Machine learning-based comparison of factors influencing estimated glomerular filtration rate in Chinese women with or without nonalcoholic fatty liver

BACKGROUND The prevalence of non-alcoholic fatty liver(NAFLD)has increased recently.Subjects with NAFLD are known to have higher chance for renal function impairment.Many past studies used traditional multiple linear regression(MLR)to identify risk factors for decreased estimated glomerular filtration rate(eGFR).However,medical research is increasingly relying on emerging machine learning(Mach-L)methods.The present study enrolled healthy women to identify factors affecting eGFR in subjects with and without NAFLD(NAFLD+,NAFLD-)and to rank their importance.AIM To uses three different Mach-L methods to identify key impact factors for eGFR in healthy women with and without NAFLD.METHODS A total of 65535 healthy female study participants were enrolled from the Taiwan MJ cohort,accounting for 32 independent variables including demographic,biochemistry and lifestyle parameters(independent variables),while eGFR was used as the dependent variable.Aside from MLR,three Mach-L methods were applied,including stochastic gradient boosting,eXtreme gradient boosting and elastic net.Errors of estimation were used to define method accuracy,where smaller degree of error indicated better model performance.RESULTS Income,albumin,eGFR,High density lipoprotein-Cholesterol,phosphorus,forced expiratory volume in one second(FEV1),and sleep time were all lower in the NAFLD+group,while other factors were all significantly higher except for smoking area.Mach-L had lower estimation errors,thus outperforming MLR.In Model 1,age,uric acid(UA),FEV1,plasma calcium level(Ca),plasma albumin level(Alb)and T-bilirubin were the most important factors in the NAFLD+group,as opposed to age,UA,FEV1,Alb,lactic dehydrogenase(LDH)and Ca for the NAFLD-group.Given the importance percentage was much higher than the 2nd important factor,we built Model 2 by removing age.CONCLUSION The eGFR were lower in the NAFLD+group compared to the NAFLD-group,with age being was the most important impact factor in both groups of healthy Chinese women,followed by LDH,UA,FEV1 and Alb.However,for the NAFLD-group,TSH and SBP were the 5th and 6th most important factors,as opposed to Ca and BF in the NAFLD+group.

Detection of decline in estimated glomerular filtration rate in patients with type 2 diabetes by cystatin C-based equations

BACKGROUND Aging population is a significant issue in Viet Nam and across the globe.Elderly individuals are at higher risk of chronic kidney disease(CKD),especially those with diabetes.Several studies found that the estimated glomerular filtration rate(eGFR)determined using creatinine-based equations was not as accurate as that determined using cystatin C-based equations.Cystatin C-based equations may be beneficial in elderly patients with an age-associated decline in kidney function.Early determination of eGFR decline and associated factors would aid in appropriate interventions to improve kidney function in elderly patients with diabetes.AIM To determine the utility of cystatin C-based equations in early detection of eGFR decline and to explore factors associated with eGFR decline in elderly patients with diabetes.METHODS This cross-sectional study included 93 participants aged≥60 years evaluated in Can Tho University of Medicine and Pharmacy Hospital between October 2022 and July 2023,including 47 and 46 participants with and without diabetes respectively,according to the American Diabetes Association criteria for diabetes.The kappa coefficient,Student’s t,Mann-Whitney,χ2,Pearson’s correlation,multivariate logistic regression,and multiple linear regression analyses were employed.RESULTS The eGFRs were lower with the cystatin C-based equations than with the creatinine-based equations.Good agreement was found between the Modification of Diet in Renal Disease(MDRD)and CKD Epidemiology Collaboration(CKD-EPI)2021 creatinine-cystatin C equations(kappa=0.66).In the diabetes group,30%of the participants had low eGFR.Both plasma glucose and glycated hemoglobin were associated with an increased risk of eGFR decline(P<0.05)and negatively correlated with eGFR(P=0.001).By multivariate logistic regression,total cholesterol,and exercise were independently associated with low eGFR.By multiple linear regression,higher plasma glucose levels were correlated with lower eGFR(P=0.026,r=-0.366).CONCLUSION Cystatin C-based equations were superior in the early detection of a decline in eGFR,and the MDRD equation may be considered as an alternative to the CKD-EPI 2021 creatinine-cystatin C equation.Exercise,plasma glucose,and total cholesterol were independently associated with eGFR in patients with diabetes.

Decreasing serum uric acid levels might be associated with improving estimated glomerular filtration rate (eGFR) in Japanese men

The link between changes in a subject’s serum uric acid levels and his estimated glomerular filtration rate (eGFR) was evaluated in Japanese men. We used data for 108 Japanese men (45.3 ± 8.0 years) with a 1-year follow up. eGFR was defined by a new equation developed for Japan. eGFR was weakly correlated with serum uric acid levels (r = –0.287, p = 0.0026) at baseline. Subjects were given advice for dietary and life-style improvement. At the 1-year follow up, almost metabolic syndrome components were significantly improved. However, blood sugar and uric acid did not change and eGFR was significantly decreased. The changes in eGFR were weakly correlated with abdominal circum-ference (r = –0.249, p = 0.0094) and uric acid (r = –0.340, p = 0.0003). A decrease in serum uric acid levels may be associated with improving eGFR in Japanese men.

The relation between estimated glomerular filtration rate (eGFR) and coffee consumption in the Japanese

We investigated the link between estimated glomerular filtration rate (eGFR) and coffee consumption in Japanese. We used data of 376 men and 794 women who were not taking any medications, aged 20 - 78 years, in this cross- sectional investigation study. eGFR was calcu-lated using serum creatinine (Cr), age and sex. Habitual coffee consumption was defined as drinking one or more cups of coffee per day. Two hundred thirty three men (62.0%) and 400 women (50.4%) were subjects with habitual coffee consumption (coffee consumption 1 cup/ day ≥). eGFR was negatively correlated with age (men: r = –0.533, women: r = –624). eGFR in subjects with coffee consumers was not significantly different from that in subjects without coffee consumers after adjusting for age in both sexes (men: p = 0.1375, women: p = 0.2069). Among Japanese not taking medications, coffee consumption was not associated with eGFR in the Japanese population.

Decreasing serum uric acid levels are associated with improving estimated glomerular filtration rate (eGFR) in Japanese women

The aim of this study was to investigate the link between changes in a subject’s serum uric acid levels and the estimated glomerular filtration rate (eGFR) in Japanese women. We used data for 161 Japanese women (49.8 ± 11.7 years) with a 1-year follow up. eGFR was defined by a new equation developed for Japan. eGFR was negatively correlated with serum uric acid levels (r = -0.402, p

Plasma hemoglobin concentration was related to estimated glomerular filtration rate in elderly patients with ischemic cardiomyopathy

Objectives To study the relationship between plasma hemoglobin concentration and estimated glomerular filtration rate （eGFR） in elderly patients with ischemic cardiomyopathy （ICM）.Methods Clinical data of patients with coronary heart disease who were discharged from The First Affiliated Hospital,Chongqing Medical University between 2005 and 2007 were analyzed retrospectively. Echocardiography results,plasma hemoglobin and creatinine concentration were abstracted from the medical records.The study included 235 Chinese Hart patients with age 60 years and older with angiography confirmed coronary heart disease,silent myocardial ischemia or angina pectoris,of whom 154 had ICM defined as left ventricular end-diastolic diameter （LVDd）,male≥56 mm,female≥51 mm （63. 51±7.70 mm） measured by M-mode echocardiography.The differences in plasma hemoglobin concentration were analyzed retrospec- tively between patients with and without ICM,and between patients with an eGFR【60 ml·min-1·1.73m-2 and those with an eGFR≥60 ml·min-1·1.73m-2.Results There were no significant differences in plasma hemoglobin concentration and eGFR between ICM and non-ICM group (118.49±20.52 g·L-1 vs.115.80±23.32 g·L-1 and 75.13±24.21 ml·min-1·1.73m-2 vs.79.09±28.41 ml·min- 1·1.73m-2,respectively,both P】0.05).However,in both ICM and non-ICM groups,plasma hemoglobin concentration was lower in those with an eGFR【60 ml·min-1·1.73m-2 compared with compared with those with an eGFR≥60 ml·min-1·1.73m-2 group (112. 29±18.61 g·L-1 vs.119.92±20.74L-1,P【0.05);plasma hemoglobin concentration was related positively to eGFR.Conclusions There were no significant changes in plasma hemoglobin concentration and eGFR;however,plasma hemoglobin concentration was related to eGFR significantly positively in elderly patients with ICM due to coronary heart

Is an estimated glomerular filtration rate better than creatinine to be incorporated into the end-stage liver disease score?

AIM: To incorporate estimated glomerular filtration rate (eGFR) into the model for end-stage liver disease (MELD) score to evaluate the predictive value. METHODS: From January 2004 to October 2008, the records of 4127 admitted cirrhotic patients were reviewed. Patients who survived and were followed up as outpatients were defined as survivors and their most recent available laboratory data were collected. Patients whose records indicated death at any time during the hospital stay were defined as non-survivors (in-hospital mortality). Patients with incomplete data or with cirrhosis due to a congenital abnormality such as primary biliary cirrhosis were excluded; thus, a total of 3857 patients were enrolled in the present study. The eGFR, which was calculated by using either the modification of diet in renal disease (MDRD) equation or the chronic kidney disease epidemiology collaboration (CKD-EPI) equation, was incorporated into the MELD score after adjustment with the original MELD equation by logistic regression analysis [bilirubin and international normalized ratio (INR) were set at 1.0 for values less than 1.0]. RESULTS: Patients defined as survivors were significantly younger, had a lower incidence of hepatoma, lower Child-Pugh and MELD scores, and better renal function. The underlying causes of cirrhosis were very different from those in Western countries. In Taiwan, most cirrhotic patients were associated with the hepatitis virus, especially hepatitis B. There were 16 parameters included in univariate logistic regression analysis to predict in-hospital mortality and those with significant predicting values were included in further multivariate analysis. Both 4-variable MDRD eGFR and 6-variable MDRD eGFR, rather than creatinine, were significant predictors of in-hospital mortality. Three new equations were constructed (MELD-MDRD-4, MELD-MDRD-6, MELD-CKD-EPI). As expected, original MELD score was a significant predictor of in-hospital mortality (odds ratio = 1.25, P < 0.001). MELD-MDRD-4 excluded serum creatinine, with the coefficients refit among the remaining 3 variables, i.e., total bilirubin, INR and 4-variable MDRD eGFR. This model represented an exacerbated outcome over MELD score, as suggested by a decrease in chi-square (2161.45 vs 2198.32) and an increase in -2 log (likelihood) (2810.77 vs 2773.90). MELD-MDRD-6 included 6-variable MDRD eGFR as one of the variables and showed an improvement over MELD score, as suggested by an increase in chi-square (2293.82 vs 2198.32) and a decrease in -2 log (likelihood) (2810.77 vs 2664.79). Finally, when serum creatinine was replaced by CKD-EPI eGFR, it showed a slight improvement compared to the original MELD score (chi-square: 2199.16, -2 log (likelihood): 2773.07). In the receiver-operating characteristic curve, the MELD-MDRD-6 score showed a marginal improvement in area under the curve (0.909 vs 0.902), sensitivity (0.854 vs 0.819) and specificity (0.818 vs 0.839) compared to the original MELD equation. In patients with a different eGFR, the MELD-MDRD-6 equation showed a better predictive value in patients with eGFR ≥ 90, 60-89, 30-59 and 15-29. CONCLUSION: Incorporating eGFR obtained by the 6-variable MDRD equation into the MELD score showed an equal predictive performance in in-hospital mortality compared to a creatinine-based MELD score.

Protein Diet and Estimated Glomerular Filtration Rate

Chronic kidney disease (CKD) is a common health problem worldwide. CKD staging or classification, together with patients’ prognosis and treatment plan depend on the patients’ kidney function which is assessed by measurement of glomerular filtration rate (GFR). Estimated GFR can be obtained using serum or plasma creatinine as a main variable in equations or formulae such as Cockcroft-Gault equation, MDRD equation (Modification of Diet in Renal Disease), the Schwartz and Counahan-Barratt formulae. These equations, though widely accepted, still have to be adjusted or validated among different groups of patients according to the variation in some factors such as race, diet, and genetic heterogenicity. Diet, especially the high protein load, can affect GFR representing the renal functional reserve. A high protein diet can cause an increase in GFR that lasts for many hours. Long-term consumption of vegetarian diet which is low in protein and contains only protein from plant sources can cause a low baseline GFR while the renal functional reserve is still preserved. This paper aims to remind of the role of protein diet effect on GFR measurement especially when assessing the renal function in vegetarians or individuals on long-term low-protein intake.

Stabilization of estimated glomerular filtration rate in kidney transplantation from deceased donors with acute kidney injuries

AIM To evaluate and compare the outcomes of kidney transplant(KT) from deceased donors among standard criteria, acute kidney injury(AKI) and expanded criteria donors(ECDs). METHODS This retrospective study included 111 deceased donor kidney transplant recipients(DDKT). Deceased donors were classified as standard criteria donor(SCD), AKI donor and ECD. AKI was diagnosed and classified based on change of serum Cr by acute kidney injury network(AKIN) criteria. Primary outcome was one-year estimated glomerular filtration rate(eG FR) calculated from Cr by CKD-EPI. Multivariate regression analysis was done by adjusting factors such as type of DDKT, %Panel-reactive antibodies, cold ischemic time, the presence of delayed graft function and the use of induction therapy. Significantfactors that can affect the primary outcomes were then identified. RESULTS ECD group had a significantly lower eG FR at one year(33.9 ± 17.3 mL /min) when compared with AKI group(56.6 ± 23.9) and SCD group(63.6 ± 19.9)(P < 0.001). For AKI group, one-year eG FR was also indifferent among AKIN stage 1, 2 or 3. Patients with AKIN stage 3 had progressive increase of eG FR from 49.6 ± 27.2 at discharge to 61.9 ± 29.0 mL /min at one year. From Kaplan-Meier analysis, AKI donor showed better two-year graft survival than ECD(100% vs 88.5%, P = 0.006). Interestingly, AKI group had a stable eG FR at one and two year. The two-year eG FR of AKI group was not significantly different from SCD group(56.6 ± 24.5 mL /min vs 58.6 ± 23.2 mL /min, P = 0.65). CONCLUSION Kidney transplantations from deceased donors with variable stage of acute kidney injuries were associated with favorable two-year allograft function. The outcomes were comparable with KT from SCD. This information supports the option that deceased donors with AKI are an important source of organ for kidney transplantation even in the presence of stage 3 AKI.

脑小血管病患者基于血液eGFR和NLR构建发生认知功能障碍的列线图预测模型及评价

目的明确脑小血管病(cerebral small vessel disease,CSVD)患者认知障碍(cognitive impairment,CI)的独立危险因素并构建列线图临床预测模型。方法回顾性纳入2017年1月1日~2022年12月31日于西安交通大学第一附属医院住院诊断为脑小血管病的患者共247例,依据简易认知状态量表(mini-mental state examination,MMSE)分为伴有认知障碍组(CSVD-CI组,n=83)及无认知障碍组(CSVD-NCI组,n=164),通过Logistic回归筛选其发生认知障碍的影响因素,基于筛选的影响因素建立列线图临床预测模型并检验该模型效能。结果与CSVD-NCI组相比,CSVD-CI组患者中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)(3.03±2.56 vs 2.33±1.34)和清蛋白/球蛋白比值(1.58±0.27 vs 1.49±0.28)显著增高、估测肾小球滤过率(estimated glomerular filtration rate,eGFR)[88.59±16.59 ml/(min·1.73m^(2))vs 94.02±12.45 ml/(min·1.73m^(2))]显著减低,差异具有统计学意义(t=2.282,2.426,2.689,均P<0.05)。与CSVD-NCI组比较,CSVD-CI组患者男性比例更低(43.4%vs 67.7%),且受教育程度更低(2.13±1.50 vs 2.86±1.12),差异具有统计学意义(χ^(2)=13.516,t=4.283,均P<0.001)。NLR(OR:1.20,95%CI:1.01~1.43),性别(OR:0.43,95%CI:0.24~0.79),eGFR(OR:0.97,95%CI:0.95~0.99)及受教育程度(OR:0.72,95%CI:0.57~0.91)为CSVD患者发生认知障碍的影响因素。基于此四项影响因素建立列线图预测模型具有良好的认知障碍预测效能(AUC=0.704,95%C:0.633~0.766)。结论构建的列线图在预测CSVD患者认知功能障碍的发生方面具有较高的准确度和临床实用性。

血清肌酐的特异性分析及新eGFR公式的适用性研究

目的验证血清肌酐(Cr)参考区间的适用性及不同影响因素下Cr的分布特征,探讨不同估算肾小球滤过率(eGFR)公式在慢性肾脏病中的差异及新公式的验证。方法选取2020年9月1日至2023年8月31日该院实验室信息系统中健康体检者的数据。采用偏度-峰度法判断数据正态性,Box-Cox法转换偏态数据,四分位间距法剔除离群值。Mann-Whitney U检验、Kruskal-Wallis单因素方差分析及协方差分析比较Cr在性别、年龄及季节上的差异。参照我国行业标准对现行的Cr参考区间进行适用性验证。另选取同期住院的慢性肾脏病患者数据,以目前实验室在用的CKD-EPI Cr2009公式为标准,验证法国新开发的MMB-eGFR公式。Spearman相关、Deming回归及Bland-Altman图分析两种估算公式结果的相关性、线性关系与一致性。结果纳入健康体检者数据54710例。Cr在性别、年龄、季节间差异均有统计学意义:男性Cr水平明显高于女性(P<0.001);除20~<30岁与30~<40岁外,其余年龄段间差异有统计学意义(P<0.001),随年龄增长,Cr水平升高;男、女性Cr水平在四季之间变化呈“对号”形和“倒梯”形。上述数据均用于Cr参考区间的适用性验证,各亚组通过率均大于90%。筛选慢性肾脏病患者数据后,纳入研究336例,进行CKD-EPI Cr2009和MMB-eGFR结果间的比较,两种估算公式的结果呈正相关(r=0.943,P<0.001),并且存在线性关系,具有92.86%的一致性。结论血清Cr水平在年龄、性别、季节方面的差异均有统计学意义。行业标准中提供的Cr参考区间适用于长春地区。MMB-eGFR与CKD-EPI Cr2009公式一致性较高,适用于该地区。

Establishing the presence or absence of chronic kidney disease:Uses and limitations of formulas estimating the glomerular filtration rate

The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease(CKD),which is based on e GFR values and albuminuria.This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based e GFR values and between e GFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all e GFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and,particularly, biomarkers of early renal tissue injury.

外周血GPR120水平与eGFR关系及预测冠状动脉造影术后CI-AKI的价值

目的探讨G蛋白偶联受体120(GPR120)水平与行冠状动脉(冠脉)造影术患者估算的肾小球滤过率(eGFR)的关系,并评估GPR120对术后对比剂急性肾损伤(CI-AKI)的预测价值。方法选取2020年1月至2023年1月于攀枝花市中心医院行冠脉造影患者293例为研究对象,其中发生CI-AKI 32例(观察组);未发生CI-AKI261例(对照组)。两组均于术前检测外周血白细胞中GPR120 mRNA、eGFR水平。通过电子病历系统收集入选患者资料,根据最邻近匹配法对两组患者进行1:1匹配,Logistic回归模型计算评分值。分析GPR120 mRNA与eGFR的相关性,采用Logisitic回归模型分析GPR120 mRNA与冠脉造影术后CI-AKI的独立关系,绘制受试者工作曲线(ROC)评估GPR120 mRNA预测冠脉造影术后CI-AKI的价值。结果倾向性评分匹配后观察组左室射血分数、基线eGFR、基线eGFR<60 ml/(min·1.73 m^(2))比例、GPR120 mRNA低于对照组,造影剂用量大于对照组,造影剂接触时间长于对照组(P<0.05);GPR120 mRNA与基线eGFR呈正相关(r=0.707,95%CI:0.559~0.812,P<0.001);随着GPR120 mRNA水平升高,患者冠脉造影术后CI-AKI发生率呈降低趋势(P<0.05);调整混杂因素后GPR120 mRNA表达上调仍可降低冠脉造影术后CI-AKI发生风险(P<0.05);GPR120 mRNA对冠脉造影术后CI-AKI的AUC值为0.774,对应敏感度、特异度分别为65.62%、84.37%。结论行冠脉造影术的患者GPR120水平与基线eGFR呈正相关,可作为预测术后CI-AKI的指标之一。

Difference between CKD-EPI and MDRD equations in calculating glomerular filtration rate in patients with cirrhosis

AIM:To evaluate the difference between the performance of the (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations in cirrhotic patients. METHODS: From Jan 2004 to Oct 2008, 4127 cirrhotic patients were reviewed. Patients with incomplete data with respect to renal function were excluded; thus, a total of 3791 patients were included in the study. The glomerular filtration rate (GFR) was estimated by the 4-variable MDRD (MDRD-4), 6-variable MDRD (MDRD-6), and CKD-EPI equations.RESULTS:When serum creatinine was 0.7-6.8 mg/dL and 0.6-5.3 mg/dL in men and women, respectively, a significantly lower GFR was estimated by the MDRD-6 than by the CKD-EPI. Similar GFRs were calculated by both equations when creatinine was > 6.9 mg/dL and > 5.4 mg/dL in men and women, respectively. In predicting in-hospital mortality, estimated GFR obtained by the MDRD-6 showed better accuracy [81.72%; 95% confidence interval (CI), 0.94-0.95] than that obtained by the MDRD-4 (80.22%; 95%CI, 0.96-0.97), CKD-EPI (79.93%; 95%CI, 0.96-0.96), and creatinine (77.50%; 95%CI, 2.27-2.63). CONCLUSION: GFR calculated by the 6-variable MDRD equation may be closer to the true GFR than that calculated by the CKD-EPI equation.

Impact of creatinine methodology on glomerular filtration rate estimation in diabetes

AIM To evaluate the influence of creatinine methodology on the performance of chronic kidney disease(CKD)-Epidemiology Collaboration Group-calculated estimated glomerular filtration rate(CKD-EPI-eGFR) for CKD diagnosis/staging in a large cohort of diabetic patients. METHODS Fasting blood samples were taken from diabetic patients attending our clinic for their regular annual examination, including laboratory measurement of serum creatinine and eGFR.RESULTS Our results indicated an overall excellent agreement in CKD staging(kappa = 0.918) between the Jaffé serum creatinine-and enzymatic serum creatinine-based CKDEPI-eGFR, with 9% of discordant cases. As compared to the enzymatic creatinine, the majority of discordances(8%) were positive, i.e., associated with the more advanced CKD stage re-classification, whereas only 1% of cases were negatively discordant if Jaffé creatinine was used for eGFR calculation. A minor proportion of the discordant cases(3.5%) were re-classified into clinically relevant CKD stage indicating mildly to moderately decreased kidney function(< 60 m L/min per 1.73 m^2). Significant acute and chronic hyperglycaemia, assessedas plasma glucose and Hb A1 c levels far above the recommended glycaemic goals, was associated with positively discordant cases. Due to a very low frequency, positive discordance is not likely to present a great burden for the health-care providers, while intensified medical care may actually be beneficial for the small number of discordant patients. On the other hand, a very low proportion of negatively discordant cases(1%) at the 60 m L/min per 1.73 m^2 eGFR level indicate a negligible possibility to miss the CKD diagnosis, which could be the most prominent clinical problem affecting patient care, considering high risk of CKD for adverse patient outcomes. CONCLUSION This study indicate that compensated Jaffé creatinine procedure, in spite of the glucose-dependent bias, is not inferior to enzymatic creatinine in CKD diagnosis/staging and therefore may provide a reliable and cost-effective tool for the renal function assessment in diabetic patients.

Estimating glomerular filtration rate preoperatively for patients undergoing hepatectomy

AIM:To compare creatinine clearance(Ccr) with estimated glomerular filtration rate(eGFR) in preoperative renal function tests in patients undergoing hepatectomy.METHODS:The records of 197 patients undergoing hepatectomy between August 2006 and August 2008 were studied,and preoperative Ccr,a three-variable equation for eGFR(eGFR3) and a five-variable equation for eGFR(eGFR5) were calculated.Abnormal values were defined as Ccr < 50 mL/min,eGFR3 and eGFR5 < 60 mL/min per 1.73 m2.The maximum increases in the postoperative serum creatinine(post Cr) level and postoperative rate of increase in the serum Cr level(post Cr rate) were compared.RESULTS:There were 37 patients(18.8%) with abnormal Ccr,31(15.7%) with abnormal eGFR3,and 40(20.3%) with abnormal eGFR5.Although there were no significant differences in the post Cr rate between patients with normal and abnormal Ccr,eGFR3 and eGFR5 values,the post Cr level was significantly higher in patients with eGFR3 and eGFR5 abnormality than in normal patients(P < 0.0001).Post Cr level tended to be higher in patients with Ccr abnormality(P = 0.0936 and P = 0.0875,respectively).CONCLUSION:eGFR5 and the simpler eGFR3,rather than Ccr,are recommended as a preoperative renal function test in patients undergoing hepatectomy.

急性缺血性卒中患者入院eGFR水平与短期预后不良关系的研究

目的探讨急性缺血性卒中患者(AIS)入院肾小球滤过率估算值(eGFR)与3个月预后不良的关系。方法基于西安卒中登记研究数据库,连续纳入西安市4所三级甲等医院住院的AIS患者临床特征和3个月随访相关资料。分别将eGFR按照连续性变量和四分组变量(Q1~Q4)处理。比较各组患者的eGFR临床特征差异;采用曲线拟合和多因素Logistic回归分析,探讨AIS患者入院eGFR水平与3个月预后不良的关系。结果最终纳入AIS患者2280例,年龄(64.2±12.2)岁,男1426例(62.5%)。校正相关混杂因素后,多因素Logistic回归分析显示,eGFR水平每升高5 mL·min^(-1)·(1.73 m^(2))-1,3个月预后不良风险降低5.0%(OR=0.95,95%CI:0.94~0.99,P=0.028),曲线拟合显示,随着e GFR水平的升高,3个月预后不良的风险呈先下降再升高的趋势。与Q1相比,Q3组患者3个月预后不良风险降低44.0%,差异有统计学意义(OR=0.56,95%CI:0.38~0.82,P=0.003),Q2组和Q4组患者3个月预后不良的风险降低差异无统计学意义。改良Rankin量表(modified Rankin scale,mRS)评分比例分布图显示,3个月预后不良患者中Q3和Q4组AIS患者中mRS>3分的比例均明显降低。结论低水平的eGFR是AIS患者短期预后不良的独立危险因素,早期干预e GFR在适当的范围内,可能会降低AIS患者短期预后不良的风险。

eGFR-CysC联合血栓弹力图对慢加急性肝衰竭患者临床预后的预测价值

目的探讨胱抑素C估算肾小球滤过率(eGFR-CysC)联合血栓弹力图(TEG)对慢加急性肝衰竭(ACLF)患者临床预后的预测价值。方法选择34例ACLF患者(ACLF组)、26例慢性肝炎患者(慢性肝炎组)及30例肝硬化患者(肝硬化组),收集患者的入院24 h内实验室检查指标、TEG参数及eGFR-CysC结果,比较3组患者的各指标差异。对ACLF患者根据是否发生并发症及预后分组,利用二元logistic回归分析影响ACLF患者预后的危险因素,并通过受试者操作特征(ROC)曲线分析相关因素对ACLF患者预后的预测价值。结果3组患者的白细胞、ALT、总胆红素、白蛋白、CRP、凝血酶原活动度、凝血酶原时间、国际标准化比值以及TEG的反应时间(R)、最大振幅(MA)和eGFR-CysC比较差异均有统计学意义(P均<0.05)。ACLF组内分析显示,MA和eGFR-CysC在有无急性肾损伤组间比较差异有统计学意义(P均<0.05),R和MA在有无上消化道出血组间比较差异均有统计学意义(P均<0.05);死亡组与生存组间MA、eGFR-CysC比较差异亦均有统计学意义(P均<0.05),二元logistic回归提示MA(OR=0.439,95%CI 0.231~0.833,P=0.012)和eGFR-CysC(OR=0.931,95%CI 0.878~0.988,P=0.018)是ACLF短期预后的危险因素。MA联合eGFR-CysC对ACLF患者临床预后的预测价值(AUC=0.933,95%CI 0.792~0.990)与终末期肝病模型(AUC=0.839,95%CI 0.672~0.942)相近(P>0.05)。结论MA、eGFR-CysC可预测ACLF患者临床预后,其预测价值与终末期肝病模型相近。

CKD-EPI 2021 eGFR公式在健康体检人群中的应用

目的应用慢性肾脏病流行病学协作(CKD-EPI)2021估算肾小球过滤率(eGFR)公式分析健康体检人群肾功能下降情况及相关影响因素,为科学防治CKD提供决策依据。方法选取2020年1-12月在广州市干部健康管理中心健康体检的51206名广州地区健康体检人群作为研究对象,并收集体检资料。采用回顾性研究,分析CKD-EPI 2021公式、CKD-EPI 2009公式及湘雅方程计算eGFR的差异,并分析健康体检人群eGFR下降情况及其与性别、年龄、体质量指数(BMI)、幽门螺杆菌、血压、血糖、血脂、尿素、血尿酸(UA)等因素的关系。采用多因素Logistic回归分析eGFR下降的影响因素。结果与CKD-EPI 2009公式比较,CKD-EPI 2021公式提高了30~120 mL/(min·1.73 m^(2))人群的eGFR。在51206名受试者肾功能下降的总体检出率为14.70%(7529/51206)。对eGFR<60 mL/(min·1.73 m^(2))人群检出比例,CKD-EPI 2021公式较CKD-EPI 2009公式更接近湘雅方程。CKD-EPI 2021公式中基于肌酐(Cr)公式与基于Cr-胱抑素C(Cys)公式计算的eGFR存在差异。多因素Logistic回归分析结果显示,男性、年龄增长、高UA是影响eGFR下降的独立危险因素(P<0.05);空腹血糖升高是影响eGFR下降的保护因素(P<0.05);BMI、血压、糖化血红蛋白、甘油三酯、总胆固醇、尿蛋白、尿红细胞不是eGFR下降的影响因素(P>0.05)。结论CKD-EPI 2021 eGFR公式可用于健康体检人群肾功能评估,建议使用联合Cr和CysC的公式。老年人肾小球滤过率下降较快,应关注相关因素对CKD进展的长期危害,积极进行生活方式干预和原发病的治疗。

eGFR降低的心肌梗死患者冠状动脉介入治疗造影剂相关急性肾损伤的观察分析

目的 分析估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)降低的急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入治疗(PCI)术后造影剂相关性急性肾损伤的发生率及相关因素。方法回顾分析于2015年5月至2020年5月于北京友谊医院行冠状动脉(冠脉)造影且eGFR降低的AMI患者85例,其中慢性肾脏病(CKD) 2期24例、CKD3期49例、CKD4期12例。记录患者的基线资料、实验室指标、冠脉特征、术后24 h、48 h、72 h肌酐情况。造影剂相关性肾损伤(PC-AKI)定义为:应用碘造影剂48~72 h内,血清肌酐水平升高26.5μmol/L或比基线增加50%。应用多因素Logistics回归分析探索PC-AKI发生的独立相关因素,ROC曲线计算造影剂剂量截断值。结果总体PC-AKI发生率为12.94%。Logistics回归提示:造影剂剂量(OR=1.020,95%CI:1.003~1.036,P=0.018)与PC-AKI正相关。ROC曲线分析:造影剂剂量预测PC-AKI的曲线下面积为0.725 (0.551~0.898),造影剂剂量取截断值为155 ml时,敏感性为63.64%,特异性为71.62%,阳性预测值为25.00%,阴性预测值为92.98%。结论 eGFR降低的AMI患者行冠脉介入治疗PC-AKI发生与造影剂剂量正相关,当造影剂剂量高于155 ml术后PC-AKI发生风险更高。