{"title":"在神经源性膀胱患者中,应谨慎使用以肌酐为基础的公式来估计肾小球滤过率。","authors":"Yingchun Ma, Tianyu Xiang, Peng Wang, Limin Liao","doi":"10.5414/CN111011","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients with neurogenic bladder (NGB) are at an increased risk of developing chronic kidney disease (CKD). However, data related to the real performance of the serum creatinine (Cr)-based estimated glomerular filtration rate (eGFR) equation in patients with NGB are limited. This study is to evaluate the performance of new Cr-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation without race and the GFR estimation equation for Chinese CKD patients for the estimation of GFR in Chinese patients with NGB.</p><p><strong>Materials and methods: </strong>GFR was determined simultaneously by three methods: a) GFR measured by renal dynamic imaging with <sup>99m</sup>Tc-DTPA (G-GFR), which was used as the reference GFR; b) GFR estimated by the new Cr-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation without race (EPI-GFR); and c) GFR estimated by the equation for Chinese CKD patients (C-GFR). Pearson correlation and linear regression were used to compare eGFR and G-GFR. Differences, absolute differences, precision, and accuracy were compared to identify which equation showed better performance in evaluating GFR in patients with NGB.</p><p><strong>Results: </strong>A total of 171 patients with NGB, including 121 men and 50 women from 20 provinces, 4 autonomous regions, and 3 municipalities in China, were enrolled in the final analysis, and the average age was 31.3 ± 11.9 years. Both C-GFR and EPI-GFR were moderately correlated with G-GFR and overestimated G-GFR. The difference between EPI-GFR and G-GFR was similar to that between C-GFR and G-GFR (median of 9.97 vs. 9.95 mL/min/1.73m<sup>2</sup> for difference, Wilcoxon signed ranks test, Z = -1.704, p = 0.088), but the absolute difference between EPI-GFR and G-GFR was significantly lower than that between C-GFR and G-GFR (median of 22.3 vs. 25.1 mL/min/1.73m<sup>2</sup> for absolute difference, Wilcoxon signed ranks test, Z = -4.806, p < 0.001). Both EPI-GFR and C-GFR displayed similar results of 15, 30, and 50% accuracies (χ<sup>2</sup>-test, p > 0.05), and there were no significant differences between EPI-GFR and C-GFR in misclassification percentages at different G-GFR levels (χ<sup>2</sup>-test, p > 0.05).</p><p><strong>Conclusion: </strong>Our study indicated that for patients with NGB in China, Cr-based eGFR equations, which include the new CKD-EPI equation without race and the Chinese GFR estimation equation, showed suboptimal performance, and limited their application in GFR estimation. Further studies are needed to investigate whether incorporating additional biomarkers, such as cystatin C, could improve their performance of GFR estimating equations in patients with NGB.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":"99 5","pages":"219-227"},"PeriodicalIF":1.1000,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Creatinine-based equations to estimate glomerular filtration rate should be used with caution in patients with neurogenic bladder.\",\"authors\":\"Yingchun Ma, Tianyu Xiang, Peng Wang, Limin Liao\",\"doi\":\"10.5414/CN111011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Patients with neurogenic bladder (NGB) are at an increased risk of developing chronic kidney disease (CKD). However, data related to the real performance of the serum creatinine (Cr)-based estimated glomerular filtration rate (eGFR) equation in patients with NGB are limited. This study is to evaluate the performance of new Cr-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation without race and the GFR estimation equation for Chinese CKD patients for the estimation of GFR in Chinese patients with NGB.</p><p><strong>Materials and methods: </strong>GFR was determined simultaneously by three methods: a) GFR measured by renal dynamic imaging with <sup>99m</sup>Tc-DTPA (G-GFR), which was used as the reference GFR; b) GFR estimated by the new Cr-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation without race (EPI-GFR); and c) GFR estimated by the equation for Chinese CKD patients (C-GFR). Pearson correlation and linear regression were used to compare eGFR and G-GFR. Differences, absolute differences, precision, and accuracy were compared to identify which equation showed better performance in evaluating GFR in patients with NGB.</p><p><strong>Results: </strong>A total of 171 patients with NGB, including 121 men and 50 women from 20 provinces, 4 autonomous regions, and 3 municipalities in China, were enrolled in the final analysis, and the average age was 31.3 ± 11.9 years. Both C-GFR and EPI-GFR were moderately correlated with G-GFR and overestimated G-GFR. The difference between EPI-GFR and G-GFR was similar to that between C-GFR and G-GFR (median of 9.97 vs. 9.95 mL/min/1.73m<sup>2</sup> for difference, Wilcoxon signed ranks test, Z = -1.704, p = 0.088), but the absolute difference between EPI-GFR and G-GFR was significantly lower than that between C-GFR and G-GFR (median of 22.3 vs. 25.1 mL/min/1.73m<sup>2</sup> for absolute difference, Wilcoxon signed ranks test, Z = -4.806, p < 0.001). Both EPI-GFR and C-GFR displayed similar results of 15, 30, and 50% accuracies (χ<sup>2</sup>-test, p > 0.05), and there were no significant differences between EPI-GFR and C-GFR in misclassification percentages at different G-GFR levels (χ<sup>2</sup>-test, p > 0.05).</p><p><strong>Conclusion: </strong>Our study indicated that for patients with NGB in China, Cr-based eGFR equations, which include the new CKD-EPI equation without race and the Chinese GFR estimation equation, showed suboptimal performance, and limited their application in GFR estimation. Further studies are needed to investigate whether incorporating additional biomarkers, such as cystatin C, could improve their performance of GFR estimating equations in patients with NGB.</p>\",\"PeriodicalId\":10396,\"journal\":{\"name\":\"Clinical nephrology\",\"volume\":\"99 5\",\"pages\":\"219-227\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2023-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical nephrology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5414/CN111011\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5414/CN111011","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:神经源性膀胱(NGB)患者发生慢性肾脏疾病(CKD)的风险增加。然而,与NGB患者基于血清肌酐(Cr)估算肾小球滤过率(eGFR)方程的实际表现相关的数据有限。本研究旨在评估新的基于cr的慢性肾脏疾病流行病学协作(CKD- epi)无种族方程和中国CKD患者GFR估计方程在估计中国NGB患者GFR方面的性能。材料与方法:采用三种方法同时测定GFR: a)肾动态显像用99mTc-DTPA (G-GFR)测定GFR,作为参考GFR;b)通过新的基于cr的慢性肾脏疾病流行病学合作(CKD-EPI)无种族方程(EPI-GFR)估算的GFR;c)中国CKD患者的GFR (c -GFR)。采用Pearson相关和线性回归比较eGFR和G-GFR。比较差异、绝对差异、精度和准确性,以确定哪个方程在评估NGB患者的GFR方面表现更好。结果:共有171例NGB患者入组,其中男性121例,女性50例,来自中国20个省、4个自治区、3个直辖市,平均年龄31.3±11.9岁。C-GFR和EPI-GFR与G-GFR和高估的G-GFR均有中度相关性。EPI-GFR与G-GFR的差异与C-GFR与G-GFR的差异相似(中位数为9.97 vs 9.95 mL/min/1.73m2, Wilcoxon符号秩检验,Z = -1.704, p = 0.088),但EPI-GFR与G-GFR的绝对差异显著低于C-GFR与G-GFR的绝对差异(中位数为22.3 vs 25.1 mL/min/1.73m2, Wilcoxon符号秩检验,Z = -4.806, p < 0.001)。EPI-GFR和C-GFR的准确率分别为15%、30%和50% (χ2检验,p > 0.05),不同G-GFR水平下EPI-GFR和C-GFR的误分率差异无统计学意义(χ2检验,p > 0.05)。结论:我们的研究表明,对于中国NGB患者,基于cr的eGFR方程(包括新的不考虑种族的CKD-EPI方程和中国GFR估计方程)表现不佳,限制了它们在GFR估计中的应用。需要进一步研究是否加入其他生物标志物,如胱抑素C,可以改善NGB患者GFR估计方程的性能。
Creatinine-based equations to estimate glomerular filtration rate should be used with caution in patients with neurogenic bladder.
Background: Patients with neurogenic bladder (NGB) are at an increased risk of developing chronic kidney disease (CKD). However, data related to the real performance of the serum creatinine (Cr)-based estimated glomerular filtration rate (eGFR) equation in patients with NGB are limited. This study is to evaluate the performance of new Cr-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation without race and the GFR estimation equation for Chinese CKD patients for the estimation of GFR in Chinese patients with NGB.
Materials and methods: GFR was determined simultaneously by three methods: a) GFR measured by renal dynamic imaging with 99mTc-DTPA (G-GFR), which was used as the reference GFR; b) GFR estimated by the new Cr-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation without race (EPI-GFR); and c) GFR estimated by the equation for Chinese CKD patients (C-GFR). Pearson correlation and linear regression were used to compare eGFR and G-GFR. Differences, absolute differences, precision, and accuracy were compared to identify which equation showed better performance in evaluating GFR in patients with NGB.
Results: A total of 171 patients with NGB, including 121 men and 50 women from 20 provinces, 4 autonomous regions, and 3 municipalities in China, were enrolled in the final analysis, and the average age was 31.3 ± 11.9 years. Both C-GFR and EPI-GFR were moderately correlated with G-GFR and overestimated G-GFR. The difference between EPI-GFR and G-GFR was similar to that between C-GFR and G-GFR (median of 9.97 vs. 9.95 mL/min/1.73m2 for difference, Wilcoxon signed ranks test, Z = -1.704, p = 0.088), but the absolute difference between EPI-GFR and G-GFR was significantly lower than that between C-GFR and G-GFR (median of 22.3 vs. 25.1 mL/min/1.73m2 for absolute difference, Wilcoxon signed ranks test, Z = -4.806, p < 0.001). Both EPI-GFR and C-GFR displayed similar results of 15, 30, and 50% accuracies (χ2-test, p > 0.05), and there were no significant differences between EPI-GFR and C-GFR in misclassification percentages at different G-GFR levels (χ2-test, p > 0.05).
Conclusion: Our study indicated that for patients with NGB in China, Cr-based eGFR equations, which include the new CKD-EPI equation without race and the Chinese GFR estimation equation, showed suboptimal performance, and limited their application in GFR estimation. Further studies are needed to investigate whether incorporating additional biomarkers, such as cystatin C, could improve their performance of GFR estimating equations in patients with NGB.
期刊介绍:
Clinical Nephrology appears monthly and publishes manuscripts containing original material with emphasis on the following topics: prophylaxis, pathophysiology, immunology, diagnosis, therapy, experimental approaches and dialysis and transplantation.