BMC Nephrology | |
Estimation of glomerular filtration rate from serum creatinine and cystatin C in octogenarians and nonagenarians | |
Ricardo C Sesso2  Maysa S Cendoroglo1  Gianna M Kirsztajn2  Sonia K Nishida2  Michelle T Passos2  Lara Q Araújo1  Marcelo B Lopes2  | |
[1] Geriatrics Divisions, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 740, 04023-900, São Paulo, Brazil;Nephrology, School of Medicine, Federal University of São Paulo, São Paulo, Brazil | |
关键词: Iohexol; Glomerular filtration rate; Elderly; Cystatin C; Creatinine; Chronic kidney disease; | |
Others : 1082774 DOI : 10.1186/1471-2369-14-265 |
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received in 2013-04-13, accepted in 2013-11-13, 发布年份 2013 | |
【 摘 要 】
Background
Equations to estimate GFR have not been well validated in the elderly and may misclassify persons with chronic kidney disease (CKD). We measured GFR and compared the performance of the Modification of Diet in Renal Disease (MDRD), the Chronic Kidney Disease-Epidemiology Collaboration (CKD-Epi) and the Berlin Initiative Study (BIS) equations based on creatinine and/or cystatin C in octogenarians and nonagenarians.
Methods
Using cross-sectional analysis we assessed 95 very elderly persons (mean 85 years) living in the community. GFR was measured by iohexol (mGFR) and compared with estimates using six equations: MDRD, CKD-Epi_creatinine, CKD-Epi_cystatin, CKD-Epi_creatinine-cystatin, BIS_creatinine and BIS_creatinine-cystatin.
Results
Mean mGFR was 55 (range,19–86) ml/min/1.73 m2. Bias was smaller with the CKD-Epi_creatinine-cystatin and the CKD-Epi_creatinine equations (-4.0 and 1.7 ml/min/1.73 m2). Accuracy (percentage of estimates within 30% of mGFR) was greater with the CKD-Epi_creatinine-cystatin, BIS_creatinine-cystatin and BIS_creatinine equations (85%, 83% and 80%, respectively). Among the creatinine-based equations, the BIS_creatinine had the greatest accuracy at mGFR < 60 ml/min/1.73 m2 and the CKD-Epi_creatinine was superior at higher GFRs (79% and 90%, respectively). The CKD-Epi_creatinine-cystatin, BIS_creatinine-cystatin and CKD-Epi_cystatin equations yielded the greatest areas under the receiver operating characteristic curve at GFR threshold = 60 ml/min/1.73 m2 (0.88, 0.88 and 0.87, respectively). In participants classified based on the BIS_creatinine, CKD-Epi_cystatin, or BIS_creatinine-cystatin equations, the CKD-Epi_creatinine-cystatin equation tended to improve CKD classification (net reclassification index: 12.7%, p = 0.18; 6.7%, p = 0.38; and 15.9%; p = 0.08, respectively).
Conclusions
GFR-estimating equations CKD-Epi_creatinine-cystatin and BIS_creatinine-cystatin showed better accuracy than other equations using creatinine or cystatin C alone in very elderly persons. The CKD-Epi_creatinine-cystatin equation appears to be advantageous in CKD classification. If cystatin C is not available, both the BIS_cr equation and the CKD-Epi_cr equation could be used, although at mGFR < 60 ml/min/1.73 m2, the BIS_cr equation seems to be the best alternative.
【 授权许可】
2013 Lopes et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
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20141224182033937.pdf | 236KB | download | |
Figure 1. | 21KB | Image | download |
【 图 表 】
Figure 1.
【 参考文献 】
- [1]Stevens LA, Li S, Wang C, Huang C, Becker BN, Bomback AS, Brown WW, Burrows NR, Jurkovits CT, McFarlane SI, Norris KC, Shlipak M, Whaley-Connell AT, Chen SC, Bakris GL, McCullough PA: Prevalence of CKD and comorbid illness in the elderly patients in the United States: results from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2010, 55(Suppl 2):S23-S33.
- [2]Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS: Prevalence of chronic kidney disease in the United States. JAMA 2007, 298:2038-2047.
- [3]Stevens LA, Padala S, Levey AS: Advances in glomerular filtration rate-estimating equations. Curr Opin Nephrol Hypertens 2010, 19:298-307.
- [4]Stevens LA, Coresh J, Greene T, Levey AS: Assessing kidney function – measured and estimated glomerular filtration rate. N Engl J Med 2006, 354:2473-2483.
- [5]Stevens LA, Schmid CH, Greene T, Beckj GJ, Joffe MM, Froissart M, Kusek JW, Zhang YL, Coresh J, Levey AS: Factors other than glomerular filtration rate affect serum cystatin C levels. Kidney Int 2009, 75:652-660.
- [6]Kyhse-Andersen J, Schmidt C, Nordin G, Andersson B, Nilsson-Ehle P, Lindstrom V, Grubb A: Serum cystatin C, determined by a rapid, automated particle-enhanced turbidimetric method, is a better marker than serum creatinine for glomerular filtration rate. Clin Chem 1994, 40:1921-1926.
- [7]Dhamidharka VR, Kwon C, Stevens G: Serum cystatin C is superior to serum serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis 2002, 40:221-226.
- [8]Kilbride HS, Stevens PE, Eaglestone G, Knight S, Carter JL, Delaney MP, Farmer CKT, Irving J, O’Riordan SE, Neil Dalton R, Lamb EJ: Accuracy of the MDRD (Modification of Diet in Renal Disease) study and CKD-EPI (CKD Epidemiology Collaboration) equations for estimation of GFR in the elderly. Am J Kidney Dis 2013, 61:57-66.
- [9]Schaeffner ES, Ebert N, Delanaye P, Frei U, Gaedeke J, Jakob O, Kuhlmann MK, Schuchardt M, Tolle M, Ziebig R, van der Giet M, Martus P: Two novel equations to estimate kidney function in persons aged 70 years or older. Ann Intern Med 2012, 157:471-481.
- [10]Krutzen E, Back SE, Nilsson-Ehle P: Determination of glomerular filtration rate using iohexol clearance and capillary sampling. Scand J Clin Lab Invest 1990, 50:279-283.
- [11]Brochner-Mortensen J: A simple method for the determination of glomerular filtration rate. Scand J Clin Lab Invest 1972, 30:271-274.
- [12]Shihabi ZK, Constantinescu MS: Iohexol in serum determined by capillary electrophoresis. Clin Chem 1992, 38:2117-2120.
- [13]DuBois D, DuBois E: A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1916, 17:1275-1283.
- [14]Levey AS, Greene T, Kusek JW, Beck GJ: A simplified equation to predict glomerular filtration rate from serum creatinine (abstract). J Am Soc Nephrol 2000, 11:155A.
- [15]Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J: CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration): a new equation to estimate glomerular filtration rate. Ann Intern Med 2009, 150:604-612.
- [16]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: Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med 2012, 367:20-29.
- [17]National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002, 39(Suppl 1):S1-S266.
- [18]Roderick PJ, Atkins RJ, Smeeth L, Nitsch DM, Hubbard RB, Flectcher AE, Bulpitt CJ: Detecting chronic kidney disease in older people; what are the implications? Age Ageing 2008, 37:179-186.
- [19]Glassock RJ, Winearls C: An epidemic of chronic kidney disease: fact or fiction? Nephrol Dial Transplant 2008, 23:1117-1121.
- [20]Murata K, Baumann NA, Saenger AK, Larson TS, Rule AD, Lieske JC: Relative performance of the MDRD and CKD-EPI equations for estimating glomerular filtration rate among patients with varied clinical presentations. Clin J Am Soc Nephrol 2011, 6:1963-1972.
- [21]Nyman U, Grubb A, Sterner G, Bjork J: The CKD-EPI and MDRD equations to estimate GFR. Validation in the Swedish Lund-Malmo Study cohort. Scand J Clin Lab Invest 2011, 71:129-138.
- [22]Flamant M, Vidal-Petiot E, Metzger M, Haymann J-P, Letavernier E, Delatour V, Karras A, Thervet E, Boffa J-J, Houillier P, Stengel B, Vrtovsnik F, Froissart M: Performance of GFR estimating equations in African Europeans: basis for a lower race-ethnicity factor than in African Americans (Letter). Am J Kidney Dis 2013, 62:182-184.
- [23]Koppe L, Klich A, Dubourg L, Ecochard R, Hadj-Aissa A: Performance of creatinine-based equations compared in older patients. J Nephrol 2013, 26:716-723.
- [24]Wasen E, Isoaho R, Mattila K, Vahlberg T, Kivela SL, Irjala K: Serum cystatin C in the aged: relationships with health status. Am J Kidney Dis 2003, 42:36-43.
- [25]Stevens LA, Coresh J, Schmid CH, Feldman HI, Froissart M, Kusek J, Rossert J, Van Lente F, Bruce RD III, Zhang Y, Greene T, Levey AS: Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis 2008, 41:395-406.
- [26]Bevc S, Hojs R, Ekart R, Gorenjak M, Puklavec L: Simple cystatin C formula compared to sophisticated CKD-EPI formulas for estimation of glomerular filtration rate in the elderly. Ther Apher Dial 2011, 15:261-268.
- [27]Frennby B, Sterner G, Almen T, Hagstam KE, Jacobsson L: Determination of low glomerular filtration rate using iohexol clearance. Invest Radiol 1994, 29(Suppl 2):S234-S235.
- [28]Schwartz GJ, Work DF: Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol 2009, 4:1832-1843.