A new equation to estimate glomerular filtration rate.
A new equation to estimate glomerular filtration rate.
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DOI：
10.7326/0003-4819-150-9-200905050-00006
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发表时间：
2009-05-05
影响因子：
39.2
通讯作者：
CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
中科院分区：
文献类型：
--
作者：
Levey AS;Stevens LA;Schmid CH;Zhang YL;Castro AF 3rd;Feldman HI;Kusek JW;Eggers P;Van Lente F;Greene T;Coresh J;CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
估算肾小球滤过率（GFR）的公式通常用于评估肾功能。目前的公式精度有限，并且系统地低估了较高水平的GFR测量值。建立一个新的估算方程（CKD-EPI肌酐方程）。横截面分析。用于方程开发和验证的单独合并数据库。代表美国人口的患病率估计。具有测量的GFR的研究和临床人群（“研究”）。1999-2006年全国健康和营养检查调查。10项研究（8254人）的方程开发和16项研究（3896人）的验证。患病率估计基于16，032人。GFR测量为外源性滤过标志物（开发数据集中的碘酞酸盐;验证数据集中的碘酞酸盐和其他标志物）的清除率。根据标准化肌酐、性别、人种和年龄估计GFR测量值对数的线性回归。在验证数据集中，CKD-EPI的表现优于MDRD研究方程（所有后续比较p<0.001），尤其是在GFR较高时：偏倚较小（GFR测量值和估计值之间的中位差异分别为2.5和5.5 mL/min/1.73 m2）;精确度提高（差异的四分位数范围分别为16.6和18.3 mL/min/1.73 m2）;准确度更高（估计GFR在测量GFR的30%范围内的百分比分别为84.1和80.6%）。在NHANES中，估计GFR的中位数（四分位距）分别为94.5（79.7 - 108.1）vs. 85.0（72.9 - 98.5）mL/min/1.73 m2，CKD的患病率（95%置信区间）分别为11.5（10.6，12.4）% vs. 13.1（12.1，14.0）%。有限数量的老年人和少数种族和少数民族测量GFR。CKD-EPI肌酐方程比MDRD研究方程更准确，可替代其用于常规临床使用。
Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher levels. To develop a new estimating equation (CKD-EPI creatinine equation). Cross-sectional analysis. Separate pooled databases for equation development and validation. Representative U.S. population for prevalence estimates. Research studies and clinical populations (“studies”) with measured GFR. National Health and Nutrition Examination Survey (NHANES) 1999-2006. Equation development in 10 studies (8254 people) and validation in 16 studies (3896 people). Prevalence estimates based on 16,032 people. GFR measured as the clearance of exogenous filtration markers (iothalamate in the development dataset; iothalamate and other markers in the validation dataset). Linear regression to estimate the logarithm of measured GFR from standardized creatinine, sex, race and age. In the validation dataset, the CKD-EPI performed better than the MDRD Study equation (p<0.001 for all subsequent comparisons), especially at higher GFR: lesser bias (median difference between measured and estimated GFR of 2.5 vs. 5.5 mL/min/1.73 m2, respectively); improved precision (interquartile range of the differences of 16.6 vs. 18.3 mL/min/1.73 m2, respectively); and greater accuracy (percent of estimated GFR within 30% of measured GFR of 84.1 vs. 80.6%, respectively. In NHANES, median (interquartile range) estimated GFR was 94.5 (79.7 – 108.1) vs. 85.0 (72.9 – 98.5) mL/min/1.73 m2, and the prevalence (95% confidence interval) of CKD was 11.5 (10.6, 12.4) % vs. 13.1 (12.1, 14.0) %, respectively. Limited number of elderly people and racial and ethnic minorities with measured GFR. The CKD-EPI creatinine equation is more accurate than the MDRD Study equation and could replace it for routine clinical use.
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