Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate
Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate
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DOI：
10.7326/0003-4819-145-4-200608150-00004
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发表时间：
2006-08-15
影响因子：
39.2
通讯作者：
Van Lente, Frederick
中科院分区：
文献类型：
--
作者：
Levey, Andrew S.;Coresh, Josef;Van Lente, Frederick
背景：肾小球滤过率（GFR）估计有助于检测慢性肾脏疾病，但需要对发展方程的实验室进行血清肌酐测定法进行校准。肾脏疾病（MDRD）研究中饮食修饰（MDRD）研究的4个方程已被重新表达与标准化测定的使用。目标：描述修订后的4个可变量MDRD研究方程的性能，并将其与表现进行比较，并将其与表现进行比较。 6变量的MDRD研究和Cockcroft-Gault方程。设计：估计和测量的GFR的比较。设置：15个参与随机的临床中心患者：1628例参加MDRD研究的慢性肾脏疾病患者。测量：将血清肌酐水平校准为可追溯到同位素稀释质谱的测定法。肾小球丝顿速率被测量为I-125-碘硫氨酸酯的尿清除。回流：平均测量的GFR为39.8 ml/min，每1.73 m（2）（SD，21.2）。修订后的4变量方程的准确性和精度与原始6变量方程的准确性和精度相似，并且比Cockcroft-Gault方程更好，即使后者纠正了偏见，90％，91％，60％，60％，60％，60％，60％和83％的估计值分别在测得的GFR的30％以内。当估计的GFR为每1.73 m（2）或更大的估计GFR时，所有方程的测得的GFR之间的差异均大。 2）。在单独的研究样本中未比较方程。结论：4-变量的MDRD研究方程提供了相当准确的GFR估计值，其慢性肾脏疾病患者的GFR估计值和每1.73 m的GFR小于90 mL/min的测量值（2）。通过将重新表达的MDRD研究方程与标准化的血清肌酐测定法使用，临床实验室可以报告更准确的GFR估计值。
Background: Glomerular filtration rate (GFR) estimates facilitate detection of chronic kidney disease but require calibration of the serum creatinine assay to the laboratory that developed the equation. The 4-variable equation from the Modification of Diet in Renal Disease (MDRD) Study has been reexpressed for use with a standardized assay.Objective: To describe the performance of the revised 4-variable MDRD Study equation and compare it with the performance of the 6-variable MDRD Study and Cockcroft-Gault equations.Design: Comparison of estimated and measured GFR.Setting: 15 clinical centers participating in a randomized, controlled trial.Patients: 1628 patients with chronic kidney disease participating in the MDRD Study.Measurements: Serum creatinine levels were calibrated to an assay traceable to isotope-dilution mass spectrometry. Glomerular filtraton rate was measured as urinary clearance of I-125-iothalamate.Results: Mean measured GFR was 39.8 mL/min per 1.73 m(2) (SD, 21.2). Accuracy and precision of the revised 4-variable equation were similar to those of the original 6-variable equation and better than in the Cockcroft-Gault equation, even when the latter was corrected for bias, with 90%, 91%, 60%, and 83% of estimates within 30% of measured GFR, respectively. Differences between measured and estimated GFR were greater for all equations when the estimated GFR was 60 mL/min per 1.73 m(2) or greater.Limitations: The MDRD Study included few patients with a GFR greater than 90 mL/min per 1.73 m(2). Equations were not compared in a separate study sample.Conclusions: The 4-variable MDRD Study equation provides reasonably accurate GFR estimates in patients with chronic kidney disease and a measured GFR of less than 90 mL/min per 1.73 m(2). By using the reexpressed MDRD Study equation with the standardized serum creatinine assay, clinical laboratories can report more accurate GFR estimates.