在非补偿性肝硬化患者中,种族中立的eGFR方程的性能
Mohammad Amin Fallahzadeh1,2, Andrew S Allegretti3, Mitra K Nadim4
1Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas, USA.
概括
2021年慢性病流行病学协作 (CKD-EPI 2021) 方程估计了膜过率 (GFR),但可能高估了肝硬化中的功能,特别是低GFR水平. 需要进一步的研究来准确评估肝脏疾病患者的GFR.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 肝病学 肝病学是一种肝病学.
- 临床化学 临床化学
背景情况:
- 2021年慢性病流行病学合作方程 (CKD-EPI 2021) 是一个最近开发的,种族中立的标准,用于估计膜过率 (GFR).
- 它在肝硬化患者,特别是那些低GFR患者的表现尚未被彻底评估.
研究的目的:
- 为了比较CKD-EPI 2021方程与肝硬化患者其他已确定的GFR估计方程的性能.
- 评估CKD-EPI 2021在各种子组的准确性,包括患有炎,低GFR和不同肝病严重程度得分的子组.
主要方法:
- 对2090名成年肝硬化患者的分析,这些患者接受了采用IOTALAMATE清除率进行的GFR测量.
- 2021年的CKD-EPI与2012年的CKD-EPI,MDRD-4,MDRD-6,皇家自由医院和GALEN方程的比较.
- 评估偏差,准确性 (p30) 和估计GFR (eGFR) 与测量GFR (mGFR) 在不同小组之间的一致性.
主要成果:
- 2021年CKD-EPI显示了第二低的整体偏差,但在mGFR≤30mL/min/1.73m2 (18.5mL/min/1.73m2) 的患者中显著高估了GFR.
- 2021年CKD-EPI的准确性 (p30) 与2012年CKD-EPI可比,优于其他方程,除黑人患者外,在各个子组中表现相似.
- 在黑人患者中,CKD-EPI 2021低估了eGFR (-17.9mL/min/1.73m2),64%的低mGFR患者被错误地分类为较不严重的CKD阶段.
结论:
- 虽然CKD-EPI 2021提供了改进的整体GFR估计,但它可能不会准确地反映肝硬化中的功能,特别是低GFR.
- 迫切需要一种种族中立的GFR方程式,以适应肝病的独特生理学,以确保准确的器官分配和移植决策.
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