Clinical role of combined application of different eGFR equations and ACR in high-risk renal dysfunction patients

doi:10.3969/j.issn.1673-8640.2021.01.003

Abstract

Abstract:

Objective To investigate the combined application of different estimating glomerular filtration rate（eGFR） equations and urinary albumin to creatinine ratio（ACR） in high-risk renal injury or early renal dysfunction patients. Methods Clinical data of 850 patients with chronic kidney disease（CKD） were collected,including sex,age,height,weight,serum creatinine（SCr）,cystatin C（Cys C）,ACR,serum urea,serum uric acid（UA）,glomerular filtration rate measured by ^99mtechnetium-diethyenetriamine pentaacetic acid（^99mTC-DTPA） renal dynamic imaging measuring glomerular filtration rate（mGFR） and basic medical history. Totally,3 SCr-based equations（CKD-EPI 2009Scr,simplified MDRD and improved MDRD）,6 equations based on Cys C（CKD-EPI 2012Cys C,Grubb,Arnal-Dade,Rule,Macisaac and Tan） and 1 equation based on Cys C combined with SCr（CKD-EPI 2012SCr-Cys C）were applied respectively to calculate eGFR of all the subjects. The correlations between different eGFRs and between different eGFRs and mGFR were analyzed by Spearman correlation analysis. Bland-Altman analysis was used to evaluate the consistency between eGFR and mGFR. Results In male and female groups,the level of eGFR based on SCr（eGFR-SCr） was higher than that of mGFR（P<0.01）,and the level of eGFR based on Cys C（eGFR-Cys C） was lower than that of mGFR（P<0.01）. There were positive correlations among eGFR-SCr,among eGFR-Cys C,between eGFR and mGFR（P<0.01）. The average deviation between eGFR-SCr and mGFR was –4.2-20.8 mL/（min•1.73 m²）,which overestimated patient's GFR. Between eGFR-Cys C and mGFR,the average deviation was 3.7-16.9 mL/（min•1.73 m²）,which underestimated the GFR. Between eGFR_{CKD-EPI 2012SCr-Cys C} and mGFR,the average deviation was 9.6 mL/（min•1.73 m²）,which was also lower than the actual GFR. For patients with G2 stage which were missed by eGFR_{CKD-EPI 2009SCr},79.2% and 55.8% was detected by eGFR_Macisaac and ACR,respectively,and the combination of eGFR_Macisaac and ACR was 87.7%. Furthermore,for patients with G3 to G5 stage missed by eGFR_{CKD-EPI 2009SCr},43.3% and 61.1% were detected with eGFR_Macisaac and ACR,respectively,and 73.3% were detected by the combination of eGFR_Macisaac and ACR. Compared with eGFR_{CKD-EPI 2009SCr} alone,the detection rate of G2 stage was increased to 94.4%,and the detection of G3-G5 stage was increased to 91.7% after combining eGFR_Macisaac and ACR. Conclusion The combined application of eGFR_{CKD-EPI 2009SCr},eGFRMacisaac and ACR can significantly improve the detection rate of high-risk renal impairment and early renal dysfunction.

Key words: Estimating glomerular filtration rate, Urinary albumin/creatinine ratio, Renal dysfunction

CLC Number:

R446.1

XU Wenjun, LI Jiayong, LI Huidan. Clinical role of combined application of different eGFR equations and ACR in high-risk renal dysfunction patients[J]. Laboratory Medicine, 2021, 36(1): 13-19.

Figures/Tables 11

References 13

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分期	例数	mGFR分期标准/[mL/（min·1.73 m²）]
G1期	222	≥90
G2期	339	60~<90
G3a期	137	45~<60
G3b期	80	30~<45
G4期	59	15~<30
G5期	13	<15

分期	例数	mGFR分期标准/[mL/（min·1.73 m²）]
G1期	222	≥90
G2期	339	60~<90
G3a期	137	45~<60
G3b期	80	30~<45
G4期	59	15~<30
G5期	13	<15

公式名称	方程	相关参数说明
CKD-EPI 2009SCr公式	eGFR=141× min（SCr/κ,1）^α×Max（SCr/κ,1）^-1.209×0.993^年龄[女性×1.018]	女性：κ=0.7,α=-0.248;男性：κ=0.9,α=-0.411
简化MDRD方程	eGFR=186×（SCr）^-1.154×（年龄）^-0.203×（0.742女性）
改良MDRD方程	eGFR=175×（SCr）^-1.234×（年龄）^-0.179×（0.79女性）
CKD-EPI 2012Cys C 公式	eGFR=133×Min（Cys C/0.8,1）^-0.499×Max（Cys C/0.8,1）^-1.328× 0.996^年龄 [女性×0.932]
Arnal-Dade公式	eGFR=74.835/（Cys C^1.333）
Rule公式	eGFR=66.8×（Cys C^-1.30）
Macisaac公式	eGFR=（84.6/Cys C）-3.2
Tan公式	eGFR=（87.1/Cys C）-6.87
Grubb公式	eGFR=84.69×Cys C-1.680×1.384^*	*年龄<14岁的儿童使用该系数,成人不使用
CKD-EPI 2012SCr- Cys C公式	eGFR=135×Min（SCr/κ,1）^-α×Max（SCr/κ,1）^-0.601×Min （Cys C/0.8,1）^-0.375×Max（Cys C/0.8,1）^-0.711×0.993^年龄 [女性×0.969]	女性：κ=0.7,α=-0.248;男性：κ=0.9,α=-0.411

公式名称	方程	相关参数说明
CKD-EPI 2009SCr公式	eGFR=141× min（SCr/κ,1）^α×Max（SCr/κ,1）^-1.209×0.993^年龄[女性×1.018]	女性：κ=0.7,α=-0.248;男性：κ=0.9,α=-0.411
简化MDRD方程	eGFR=186×（SCr）^-1.154×（年龄）^-0.203×（0.742女性）
改良MDRD方程	eGFR=175×（SCr）^-1.234×（年龄）^-0.179×（0.79女性）
CKD-EPI 2012Cys C 公式	eGFR=133×Min（Cys C/0.8,1）^-0.499×Max（Cys C/0.8,1）^-1.328× 0.996^年龄 [女性×0.932]
Arnal-Dade公式	eGFR=74.835/（Cys C^1.333）
Rule公式	eGFR=66.8×（Cys C^-1.30）
Macisaac公式	eGFR=（84.6/Cys C）-3.2
Tan公式	eGFR=（87.1/Cys C）-6.87
Grubb公式	eGFR=84.69×Cys C-1.680×1.384^*	*年龄<14岁的儿童使用该系数,成人不使用
CKD-EPI 2012SCr- Cys C公式	eGFR=135×Min（SCr/κ,1）^-α×Max（SCr/κ,1）^-0.601×Min （Cys C/0.8,1）^-0.375×Max（Cys C/0.8,1）^-0.711×0.993^年龄 [女性×0.969]	女性：κ=0.7,α=-0.248;男性：κ=0.9,α=-0.411

性别	例数	年龄/岁	BSA/m²	BMI/（kg/m²）	SCr/（μmol/L）	UA/（μmol/L）
男性	151	59（51~67）	1.90（1.80~2.01）	25.1（23.1~27.4）	86（68~120）	380（311~449）
女性	339	62（55~71）^**	1.66（1.56~1.77）^**	24.2（21.6~26.8）^**	66（51~100）^**	323（268~421）^**
性别	尿素/（mmol/L）		Cys C/（mg/L）	ACR/（μg/mg）	ACR阳性率/%	mGFR
男性	6.5（5.2~8.6）		1.18（0.99~1.53）	73.8（15.7~522.8）	62.80	71.4（51.2~88.3）
女性	6.1（4.8~8.8）		1.16（0.94~1.58）	60.2（23.9~406.1）	66.10^*	73.7（52.7~94.6）^*
性别	eGFR_简化MDRD		eGFR_改良MDRD	eGFR_{CKD-EPI 2009SCr}	eGFR_{CKD-EPI 2012SCr-Cys C}	eGFR_{CKD-EPI 2012Cys C}
男性	82.3（54.0~111.0）^#		85.4（57.2~117.3）^#	82.5（55.5~101.2）^#	63.5（43.6~79.8）^#	62.5（44.1~80.3）^#
女性	82.9（50.7~115.4）^*		94.2（55.3~134.1）^**	80.4（48.5~97.8）^#	62.2（39.6~82.2）^#	62.8（41.2~84.5）^#
性别	eGFR_Grubb		eGFR_Arnal-Dade	eGFR_Rule	eGFR_Macisaac	eGFR_Tan
男性	65.5（42.3~88.0）^#		60.0（42.5~75.8）^#	53.9（38.4~67.7）^#	68.5（52.1~82.3）^#	66.9（50.1~81.1）^#
女性	67.4（40.1~96.0）^#		61.4（40.7~81.3）^#	55.1（36.9~72.4）^#	69.7（50.3~86.8）^#	68.2（48.3~85.8）^#