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 | |
【 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
【 预 览 】
Files | Size | Format | View |
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RO202311109481227ZK.pdf | 1266KB | download |
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