基于肌酐和胱抑素 C 的实体器官移植患者肾小球滤过率(eGFR)估算结果不一致。

IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY
Mary Kathryn Bohn, Meshach Asare-Werehene, Felix Leung, Davor Brinc, Rajeevan Selvaratnam
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引用次数: 0

摘要

背景:估算肾小球滤过率是评估实体器官移植后肾功能和监测急性损伤风险的重要组成部分。我们的目的是在一组移植受者中评估根据肌酐(eGFRcr)、胱抑素 C(eGFRcys)和两者(eGFRcr-cys)得出的估计肾小球滤过率(eGFR):方法:共纳入 47 名接受他克莫司治疗的独特的实体器官移植后患者。采用 2021 年慢性肾脏病 (CKD) -EPI 公式估算 eGFR。通过戴明回归比较结果,并使用非参数累积分布图评估偏差。结果:eGFRcr 相对于 eGFRcys 估计值的中位偏差为 -22 mL/min/1.73 m2,在 CKD 分期中的总体一致性为 21.3% [95 % CI: 12.1, 35.0]。不一致性随 eGFR 成比例增加,但肌酐测定(雅法或酶法)并无差异:结论:胱抑素 C 的加入会导致实体器官移植患者的 eGFR 估计值之间出现明显的负偏差,这意味着胱抑素 C 在移植环境中缺乏适用性。这凸显了患者特征对方程性能的依赖性,以及在解释和使用基于胱抑素 C 的方程时考虑混杂因素的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Discordance between creatinine and cystatin C-based estimation of glomerular filtration rate (eGFR) in solid organ transplant patients.

Background: Estimation of glomerular filtration rate is a critical component of assessing kidney function post-solid organ transplantation and in monitoring risk of acute injury. Our objective was to evaluate estimated glomerular filtration rate (eGFR) as derived from creatinine (eGFRcr), cystatin C (eGFRcys), and both (eGFRcr-cys) in a cohort of transplant recipients.

Methods: A total of 47 unique post-solid organ transplant patients receiving tacrolimus were included. Residual specimens were assayed for creatinine (Jaffe and enzymatic), cystatin C, and tacrolimus. eGFR was estimated using the 2021 chronic kidney disease (CKD)-EPI formulae. Results were compared by Deming regression and bias was assessed using non-parametric cumulative distribution plots. Percent agreement in chronic kidney disease (CKD) by stage was evaluated across equations.

Results: eGFRcr relative to eGFRcys estimates demonstrated a median bias of -22 mL/min/1.73 m2 and an overall 21.3 % [95 % CI: 12.1, 35.0] agreement in CKD staging. eGFRcr-cys demonstrated a median bias of -14 mL/min/1.73 m2 and overall agreement of 34.0 % [95 % CI: 22.3, 48.4] relative to eGFRcr (enzymatic). Discordance increased proportionally with eGFR and did not differ by creatinine assay (Jaffe or enzymatic).

Conclusion: Cystatin C incorporation leads to markedly negative biases between eGFR estimates in patients with solid organ transplant, implying lack of applicability in the transplant setting. This highlights the dependency of patient characteristics on equation performance and the need to consider confounding factors in interpretation and utilization of cystatin C based equations.

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来源期刊
Clinical biochemistry
Clinical biochemistry 医学-医学实验技术
CiteScore
5.10
自引率
0.00%
发文量
151
审稿时长
25 days
期刊介绍: Clinical Biochemistry publishes articles relating to clinical chemistry, molecular biology and genetics, therapeutic drug monitoring and toxicology, laboratory immunology and laboratory medicine in general, with the focus on analytical and clinical investigation of laboratory tests in humans used for diagnosis, prognosis, treatment and therapy, and monitoring of disease.
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