期刊论文详细信息
BMC Nephrology
The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation does not improve the underestimation of Glomerular Filtration Rate (GFR) in people with diabetes and preserved renal function
Research Article
Glenn M. Ward1  Ray Boston2  Yue Li2  Richard J. MacIsaac2  Jas-mine Seah3  Erosha Premaratne3  George Jerums4  Elif I. Ekinci5  Zhong X. Lu6 
[1] Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, PO Box 2900, 4th Floor, Daly Wing, 35 Victoria Parade, 3065, Fitzroy, VIC, Australia;Clinical Chemistry, St Vincent’s Hospital Melbourne, 3065, Fitzroy, Victoria, Australia;Department of Medicine, St Vincent’s Hospital, University of Melbourne, 3065, Fitzroy, Victoria, Australia;Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, PO Box 2900, 4th Floor, Daly Wing, 35 Victoria Parade, 3065, Fitzroy, VIC, Australia;Department of Medicine, St Vincent’s Hospital, University of Melbourne, 3065, Fitzroy, Victoria, Australia;Endocrine Centre, Austin Health, 3081, West Heidelberg, Victoria, Australia;Endocrine Centre, Austin Health, 3081, West Heidelberg, Victoria, Australia;Department of Medicine, Austin Health, University of Melbourne, 3084, Heidelberg, Victoria, Australia;Endocrine Centre, Austin Health, 3081, West Heidelberg, Victoria, Australia;Menzies School of Health Research, 0811, Casuarina, Northern Territory, Australia;Department of Medicine, Austin Health, University of Melbourne, 3084, Heidelberg, Victoria, Australia;Melbourne Pathology, 3066, Collingwood, Victoria, Australia;
关键词: Diabetes;    Chronic;    Kidney Disease;    Nephropathy;    CKD-EPI equation;    Glomerular filtration rate;   
DOI  :  10.1186/s12882-015-0196-0
 received in 2015-06-01, accepted in 2015-11-25,  发布年份 2015
来源: Springer
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【 摘 要 】

BackgroundOur hypothesis was that both the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations would underestimate directly measured GFR (mGFR) to a similar extent in people with diabetes and preserved renal function.MethodsIn a cross-sectional study, bias (eGFR – mGFR) was compared for the CKD-EPI and MDRD equations, after stratification for mGFR levels. We also examined the ability of the CKD-EPI compared with the MDRD equation to correctly classify subjects to various CKD stages. In a longitudinal study of subjects with an early decline in GFR i.e., initial mGFR >60 ml/min/1.73 m2 and rate of decline in GFR (ΔmGFR) > 3.3 ml/min/1.73 m2 per year, ΔmGFR (based on initial and final values) was compared with ΔeGFR by the CKD-EPI and MDRD equations over a mean of 9 years.ResultsIn the cross-sectional study, mGFR for the whole group was 80 ± 2.2 ml/min/1.73 m2 (n = 199, 75 % type 2 diabetes). For subjects with mGFR >90 ml/min/1.73 m2 (mGFR: 112 ± 2.0, n = 76), both equations significantly underestimated mGFR to a similar extent: bias for CKD-EPI: -12 ± 1.4 ml/min/1.73 m2 (p < 0.001) and for MDRD: -11 ± 2.1 ml/min/1.73 m2 (p < 0.001). Using the CKD-EPI compared with the MDRD equation did not improve the number of subjects that were correctly classified to a CKD-stage. No biochemical or clinical patient characteristics were identified to account for the under estimation of mGFR values in the normal to high range by the CKD-EPI equation. In the longitudinal study (n = 30, 66 % type 1 diabetes), initial and final mGFR values were 102.8 ± 6 and 54.6 ± 6.0 ml/min/1.73 m2, respectively. Mean ΔGFR (ml/min/1.73 m2 per year) was 6.0 by mGFR compared with only 3.0 by MDRD and 3.2 by CKD-EPI (both p < 0.05 vs mGFR)ConclusionsBoth the CKD-EPI and MDRD equations underestimate reference GFR values >90 ml/min/1.73 m2 as well as an early decline in GFR to a similar extent in people with diabetes. There is scope to improve methods for estimating an early decline in GFR.

【 授权许可】

CC BY   
© MacIsaac et al. 2015

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