Assessment of changes in kidney allograft function using creatinine-based estimates of glomerular filtration rate
Assessment of changes in kidney allograft function using creatinine-based estimates of glomerular filtration rate
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DOI：
10.1111/j.1600-6143.2006.01690.x
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发表时间：
2007-04-01
影响因子：
8.8
通讯作者：
Cosio, F. G.
中科院分区：
文献类型：
--
作者：
Gera, M.;Slezak, J. M.;Cosio, F. G.
这些分析评估了基于肌酐的肾小球滤过率（eGFR）估计值是否准确代表（1）移植后不同时间的移植物功能和（2）功能随时间的变化。这些分析比较了684例肾移植受者的碘酞酸盐GFR与eGFR。在459名接受者中的360名（78%）中测量了移植物功能随时间的变化（GFR斜率），这些接受者至少随访了3年。95%的患者是白人，72%的患者接受了活体捐赠者的肾脏。所有eGFR计算值在所有时间点均与GFR显著相关。然而，eGFR在移植后第一年的精确度和准确度低于此后。GFR的平均变化率（斜率）为-2.93 +/- 11.3%/年（-1.06 +/- 5.3 mL/min/1.73 m2/年）。54%的患者GFR斜率稳定或为正。GFR和eGFR斜率高度相关。然而，eGFR斜率，特别是当通过MDRD计算时，显著低估了移植物功能下降的患者数量。例如，360例患者中有165例（46%）的GFR下降速度快于-1 mL/min/1.73m2/年。eMDRD仅识别了其中83例患者（50%），而eMayo公式识别了134例患者（81%）。总之，eGFR与GFR相关，但它们的精确度和准确度相对较低，特别是在移植后早期。eGFR斜率低估了移植物功能损失，尽管对于该计算，某些公式明显优于其他公式。
These analyses assessed whether creatinine based estimates of glomerular filtration rate (eGFR) accurately represent (1) graft function at different times post-transplant and (2) changes in function over time. These analyses compared iothalamate GFR to eGFR in 684 kidney allograft recipients. Changes in graft function over time (GFR slope) were measured in 360 of 459 recipients (78%) who were followed for at least 3 years. Ninety-five percent of the patients were Caucasians and 72% received kidneys from living donors. All eGFR calculations correlated significantly with GFR at all time points. However, eGFR were less precise and less accurate during the first-year post-transplant than thereafter. The average rate of GFR change (slope) was -2.93 +/- 11.3%/year (-1.06 +/- 5.3 mL/min/1.73m(2)/year). Fifty-four percent of patients had stable or positive GFR slopes. The GFR and eGFR slopes were highly correlated. However, eGFR slope, particularly when calculated by MDRD, significantly underestimated the number of patients with declining graft function. For example, 165 out of 360 patients (46%) lost GFR faster than -1 mL/min/1.73m(2)/year. eMDRD identified only 83 of these patients (50%) while the eMayo formula identified 134 (81%). In conclusion, eGFR correlate with GFR but they have relatively low precision and accuracy particularly early post-transplant. eGFR slopes underestimate graft functional loss although some formulas are significantly better than others for this calculation.