Estimating glomerular filtration rate from serum creatinine and cystatin C.
Estimating glomerular filtration rate from serum creatinine and cystatin C.
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DOI：
10.1056/nejmoa1114248
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发表时间：
2012-07-05
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影响因子：
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通讯作者：
CKD-EPI Investigators
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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
通常使用基于血清肌酐的肾小球滤过率（GFR）估计值;然而，它们不精确，可能导致慢性肾脏疾病的过度诊断。胱抑素C是估计GFR的替代滤过标志物。使用横断面分析，我们开发了基于胱抑素C单独和与肌酐结合的估计方程，来自13项研究的5352名参与者来自不同人群。这些方程在来自5项不同研究的1119名参与者中进行了验证，这些研究中测量了GFR。胱抑素和肌酐测定可溯源至一级参比物质。在开发和验证数据集中，平均测量GFR分别为68和70 ml/min/1.73 m2体表面积。在验证数据集中，肌酐-半胱氨酸蛋白酶抑制剂C方程的性能优于单独使用肌酐或半胱氨酸蛋白酶抑制剂C的方程。三个方程之间的偏倚相似，联合方程的GFR测量值和估计值之间的中位差异为3.9 ml/min/1.73 m2，而肌酐方程和胱抑素C方程分别为3.7 ml/min/1.73 m2和3.4 ml/min/1.73 m2（P = 0.07和P = 0.05）。采用组合方程可提高精度（差异的四分位数范围分别为13.4 vs. 15.4和16.4 ml/min/1.73 m2 [P = 0.001和P<0.001]），结果更准确（估计值>测量GFR的30%的百分比，分别为8.5 vs. 12.8和14.1 [两种比较P<0.001]）。在根据肌酐估计的GFR为45至74 ml/min/1.73 m2的参与者中，组合方程将测量的GFR分类改进为小于60 ml/min/1.73 m2或大于或等于60 ml/min/1.73 m2（净重新分类指数，19.4% [P<0.001]），并正确地将16.9%的估计GFR为45至59 ml/min/1.73 m2的患者重新分类为GFR为60 ml/min/1.73 m2或更高。肌酐-胱抑素C联合方程的表现优于单独基于这些标志物的方程，可能是一个有用的慢性肾脏疾病的验证性试验。（由国家糖尿病、消化和肾脏疾病研究所资助。
Estimates of glomerular filtration rate (GFR) that are based on serum creatinine are routinely used; however, they are imprecise, potentially leading to the overdiagnosis of chronic kidney disease. Cystatin C is an alternative filtration marker for estimating GFR. Using cross-sectional analyses, we developed estimating equations based on cystatin C alone and in combination with creatinine in diverse populations totaling 5352 participants from 13 studies. These equations were then validated in 1119 participants from 5 different studies in which GFR had been measured. Cystatin and creatinine assays were traceable to primary reference materials. Mean measured GFRs were 68 and 70 ml per minute per 1.73 m2 of body-surface area in the development and validation data sets, respectively. In the validation data set, the creatinine–cystatin C equation performed better than equations that used creatinine or cystatin C alone. Bias was similar among the three equations, with a median difference between measured and estimated GFR of 3.9 ml per minute per 1.73 m2 with the combined equation, as compared with 3.7 and 3.4 ml per minute per 1.73 m2 with the creatinine equation and the cystatin C equation (P = 0.07 and P = 0.05), respectively. Precision was improved with the combined equation (inter-quartile range of the difference, 13.4 vs. 15.4 and 16.4 ml per minute per 1.73 m2, respectively [P = 0.001 and P<0.001]), and the results were more accurate (percentage of estimates that were >30% of measured GFR, 8.5 vs. 12.8 and 14.1, respectively [P<0.001 for both comparisons]). In participants whose estimated GFR based on creatinine was 45 to 74 ml per minute per 1.73 m2, the combined equation improved the classification of measured GFR as either less than 60 ml per minute per 1.73 m2 or greater than or equal to 60 ml per minute per 1.73 m2 (net reclassification index, 19.4% [P<0.001]) and correctly reclassified 16.9% of those with an estimated GFR of 45 to 59 ml per minute per 1.73 m2 as having a GFR of 60 ml or higher per minute per 1.73 m2. The combined creatinine–cystatin C equation performed better than equations based on either of these markers alone and may be useful as a confirmatory test for chronic kidney disease. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.)