MDRD与CKD-EPI肾小球滤过率评估公式在外周动脉疾病患者中的应用

Application of MDRD and CKD- EPI equations in patients with peripheral arterial diseases

目的比较简化MDRD公式与慢性肾脏病学流行病学合作研究（CKD—EPI）公式在评估外周动脉疾病（peripheral arterial disease，PAD）患者肾小球滤过率（GFR）中的适用性。方法采用回顾性队列研究，选择2005年在上海市和北京市8家医院被确诊为PAD的841例患者作为研究对象，分别利用MDRD与CKD—EPI公式估算肾小球滤过率（eGFR），应用Spearman相关性检验、Bland-Altman曲线和Kappa检验比较两种方程估算GFR的相关性和一致性，并利用净重新分类指数（net re-classification improvement，NRI）比较2个公式对死亡风险的评估能力。结果eGFRMDRD高于eGFRCKD-EPI，均值差为4．33ml·min^-1·（1．73m^2）^-1，但两者评估eGFR值的相关性和一致性良好（Kappa值为0．749，r=0．991，P〈0．05）。以MDRD为标准，CKD-EPI公式改变了152例（18．1％）患者的分期，其中9例（1．1％）分期上调，143例（17．0％）分期下调。全因死亡NRI为0．059（P〈0．05），心血管死亡NRI为0．022（P〉0．05），提示CKD—EPI公式仅对全因死亡的风险评估能力优于MDRD。结论CKD-EPI公式在PAD患者中的应用并未显著优于MDRD公式。

Objective To compare the performance of newly developed Chronic Kidney Disease Epidemiology Collaboration （CKD- EPI） equation and Modification of Diet in Renal Disease （MDRD） equation in patients with peripheral arterial diseases （PAD）. Methods A total of 841 patients with PAD were enrolled in this retrospective cohort study. Estimated glomerular filtration rate （eGFR）, calculated by MDRD and CKD-EPI equation respectively, was analyzed by Spearman correlation analysis, Bland-Ahman method and Kappa test for the evaluation of correlation and consistency. Net re- classification improvement （NRI） was adopted to compare the death risk assessment between these two equations. Results Although the eGFR was 4.33 ml. min^-1. （1.73 m^2）^-1 higher with MDRD equation than with CKD- EPI equation, there were still significant correlation and fine consistency between eGFRMDRD and eGFRCKD-EPI （Kappa： 0.749, r=0.991, P〈 0.05）. The CKD- EPI equation reclassified 9 （1.1%） patients upward to higher eGFR category and 143 （17.0%） patients downward to lower eGFR category. Besides, the performance of risk assessment for all-cause death was better with CKD- EPI equation than with MDRD equation （NRI=0.059, P 〈 0.05）, which was not the case for cardiovascular death （NRI=0.022, P 〉 0.05）. Conclusions There is no solid evidence suggesting that CKD- EPI equation performs better than MDRD equation.