2021慢性肾脏病流行病学合作研究CKD-EPI和欧洲肾脏功能联盟EKFC估算肾小球滤过率公式的临床应用评估

Clinical evaluation of 2021 CKD-EPI equation and EKFC equation for estimated glomerular filtration rate

目的评估2021慢性肾脏病流行病学合作研究(CKD-EPI)和欧洲肾脏功能联盟(EKFC)估算肾小球滤过率公式在中国人群的临床应用效果。方法入组2023年1月1日至12月31日于复旦大学附属中山医院就诊的患者和健康体检者, 排除年龄小于18岁、妊娠状态、肌肉相关疾病、超滤状态和透析患者后共660 078例, 年龄58(44, 68)岁, 男性占56.51%(372 987/660 078), 每人选取第一次肌酐检测结果。按不同性别、年龄、肌酐结果比较2021 CKD-EPI和EKFC公式与科室现用2009 CKD-EPI公式 eGFRcr结果之间的差异(P10)、人群分布改变, 以及对慢性肾脏病(CKD)分期的影响。结果 2021与2009 CKD-EPI eGFRcr结果相比, P10为99.99%(R^(2)=0.997), 2021CKD-EPI eGFRcr整体偏高3.77(2.92, 4.47)ml/(min×1.73 m^(2))。应用2021CKD-EPI公式后, 86.42%(570 455/660 078)偏高且CKD分期一致, 12.35%(81 514/660 078)偏高而分期不同;1.23%(8 109/660 078)eGFRcr结果偏低且分期一致。EKFC eGFRcr与2009 CKD-EPI eGFRcr结果相比, P10为89.79%(R^(2)=0.976), EKFC eGFRcr总体偏低4.63(-2.22, -7.04)ml/(min×1.73 m^(2))。应用EKFC公式后, 75.14%(495 992/660 078)eGFRcr结果偏低且分期一致, 15.63%(103 161/660 078)人结果偏低而CKD分期不同;8.80%(58 077/660 078)eGFRcr结果偏高且分期一致, 0.43%(2 848/660 078)结果偏高而CKD分期不同。结论与2009 CKD-EPI eGFRcr结果相比, 2021 CKD-EPI eGFRcr结果在不同性别和年龄的人群中一致性好, 结果整体略高;而EKFC eGFRcr与2009 CKD-EPI eGFRcr相比一致性较差, 结果整体偏低。在判断患者CKD分期时, 应考虑应用不同eGFR公式带来的影响。

Objective:To retrospectively compare the clinical effects of the 2021 Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI)equation and the European Kidney Function Consortium(EKFC)equation based on creatinine to estimate glomerular filtration rate(eGFRcr)in a Chinese population.Methods:Patients and healthy individuals who visited the Zhongshan Hospital,Fudan University,between January 1,2023,and December 31,2023,were enrolled.The exclusion criteria were age<18 years,amputees,pregnant women,patients with muscle-related diseases,and patients who had undergone ultrafiltration or dialysis.The final study population included 660078 individuals with a median age of 58 years(44,68),56.51%(372987/660078)of them were men.eGFRcr was calculated using the 2021 CKD-EPI,EKFC equations and initial 2009 CKD-EPI equation.Results were compared by differences(P 10),charges in population distribution and impact on staging of chronic kidney disease(CKD)by gender,age and creatinine results.Results:Compared with the results of 2009 and 2021 CKD-EPI eGFRcr,the P 10was 99.99%(R^(2)=0.997).When applying the 2021 CKD-EPI eGFRcr equation,there was a slight overestimation of 3.77(2.92,4.47)ml/(min×1.73 m^(2)).86.42%(570455/660078)participants had higher eGFRcr owing to the utilization of the 2021 CKD-EPI equation,which did not cause CKD stage change.A total of 12.35%(81514/660078)of subjects had different CKD stage with the higher 2021 CKD-EPI eGFRcr.1.23%(8109/660078)had lower eGFRcr but no change in the CKD stage with the 2021 equation.Compared to the 2009 CKD-EPI eGFRcr results,the EKFC eGFRcr demonstrates P 10 values of 89.79%,with a correlation coefficient of R^(2)=0.976.The overall eGFRcr values using the EKFC equation were decreased by 4.63(-2.22,-7.04)ml/(min×1.73 m^(2)).There were 75.14%(495992/660078)individuals whose eGFRcr results were lower in EKFC equation,which did not cause CKD stage change.There were 15.63%(103161/660078)leading to a different CKD stage.Additionally,8.80%(58077/660078)individuals with a higer eGFRcr result did not change CKD stage,while 0.43%(2848/660078)experienced a change in CKD staging due to the overestimation.Conclusions:Compared with the 2009 CKD-EPI eGFRcr results,the 2021 CKD-EPI eGFRcr results were slightly higher and had good consistency in different genders and ages.However,the EKFC eGFRcr was generally lower than 2009 CKD-EPI eGFRcr,showing poor consistency.The differences between eGFR equations should be considered when judging the CKD stage of patients.