Assessment of GFR by four methods in adults in Ashanti, Ghana: the need for an eGFR equation for lean African populations
Assessment of GFR by four methods in adults in Ashanti, Ghana: the need for an eGFR equation for lean African populations
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DOI：
10.1093/ndt/gfp765
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发表时间：
2010-07-01
影响因子：
6.1
通讯作者：
Cappuccio, Francesco P.
中科院分区：
文献类型：
--
作者：
Eastwood, John B.;Kerry, Sally M.;Cappuccio, Francesco P.
方法。使用 24 小时尿液收集的肌酐清除率 (Ccr) 计算的 GFR，并使用肾脏疾病饮食四变量修改 (MDRD-4) [根据同位素稀释质谱 (IDMS) 标准校准的肌酐]、慢性肾脏病流行病学协作 (CKD-EPI) 和 Cockcroft-Gault 方程估算 GFR (eGFR)，这些方程是在加纳老年人中获得的 40-75。人口包括 12 个村庄的 1013 名居民； 944提供了血清肌酐和两次24小时尿液。平均体重为54.4公斤；平均体重指数为 21.1 kg/m(2)。结果。 Ccr 的平均 GFR 为 84.1 ml/min/1.73 m(2)； 86.8% 的参与者的 GFR ≥ 60 ml/min/1.73 m(2)。平均 MDRD-4 eGFR 为 102.3 ml/min/1.73 m(2)（与 Ccr 的差异，18.2：95% CI：16.8-19.5）；当忽略黑人种族因素时，该值（平均值 84.6 ml/min/1.73 m(2)）接近 Ccr。平均 CKD-EPI eGFR 为 103.1 ml/min/1.73 m(2)，当忽略种族因素时，平均 CKD-EPI eGFR 为 89.4 ml/min/1.73 m(2)。与 Ccr 相比，Cockcroft-Gault 方程低估了 GFR 9.4 ml/min/1.73 m(2) (CI: 8.3-10.6)；特别是在老年群体中。 Ccr 的 GFR 和 MDRD-4、CKD-EPI 和 Cockcroft-Gault 的 eGFR 显示随年龄的增长而下降：MDRD-4 5.5、Ccr 7.7、CKD-EPI 8.8 和 Cockcroft-Gault 11.0 ml/min/1.73 m(2)/10 年。确定为 CKD 3-5 期的个体百分比取决于所使用的方法：MDRD-4 1.6%（不考虑黑人种族因素为 7.2%；CKD-EPI 1.7%（不考虑黑人种族因素为 4.7%）、Ccr 13.2% 和 Cockcroft-Gault 21.0%。结论。MDRD-4 和 CKD-EPI 的平均 eGFR 显着高于 GFR Ccr 和 Cockcroft-Gault， 这种差异可能是由于瘦削造成的。与其他三个测量值相比，MDRD-4 似乎低估了 GFR 随着年龄的下降；没有进行比赛调整的 CKD-EPI 的跌幅与 Ccr 的跌幅最接近。迫切需要一个专门针对非洲瘦人口需求的方程式。目前，未针对黑人种族进行调整的 CKD-EPI 方程似乎是最有用的。
Methods. GFR by creatinine clearance (Ccr) using 24-hour urine collections and estimated GFR (eGFR) using the four-variable Modification of Diet in Renal Disease (MDRD-4)[creatinine calibrated to isotope dilution mass spectrometry (IDMS) standard], Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Cockcroft-Gault equations were obtained in Ghanaians aged 40-75. The population comprised 1013 inhabitants in 12 villages; 944 provided a serum creatinine and two 24-hour urines. The mean weight was 54.4 kg; mean body mass index was 21.1 kg/m(2).Results. Mean GFR by Ccr was 84.1 ml/min/1.73 m(2); 86.8% of participants had a GFR of >= 60 ml/min/1.73 m(2). Mean MDRD-4 eGFR was 102.3 ml/min/1.73 m(2) (difference vs. Ccr, 18.2: 95% CI: 16.8-19.5); when the factor for black race was omitted, the value (mean 84.6 ml/min/1.73 m(2)) was close to Ccr. Mean CKD-EPI eGFR was 103.1 ml/min/1.73 m(2), and 89.4 ml/min/1.73 m(2) when the factor for race was omitted. The Cockcroft-Gault equation underestimated GFR compared with Ccr by 9.4 ml/min/1.73 m(2) (CI: 8.3-10.6); particularly in older age groups. GFR by Ccr, and eGFR by MDRD-4, CKD-EPI and Cockcroft-Gault showed falls with age: MDRD-4 5.5, Ccr 7.7, CKD-EPI 8.8 and Cockcroft-Gault 11.0 ml/min/1.73 m(2)/10 years. The percentage of individuals identified with CKD stages 3-5 depended on the method used: MDRD-4 1.6% (7.2 % without factor for black race; CKD-EPI 1.7% (4.7% without factor for black race), Ccr 13.2% and Cockcroft-Gault 21.0%.Conclusions. Mean eGFR by both MDRD-4 and CKD-EPI was considerably higher than GFR by Ccr and Cockcroft-Gault, a difference that may be attributable to leanness. MDRD-4 appeared to underestimate the fall in GFR with age compared with the three other measurements; the fall with CKD-EPI without the adjustment for race was the closest to that of Ccr. An equation tailored specifically to the needs of the lean populations of Africa is urgently needed. For the present, the CKD-EPI equation without the adjustment for black race appears to be the most useful.