Estimating glomerular filtration rate in kidney transplantation: A comparison between serum creatinine and cystatin C-based methods
Estimating glomerular filtration rate in kidney transplantation: A comparison between serum creatinine and cystatin C-based methods
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DOI：
10.1681/asn.2005050512
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发表时间：
2005-12-01
影响因子：
13.6
通讯作者：
Knoll, GA
中科院分区：
文献类型：
--
作者：
White, C;Akbari, A;Knoll, GA
准确测量GFR对于评估新疗法和肾移植受者的护理至关重要。虽然在肾移植中不准确，但GFR通常使用基于肌酐的方程估计。Cystatin C是GFR的一种标志物，似乎比肌酐更准确。已经开发了基于血清胱抑素C浓度预测GFR的方程，但其在移植中的准确性尚不清楚。在117例成人肾移植受者中，使用基于血清胱抑素C的四个方程（Filler、Le Bricon、Larsson和Hoek）和基于血清肌酐的七个方程估计GFR。使用放射性标记的二亚乙基三胺五乙酸（Tc-99 m-DTPA）测量GFR，并确定每个方程的偏倚、精密度和准确度。平均Tc-99 m-DTPA GFR为58 +/- 23 ml/min/1.73 m2。Filler和Le Bricon基于半胱氨酸蛋白酶抑制剂C的方程具有最低偏倚（-1.7和-3.8 ml/min/1.73 m2）、最高精确度（11.4和11.8 ml/min/1.73 m2）和最高准确度（分别为87%和89%，在GFR测量值的30%范围内）。即使当测量的GFI> 60 ml/min/1.73 m2时，半胱氨酸蛋白酶抑制剂C方程仍保持准确。基于肌酐的方程不那么准确，只有53 - 80%的估计值在测量的GFR的30%以内。半胱氨酸蛋白酶抑制剂C为基础的方程更准确地预测GFR在肾移植受者比传统的肌酐为基础的方程。需要进一步进行胱抑素C重复测量的前瞻性研究，以确定基于胱抑素C的GFR估计值是否足够准确，以监测长期移植物功能。
Accurate measurement of GFR is critical for the evaluation of new therapies and the care of renal transplant recipients. Although not accurate in renal transplantation, GFR is often estimated using creatinine-based equations. Cystatin C is a marker of GFR that seems to be more accurate than creatinine. Equations to predict GFR based on the serum cystatin C concentration have been developed, but their accuracy in transplantation is unknown. GFR was estimated using four equations (Filler, Le Bricon, Larsson, and Hoek) that are based on serum cystatin C and seven equations that are based on serum creatinine in 117 adult renal transplant recipients. GFR was measured using radiolabeled diethylenetriaminepentaacetic acid (Tc-99m-DTPA), and the bias, precision, and accuracy of each equation were determined. The mean Tc-99m-DTPA GFR was 58 +/- 23 ml/min per 1.73 m(2). The cystatin C-based equations of Filler and Le Bricon had the lowest bias (-1.7 and -3.8 ml/min per 1.73 m(2)), greatest precision (11.4 and 11.8 ml/min per 1.73 m(2)), and highest accuracy (87 and 89% within 30% of measured GFR, respectively). The cystatin C equations remained accurate even when the measured GFI: was > 60 ml/min per 1.73 m2. The creatinine-based equations were not as accurate, with only 53 to 80% of estimates within 30% of measured GFR. Cystatin C-based equations are more accurate at predicting GFR in renal transplant recipients than traditional creatinine-based equations. Further prospective studies with repetitive measurement of cystatin C are needed to determine whether cystatin C-based estimates of GFR will be sufficiently accurate to monitor long-term allograft function.