yet, further modification of FAS equations from a large-scale study could be more suitable for the Chinese population, particularly in older people.