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CKD-EPI和EKFC GFR估计方程:成年人实施方程选择的性能和其他考虑因素
Lesley A Inker1, Hocine Tighiouart2,3, Ogechi M Adingwupu1
1Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
Journal of the American Society of Nephrology : JASN
|October 5, 2023
概括
使用肌素和囊素C (eGFRcr-cys) 的新估计球过率 (eGFR) 方程,在不同种群中显示出卓越的准确性和统一性. 更广泛地采用囊素C测试可以提高全球GFR估计.
科学领域:
- 科和临床化学
- 基于生物标志物的GFR估计.
- 慢性病的流行病学 慢性病的流行病学
背景情况:
- 来自CKD-EPI和EKFC的新估计膜过率 (eGFR) 方程,利用肌素 (eGFRcr),囊素C (eGFRcys) 或两者 (eGFRcr-cys),提供了足够的临床准确性.
- 在选择广泛临床实施的最佳eGFR方程时存在不确定性.
- 了解不同的人口分组的方程表现对于全球采用至关重要.
研究的目的:
- 在一个独立的群体中评估新的CKD-EPI和EKFC eGFR方程的性能.
- 评估eGFRcr,eGFRcys和eGFRcr-cys方程在种族,性别和年龄子组中的准确性和统一性.
- 根据有关选择和全球实施eGFR方程的决策进行信息化.
主要方法:
- 对CKD-EPI和EKFC的eGFR方程的性能评估 (偏差和P30).
- 利用了来自12项研究的4050名成年人独立研究群体.
- 分析了包括性别 (38%的女性) 和种族 (14%的黑人参与者) 在内的人口学子组.
主要成果:
- CKD-EPI和EKFC方程显示了肌素,囊素C,年龄和性别的收系数.
- 与单独的eGFRcr或eGFRcys相比,eGFRcr-cys方程在总体群体中表现出更高的性能 (偏差<±5ml/min/1.73m2,P30>90%).
- 根据eGFRcr-cys方程,种族,性别和年龄分组之间的表现差异比eGFRcr方程少.
结论:
- CKD-EPI和EKFC的eGFR方程正在接近融合,但最大限度地提高对当前eGFR方程的准确性和统一性是全球实施的挑战.
- 实施决策应将方程开发方法与性能数据相结合.
- 与肌素测试一起增加囊素C的利用,有可能提高GFR估计的准确性和统一性.
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