CKD—EPI方程对基于简化MDRD方程的慢性肾脏病患者分期的影响

Impact of the new CKD-EPI equation on the staging of patients with chronic kidney diseasebased on abbreviated MDRD equation

目的研究CKD．EPI方程对基于简化MDRD方程的慢性肾脏病（CKD）患者分期的影响。方法选择2008年6月至2009年9月在我院。肾内科就诊的CKD患者450例，分别用简化MDRD方程和CKD—EPI方程估测GFR（eGFR）。用Bland—Altman曲线对二方程计算的eGFR进行一致性检验。根据eGFR对CKD患者分期，对基于不同方程的CKD患者的分期情况进行Kappa检验。结果简化MDRD方程和CKD—EPI方程估测eGFR的一致性好，但CKD—EPI—eGFR较MDRD—eGFR平均高出约2．4m1·（min）-1·（1．73m。）。简化MDRD方程和CKD—EPI方程在CKDl、2、3A、3B、4和5期符合率分别为97．10％（n=67），80．77％（n=105），60．86％（n=48），87．69％（n=57），90．38％（n=47）和98．18％（n=54）。Kappa检验提示2方程对CKD患者分期的一致性极好[Kappa值0．913（95％CI：0．881 ～0．945）]。然而，若依据CKD—EPI方程结果，仍须将由简化MDRD方程分类至60。89m1．（min）-1·（1．73㎡）-1及45～59ml·（min）-1·（1．73㎡）-1两组中的19．23％（n=25）及39．24％（n=31）的患者进行再次分类，且均被归为更高eGFR等级。结论CKD—EPI方程可“上调”基于简化MDRD方程的CKD2期～3A期患者的分期等级，纠正了简化MDRD方程对CKD的过度诊断。

Objective To compare the estimated GFR （eGFR） values using the new chronic kidney disease epidemiology collaboration （CKD-EPI） equation with those from the abbreviated MDRD equation in a Chinese cohort with chronic kidney disease （CKD） and to analyze the impact of the new CKD-EPI equation on the staging of CKD. Methods A total of 450 Chinese patients （239 female and 211 male） with CKD were enrolled, eGFRs obtained by the CKD- EPI equation and the abbreviated MDRD equation were compared with the Bland and Altman method. The agreement between two equations in CKD staging was assessed by Kappa test. Results Mean eGFR was 2.4 ml·（min）-l·（1.73 ㎡）-1higher with the CKD-EPI equation as compared to the abbreviated MDRD equation. The percentage of CKD staging concordance between equations for stage 1, 2, 3A, 3B, 4, and 5 was 97.10% （n=67）, 80.77% （n=105）, 6 0.86% （n= 48）, 87.69%（n=57）, 90.38% （n=47） and 98.18% （n=54） respectively. Kappa index was 0.913 （95%CI： 0.881-0.945）. The CKD-EPI equation reclassified 19.23% （n=25） and 39.24% （n=31） of patients with CKD stage 2 and 3A,upward to a higher eGFR category. Conclusions The new CKD-EPI equation reclassifies a number of patients to higher CKD stages, especially thoseclassified as CKD stage 2 or 3A by the abbreviated MDRD equation.