Revised Equations for Estimated GFR From Serum Creatinine in Japan
Revised Equations for Estimated GFR From Serum Creatinine in Japan
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DOI：
10.1053/j.ajkd.2008.12.034
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发表时间：
2009-06-01
影响因子：
13.2
通讯作者：
Hishida, Akira
中科院分区：
文献类型：
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作者：
Matsuo, Seiichi;Imai, Enyu;Hishida, Akira
背景：肾小球滤过率（GFR）的估计受到种族间肌酐生成差异的限制。我们之前报道的日本人GFR估算公式存在局限性，因为所有受试者的GFR均小于90 mL/min/1.73 m（2），并且血清肌酐在不同的实验室进行测定。研究设计：采用前瞻性横断面设计的诊断性试验研究。413名参与者开发了新的方程，并在350名参与者中进行了验证。所有样本在中心实验室进行分析。设置和参与者：日本80个医疗中心的住院患者。患者没有参加过以前的研究。参考试验：根据菊粉清除率计算的GFR测量值（mGFR）。指数试验：使用改良同位素稀释质谱法（IDMS）估计的GFR（eGFR）-使用既往日本肾脏病学会慢性肾脏病倡议的可追溯4变量肾脏病饮食改良（MDRD）研究方程（JSN-CKDI）系数为0.741（等式1），先前的JSN-CKDI等式（公式2）和开发数据集中推导的新公式：使用新日本系数的改良MDRD研究（方程3），以及3变量日本方程（等式4）.测量：方程的性能通过偏倚进行评估（eGFR - mGFR），准确度（估计值在mGFR的15%或30%范围内的百分比）、均方根误差和相关系数。在开发数据集中，新日本系数为0.808 IDMS-MDRD研究方程的（95%置信区间，0.728 - 0.829）3变量日本方程（方程4）为eGFR（mL/min/1.73 m（2））= 194 x血清肌酐（-1.094）x年龄（-0.287）x 0.739（如果为女性）。在验证数据集中，偏倚为-1.3 +/- 19.4 vs-5.9 +/- 19.0 mL/min/1.73 m（2）（P = 0.002），在mGFR的30%范围内的准确性为73%，（P = 0.6）公式3与公式1和-2.1 +/- 19.0与-7.9 +/- 18.7 mL/min/1.73 m（2）（P < 0.001）和75%对73%公式4与公式2（P = 0.06）（P = 0.06）。局限性：大多数研究参与者患有慢性肾脏疾病，有些可能有变化的GFR。改良IDMS-MDRD研究方程的新日本系数和新日本方程对于日本人群比先前报告的方程更准确。美国肾脏病杂志53：982-992。(C)2009年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Background: Estimation of glomerular filtration rate (GFR) is limited by differences in creatinine generation among ethnicities. Our previously reported GFR-estimating equations for Japanese had limitations because all participants had a GFR less than 90 mL/min/1.73 m(2) and serum creatinine was assayed in different laboratories.Study Design: Diagnostic test study using a prospective cross-sectional design. New equations were developed in 413 participants and validated in 350 participants. All samples were assayed in a central laboratory.Setting & Participants: Hospitalized Japanese patients in 80 medical centers. Patients had not participated in the previous study.Reference Test: Measured GFR (mGFR) computed from inulin clearance.Index Test: Estimated GFR (eGFR) by using the modified isotope dilution mass spectrometry (IDMS)-traceable 4-variable Modification of Diet in Renal Disease (MDRD) Study equation using the previous Japanese Society of Nephrology Chronic Kidney Disease Initiative (JSN-CKDI) coefficient of 0.741 (equation 1), the previous JSN-CKDI equation (equation 2), and new equations derived in the development data set: modified MDRD Study using a new Japanese coefficient (equation 3), and a 3-variable Japanese equation (equation 4).Measurements: Performance of equations was assessed by means of bias (eGFR - mGFR), accuracy (percentage of estimates within 15% or 30% of mGFR), root mean squared error, and correlation coefficient.Results: In the development data set, the new Japanese coefficient was 0.808 (95% confidence interval, 0.728 to 0.829) for the IDMS-MDRD Study equation (equation 3), and the 3-variable Japanese equation (equation 4) was eGFR (mL/min/1.73 m(2)) = 194 x Serum creatinine(-1.094) x Age(-0.287) x 0.739 (if female). In the validation data set, bias was -1.3 +/- 19.4 versus -5.9 +/- 19.0 mL/min/1.73 m(2) (P = 0.002), and accuracy within 30% of mGFR was 73% versus 72% (P = 0.6) for equation 3 versus equation 1 and -2.1 +/- 19.0 versus -7.9 +/- 18.7 mL/min/1.73 m(2) (P < 0.001) and 75% versus 73% (P = 0.06) for equation 4 versus equation 2 (P = 0.06), respectively.Limitation: Most study participants had chronic kidney disease, and some may have had changing GFRs.Conclusion: The new Japanese coefficient for the modified IDMS-MDRD Study equation and the new Japanese equation are more accurate for the Japanese population than the previously reported equations. Am J Kidney Dis 53:982-992. (C) 2009 by the National Kidney Foundation, Inc.