Creatinine- versus cystatin C-based renal function assessment in the Northern Manhattan Study.
Creatinine- versus cystatin C-based renal function assessment in the Northern Manhattan Study.
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DOI：
10.1371/journal.pone.0206839
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Mohan S
中科院分区：
文献类型：
--
作者：
Husain SA;Willey JZ;Park Moon Y;Elkind MSV;Sacco RL;Wolf M;Cheung K;Wright CB;Mohan S
准确的肾小球滤过率估计有助于药物剂量和风险分层。体成分的异质性影响肌酐生成和基于肌酐估算的老年人肾小球滤过率（eGFRcr）的准确性。我们在一个种族/民族多样化的老年人队列中，使用eGFRcr和基于胱抑素c的估计GFR （eGFRcys）来比较慢性肾脏疾病（CKD）的分类，以确定它们的一致性。北曼哈顿研究（NOMAS）是一个以老年人为主的多种族队列研究，主要目的是研究心血管疾病流行病学。我们纳入了同时测量肌酐和胱抑素c的参与者。eGFRcr使用CKD-EPI 2009方程计算。egfrys采用CKD-EPI 2012方程计算。采用Logistic回归估计与eGFRcr≥60ml/min/1.73m2至eGFRcr <60ml/min/1.73m2的重分类相关因素的比值比和95%置信区间。参与者（n = 2988，平均年龄69±10岁）主要为西班牙裔、女性和超重/肥胖。eGFRcys比eGFRcr平均低23mL/min/1.73m2。51%的参与者CKD状态不一致，只有28%的参与者在两种测量中保持相同的CKD阶段。大多数参与者（78%）eGFRcr≥60mL/min/1.73m2；其中，egfrys <60mL/min/1.73m2的占64%。在eGFRcr≥60mL/min/1.73m2的受试者中，年龄在50 ~ 65岁、肥胖、目前吸烟、白人和女性的受试者中，基于egfrcys的重分类更有可能发生。在一个大的、多种族的老年队列中，我们发现eGFRcys和eGFRcr的CKD患病率存在很大差异。确定评估老年人群GFR的最佳方法需要进一步研究，以改善风险分层和药物剂量。
Accurate glomerular filtration rate estimation informs drug dosing and risk stratification. Body composition heterogeneity influences creatinine production and the precision of creatinine-based estimated glomerular filtration rate (eGFRcr) in the elderly. We compared chronic kidney disease (CKD) categorization using eGFRcr and cystatin C-based estimated GFR (eGFRcys) in an elderly, racially/ethnically diverse cohort to determine their concordance. The Northern Manhattan Study (NOMAS) is a predominantly elderly, multi-ethnic cohort with a primary aim to study cardiovascular disease epidemiology. We included participants with concurrently measured creatinine and cystatin C. eGFRcr was calculated using the CKD-EPI 2009 equation. eGFRcys was calculated using the CKD-EPI 2012 equation. Logistic regression was used to estimate odds ratios and 95% confidence intervals of factors associated with reclassification from eGFRcr≥60ml/min/1.73m2 to eGFRcys<60ml/min/1.73m2. Participants (n = 2988, mean age 69±10yrs) were predominantly Hispanic, female, and overweight/obese. eGFRcys was lower than eGFRcr by mean 23mL/min/1.73m2. 51% of participants’ CKD status was discordant, and only 28% maintained the same CKD stage by both measures. Most participants (78%) had eGFRcr≥60mL/min/1.73m2; among these, 64% had eGFRcys<60mL/min/1.73m2. Among participants with eGFRcr≥60mL/min/1.73m2, eGFRcys-based reclassification was more likely in those with age >65 years, obesity, current smoking, white race, and female sex. In a large, multiethnic, elderly cohort, we found a highly discrepant prevalence of CKD with eGFRcys versus eGFRcr. Determining the optimal method to estimate GFR in elderly populations needs urgent further study to improve risk stratification and drug dosing.
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DOI：
10.1056/nejmoa1114248
发表时间：
2012-07-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Inker LA;Schmid CH;Tighiouart H;Eckfeldt JH;Feldman HI;Greene T;Kusek JW;Manzi J;Van Lente F;Zhang YL;Coresh J;Levey AS;CKD-EPI Investigators
通讯作者：
CKD-EPI Investigators
影响因子：
13.6
作者：
Fan, Li;Levey, Andrew S.;Inker, Lesley A.
通讯作者：
Inker, Lesley A.
影响因子：
19.6
作者：
Levey, AS;Eckardt, KU;Eknoyan, G
通讯作者：
Eknoyan, G
影响因子：
5.5
作者：
Levin, Adeera;Stevens, Paul E.
通讯作者：
Stevens, Paul E.
影响因子：
16.2
作者：
Krolewski AS;Warram JH;Forsblom C;Smiles AM;Thorn L;Skupien J;Harjutsalo V;Stanton R;Eckfeldt JH;Inker LA;Groop PH
通讯作者：
Groop PH