Which creatinine-based estimated glomerular filtration rate equation best predicts all-cause mortality in Chinese subjects with type 2 diabetes?
Which creatinine-based estimated glomerular filtration rate equation best predicts all-cause mortality in Chinese subjects with type 2 diabetes?
复制标题
DOI：
10.1016/j.diabres.2017.01.010
复制
发表时间：
2017-04-01
影响因子：
5.1
通讯作者：
Lam, K. S. L.
中科院分区：
文献类型：
--
作者：
Lee, C. H.;Shih, A. Z. L.;Lam, K. S. L.
目的：在中国，已开发了基于种族和/或糖尿病特异性的肾脏病饮食改良（MDRD）和慢性肾脏病流行病学协作组（CKD-EPI）方程修改，用于确定估计的肾小球滤过率（eGFR）。本研究旨在比较5种不同肌酐eGFR方程在预测中国2型糖尿病（T2 DM）患者全因死亡率方面的性能。使用MDRD、CKD-EPI及其各自的中国改良公式和糖尿病特异性CKD-EPI中国T2 DM公式计算eGFR。采用多元考克斯回归分析评价eGFR与全因死亡率的相关性。结果：随访5.7年，全因死亡率为12.9%（N = 867），总死亡率为12.9%（N = 867）。CKD-EPI方程比MDRD方程更能区分全因死亡率（C统计值：0.714 vs. 0.689，p < 0.0001），中国人对各自方程的修改并没有改善区分。在评价的5个eGFR方程中，CKD-EPI中国T2 DM方程在预测中国T2 DM受试者的全因死亡率方面提供了最佳区分度，并且是唯一一个相对于CKD-EPI方程提供显著正NRI和IDI的方程。在中国T2 DM受试者中，我们的研究结果表明，CKD-EPI中国T2 DM方程最能预测全因死亡率，和相对于CKD-EPI方程，赋予改善的区分和重新分类。(C)2017由Elsevier爱尔兰有限公司出版。
Aim: In Chinese, ethnicity-based and/or diabetes specific modifications of the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations have been developed for determining estimated glomerular filtrate rate (eGFR). This study aimed to compare the performance of five different creatinine-based eGFR equations in predicting all-cause mortality among Chinese subjects with type 2 diabetes (T2DM).Methods: A total of 6739 Chinese subjects with T2DM were included. Their eGFR was calculated using the MDRD, CKD-EPI, their respective modified equations for Chinese, and the diabetes specific CKD-EPI Chinese T2DM equations. Multiple Cox regression analysis was used to evaluate the associations of eGFR with all-cause mortality. C-statistics, net reclassification index (NRI) and integrated discrimination index (IDI) were applied to assess the discrimination and reclassification of each eGFR equation in predicting mortality outcome.Results: Over a follow-up of 5.7 years, the incidence of all-cause mortality was 12.9% (N = 867). The CKD-EPI equation discriminated all-cause mortality better than the MDRD equation (C-statistics: 0.714 vs. 0.689, p < 0.0001), and Chinese modification of their respective equations did not improve discrimination. Among the five eGFR equations evaluated, the CKD-EPI Chinese T2DM equation provided the best discrimination in predicting all-cause mortality among Chinese subjects with T2DM, and was the only equation providing a significantly positive NRI and IDI relative to the CKD-EPI equation.Conclusions: Among Chinese subjects with T2DM, our findings suggested that the CKD-EPI Chinese T2DM equation best predicted all-cause mortality, and relative to the CKD-EPI equation, conferred improved discrimination and reclassification. (C) 2017 Published by Elsevier Ireland Ltd.