70岁及以上老年人不同肾小球滤过率估算方程评估比较

Comparison of different equations for estimating glomerular filtration rate for evaluating renal function in people aged 70 years and older

目的对比不同肾小球滤过率(GFR)估算方程对70岁及以上患者肾功能的评估意义。方法回顾性研究,选择2012年1月至2014年12月在我院行常规体检≥70岁老年人11966名,男性5741名(48.0%),随访3年。记录年龄、性别及血肌酐情况,使用慢性肾脏病流行病学合作组(CKD-EPI)方程、糖尿病膳食改良实验(MDRD)方程、中国MDRD(MDRDc)方程、全年龄段(FAS)方程及柏林倡议研究(BIS)方程分别评估肾功能。结果男性和女性人群血肌酐水平均随增龄而增加,且标准差亦随年龄逐渐增大,表明老年人血肌酐的变化范围更大。所有方程中,FAS和BIS方程评估GFR结果最低。5种方程一致性较好,在男性中,的Kendall's W系数为0.796(P=0.000);女性的Kendall's W系数为0.715(P=0.000)。按血肌酐<88.4μmol/L(5373例),≥88.4μmol/L且<132.6μmol/L(3552例),≥132.6μmol/L(3041例)分为3组后,BIS方程与MDRD、MDRDc、FAS方程在任何肌酐水平下,对CKD的分期均能保持一致;但CKD-EPI方程在血肌酐水平较高时明显高估了肾功能水平。使用各方程计算平均3年的eGFR变化率,均未见明确的与年龄相关的变化趋势。结论CKD-EPI、MDRD、MDRDc、FAS及BIS方程估算eGFR均可用于评估肾功能,但对不同人群,各方程评估结果相差较悬殊。对中国老年人,究竟哪种方程更加准确,目前尚无定论,亟须开展进一步深入研究。

Objective To assess the value of different equations for estimating glomerular filtration rate(GFR)for evaluating renal function in people aged 70 years and older.Methods A retrospective study was conducted involving 11966 elderly people aged 70 years and older,including 5741 males(48.0%),who underwent routine physical examinations in Beijing Hospital from January 2012 to December 2014 and were followed up for 3 years.Baseline data,including the age,gender,and serum creatinine,were recorded.Results function was assessed using Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI),Modification of Diet in Renal Disease(MDRD)Study,Chinese Modification of Diet in Renal Disease(MDRD)Study,full age spectrum(FAS)equation and Berlin Initiative Study(BIS)equation,respectively.Results The serum creatinine level increased with age in male and female subjects,and the standard deviation also increased with age,indicating greater variability of serum creatinine in the elderly.Of all equations,the FAS and BIS equations had the lowest GFR estimates.The five equations showed good consistency.In males,the Kendall's W coefficient was 0.796(P=0.000);the female Kendall's W coefficient was 0.715(P=0.000).Based on three ranges of serum creatinine(<88.4μmol/L,≥88.4μmol/L and<132.6μmol/L,≥132.6μmol/L),all patients were divided into three groups.The BIS,MDRD,MDRDc and FAS equations were all consistent in staging CKD at any creatinine level;however,the CKD-EPI equation significantly overestimated renal function at higher levels of serum creatinine.There was no clear age-related trend when each of the five equations was used to calculate the average 3-year eGFR rate.Conclusions The CKD-EPI,MDRD,MDRDc,FAS and BIS equations can be used to assess renal function,but the results vary among different populations.Which equation has the best accuracy for the elderly in China remains inconclusive and further research is urgently needed.