Epidemiological Profile of Chronic Kidney Disease at the General Hospital of National Reference of N’Djamena (Chad)

Introduction: Chronic renal failure is a disease that affects many patients worldwide and increasingly in Africa. At the end of 2003, about 1.1 million people were suffering from End-Stage Renal Disease (ESRD) and were treated with periodic dialysis [12]. In Africa, CKF represents 2% to 10% of hospital admissions and is responsible for 4% to 22% of deaths [14]. So, this study is conducted for the first time in Chad, with the aims to determine the prevalence of CKD. Methods: This was a retrospective, descriptive and analytical study over a period of 12 months from April 29, 2011 to April 28, 2012. All patients with chronic renal failure regardless of etiology and stage of chronic kidney disease were included in the study. Chronic renal failure was defined as a glomerular filtration rate below 60 ml/min/1.73m (MDRD) for more than 3 months. This study was conducted in several departments of the National General Reference Hospital (NGRH) of N’Djamena. Result: Among 2039 inpatients, 195 patients had chronic renal failure, as a frequency of 9.6%. The average age of our patients was 51 ± 16.8 years, ranging from 11 to 85 years. Male predominance was noted to be 59% of men against 41% of women. We noted that high blood pressure accounted for 66.2% (N = 129) of cases, diabetes in 48.2% (N = 94), alcoholism in 28.7% (N = 56), smoking in 14.9% (N = 29) and the association alcoholism-smoking in 19.5% (N = 38). Hypertension was the leading cause of chronic renal failure (66.2%). All patients had a serum creatinine and creatinine clearance was assessed. Among them, we noted 57 patients (29%) with end-stage renal failure. The average calcium and phosphate serum were 1.8 mmol/l and 1.6 mmol/l, respectively. We noted that 120 patients as 61.5%, currently took herbal medicine. 48 out of 57 of our patients with ESRD as 24.6% of patients in the study had received replacement therapy (hemodialysis) with 12.5% of deaths. Conclusion: Chad, who compiled the first study with 195 patients at the General Hospital of N’Djamena National Reference over a period of one year has objectified a prevalence of chronic renal failure of 9.6%.

Epidemiological Clinical Profile of Chronic Kidney Disease in Adults under 50 at the University Hospital of Brazzaville

Introduction: Chronic Kidney Disease (CKD) is a major global public health problem. In Congo, we have very few studies on it. Patients and Methods: We carried out an analytical cross-sectional study with retrospective data collection including patients aged 18 to 49 years, hospitalized for CKD in the nephrology department of University Hospital of Brazzaville, during the period from January 1, 2016 to August 31, 2020. The variables considered were socio-demographic, clinical, paraclinical, therapeutic and evolutionary. The statistical test used was Pearson’s chi-square test. Results: CKD in those under 50 represented 21.1% of admissions and 35.6% of CKD. The mean age was 35.9 ± 8.4 years. There was a male predominance with a sex ratio of 1.27. Hypertension was the most common comorbidity (49.2%), followed by HIV (13.6%) and diabetes mellitus (13.2%). Stage 5 CKD was most prevalent (82.7%). Indeterminate kidney disease was in the order of 55.9%. The low socioeconomic level (74.9% of cases) hampered the achievement of dialysis in 66.3% of patients for whom this treatment was indicated. Failure to perform dialysis significantly influenced the occurrence of death (p-value = 0.005). Conclusion: CKD is common among people under 50 and more affects males with a high mortality rate due to lack of access to dialysis. The main causes are hypertension and HIV.

Prevalence and Risk Factors Associated with Chronic Kidney Disease in a Uygur Adult Population from Urumqi

Evaluating the prevalence of kidney damage according to population-based studies in different communities has been limited in developing countries.We conducted a population-based screening study in Uygur people of Urumqi, aiming to identify the prevalence and associated risk factors of chronic kidney disease (CKD) in Uygur populations.A total of 2576 residents (】18 years) from four districts of Urumqi were interviewed from June 2007 to January 2009 and tested for haematuria, albuminuria and reduced renal function.Associations between age, gender, smoking, diabetes mellitus, hypertension, hyperuricaemia and kidney damage were examined.There were 2576 subjects enrolled in this study.After age correction, the prevalence of albuminuria, haematuria and reduced estimated glomerular filtration rate (eGFR) was 3.58%, 2.26% and 1.03%, respectively.Approximately 5.65% of the sample population had at least one indicator of kidney damage.Age, diabetes mellitus, hypercholesteremia, hyperuricaemia and hyperlipidaemia were independently associated with CKD.In the general Uygur adult population from Urumqi, 5.65% had either proteinuria, haematuria or reduced eGFR, indicating the presence of kidney damage, with an awareness of only 1.05%.The high prevalence and low awareness of CKD in this population suggest an urgent need for CKD prevention programs in Uygur people.

Epidemiological and Clinical Profiles of Chronic Kidney Disease Patients Presenting for Emergency Hemodialysis: A Five-Year Retrospective Study in Two Dialysis Centres in Cameroon

Background: Late referral of Chronic Kidney Disease (CKD) patients requiring emergency hemodialysis (HD) for survival poses a serious threat to global health particularly in sub-Saharan Africa (SSA). Objective: Describe the epidemiological and clinical profiles of CKD patients starting HD in emergency. Methodology: This was a retrospective cross-sectional study. Files of patient files of CKD patients who underwent dialysis from January 1st, 2016 to December 31st, 2020 were reviewed at the HD centres of the two main hospitals of the Cameroon city capital, Yaoundé. We included all emergency HD for End Stage Renal Disease (ESRD). Socio-demographic and clinical data including past medical history, signs and symptoms at presentation and indications for emergency HD were recorded. Emergency HD was defined as a dialysis session performed in ESRD with a temporary vascular access. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 26 for Windows. Results: Out of 700 recorded CKD patients who started HD, 570 underwent an emergency HD, thus a prevalence of 81.43%. We included 311 patients, 63.7% were males. The mean age was 47.05 ± 15.60 years ranging from 8 to 83 years with a modal age group of 40 - 59 years. The most prevalent co morbidities were hypertension (66.2%), diabetes mellitus (28.6%) and HIV infection (10%). The commonest presenting symptoms were asthenia (68.2%), lower limbs swelling (52.1%) and anorexia (41.8%) and the main clinical signs were high blood pressure (74.92%), and pallor (60.5%) and altered general state (55%). The indications for emergency HD were dominated by uremic encephalopathy (33.4%) and pulmonary oedema (25.7%). Conclusion: More than eight out of ten CKD patients start emergency HD. Patients are mostly middle-aged adults with a male predominance. Hypertension and diabetes mellitus remain the most common co morbidities and uremic encephalopathy is by far the first indication for emergency HD.

Prevalence, awareness, treatment, and control of hypertension in the non-dialysis chronic kidney disease patients

Background Data on the epidemiology of hypertension in Chinese non-dialysis chronic kidney disease （CKD） patients are limited.The aim of the present study was to investigate the prevalence,awareness,treatment,and control of hypertension in the non-dialysis CKD patients through a nationwide,multicenter study in China.Methods The survey was performed in 61 tertiary hospitals in 31 provinces,municipalities,and autonomous regions in China （except Hong Kong,Macao,and Taiwan）.Trained physicians collected demographic and clinical data and measured blood pressure （BP） using a standardized protocol.Hypertension was defned as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg,and/or use of antihypertensive medications.BP 〈140/90 mmHg and 〈130/80 mmHg were used as the 2 thresholds of hypertension control.In multivariate logistic regression with adjustment for sex and age,we analyzed the association between CKD stages and uncontrolled hypertension in non-dialysis CKD patients.Results The analysis included 8927 non-dialysis CKD patients.The prevalence,awareness,and treatment of hypertension in non-dialysis CKD patients were 67.3%,85.8%,and 81.0%,respectively.Of hypertensive CKD patients,33.1% and 14.1% had controlled BP to 〈140/90 mmHg and 〈130/80 mmHg,respectively.With successive CKD stages,the prevalence of hypertension in non-dialysis CKD patients increased,but the control of hypertension decreased （P〈0.001）.When the threshold of BP 〈130/80 mmHg was considered,the risk of uncontrolled hypertension in CKD 2,3a,3b,4,and 5 stages increased 1.3,1.4,1.4,2.5,and 4.0 times compared with CKD 1 stage,respectively （P〈0.05）.Using the threshold of 〈140/90 mmHg,the risk of uncontrolled hypertension increased in advanced stages （P〈0.05）.Conclusions The prevalence of hypertension Chinese non-dialysis CKD patients was high,and the hypertension control was suboptimal.With successive CKD stages,the risk of uncontrolled hypertension increased.

Kidney transplantation in Indonesia: An update

Objective:Indonesia has overcome several barriers to the growth of kidney transplantation within the past decade.Currently,the procedure is increasingly performed in several centers across the country.However there are limited publications on kidney transplantation from Indonesia,especially from centers outside Jakarta.This study aims to give a brief overview on transplantation performed,discuss current efforts and progresses of transplantation in Indonesia and chiefly Semarang.Methods:Retrospective analysis of 20 transplant cases in Semarang during 2014e2018 was performed.Information from other transplant centers was acquired through formal correspondences with 11 central teaching hospitals in Jakarta,Surabaya,Yogyakarta,Malang,Bali,Solo,Palembang,Aceh,Medan,Bandung,and Padang.Results:There were 629 recorded kidney transplantations performed in 12 centers,and we report on 245 cases with viable data.The average age of kidney recipients were younger(35.4 years old)compared to the donors(41.3 years old).Approximately half of the kidneys were obtained from related donors(49.0%)and there was only one case of cadaveric donor.The three leading etiologies of end-stage renal disease were hypertension(37.4%),diabetes mellitus(26.1%),and autoimmune disease(11.3%).There is only one center that has performed more than 100 kidney transplants in Indonesia.Conclusion:Indonesia has successfully overcome several major hurdles that had previously hindered the growth of transplantation.Further improvement should concentrate on the development of integrated organ transplant infrastructure,decentralization of transplant professionals,establishment of National kidney transplant database and changing the Nation’s paradigm on cadaveric organ donor through public education.

Risk Factors of Renal Failure in HIV Patients at Initiation of ARV Treatment: Retrospective Study of 3118 Patients Followed in Infectious Diseases Department at LoméUniversity Hospital

HIV infection is a major cause of chronic kidney disease, associated with high morbidity and mortality in sub-Saharan Africa. The objective of this study is to assess the prevalence and risk factors of renal disease at initiation of antiretroviral therapy. This was a descriptive and analytical retrospective study carried out in the infectious and tropical diseases department at Sylvanus Olympio University Hospital. The data have been extracted from the ESOPE software. Kidney disease was defined by a GFR, estimated by MDRD (Modification of Diet in Renal Disease) formula, less than 60 ml/min/1.73 m2. Risk factors associated with kidney disease were assessed using univariate and multivariate analysis. There were 3118 HIV-infected patients included in our study. The median estimated filtration rate was 94.7 ml/min/1.73 m2: 2.9% had an eGFR 2. 1303 had kidney disease (41.8%). Most patients (30.8%) were in the WHO clinical stage 1. The median CD4 count was 165/μL [IQR = 72 - 274/μL];the median hemoglobin level was 10.4 g/dL [IQR = 8.8 - 11.9 g/dL];all patients had thrombocytopenia less than 100.000/mm3;8.5% had leukocytosis greater than 10.000/mm3. Most of patients had HIV1. In the multivariate analysis, age greater than 40 years (p 3 were significantly associated with renal disease. The prevention of kidney disease must go through the identification of its risk factors in the target populations.

Relative performance of two equations for estimation of glomerular filtration rate in a Chinese population having chronic kidney disease

Background The new Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation was developed to address the systematic underestimation of glomerular filtration rate （GFR） by the Modification of Diet in Renal Disease （MDRD） Study equation in patients with relatively well-preserved kidney function.Performance of the new equation in the Chinese population is unknown.The goal of the present study was to compare performance of these two equations in Chinese patients with chronic kidney disease （CKD）.Methods We enrolled 450 Chinese patients （239 women and 211 men） with CKD in the present study.The renal dynamic imaging method was used to measure the referenced standard GFR （rGFR） for comparison with estimations using the two equations.Their overall performance was assessed with the Bland-Altman method and receiver-operating characteristics （ROC） analysis.Performance of the two equations in lower and higher estimated GFR （eGFR） subgroups was further investigated.Results Both eGFRs correlated well with rGFR （r=0.88,0.81,P〈0.05）.In overall performance,the CKD-EPI equation showed less bias,higher precision and improved accuracy,and was better for detecting CKD.In the higher-eGFR subgroup,the CKD-EPI equation corrected the underestimation of GFR by the abbreviated MDRD equation.Conclusions The CKD-EPI equation outperformed the abbreviated MDRD equation not only in overall performance but also in the subgroups studied.For the present,the CKD-EPI equation appears to be the first-choice prediction equation for estimating GFR.

Analysis of chronic kidney disease staging with different estimated glomerular filtration rate equations in Chinese centenarians

Background: Accurate estimation of the glomerular filtration rate (GFR) and staging of chronic kidney disease (CKD) are important. Currently, there is no research on the differences in several estimated GFR equations for staging CKD in a large sample of centenarians. Thus, this study aimed to investigate the differences in CKD staging with the most commonly used equations and to analyze sources of discrepancy. Methods: A total of 966 centenarians were enrolled in this study from June 2014 to December 2016 in Hainan province, China. The GFR with the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Berlin Initiative Study 1 (BIS1) equations were estimated. Agreement between these equations was investigated with the k statistic and Bland-Altman plots. Sources of discrepancy were investigated by partial correlation analysis. Results: The k values of the MDRD and CKD-EPI equations, MDRD and BIS1 equations, and CKD-EPI and BIS1 equations were 0.610, 0.253, and 0.381, respectively. Serum creatinine (Scr) explained 10.96%, 41.60% and 17.06% of the variability in these three comparisons, respectively. Serum uric acid (SUA) explained 3.65% and 5.43% of the variability in the first 2 comparisons, respectively. Gender was associated with significant differences in these 3 comparisons (P<0.001). Conclusions: The strengths of agreement between the MDRD and CKD-EPI equations were substantial, but those between the MDRD and BIS 1 equations and the CKD-EPI and BIS 1 equations were fair. The difference in CKD staging of the first 2 comparisons strongly depended on Scr, SUA and gender, and that of CKD-EPI and BIS1 equations strongly depended on Scr and gender. The incidence at various stages of CKD staging was quite different. Thus, a new equation that is more suitable for the elderly needs to be built in the future.

肾动态显像法与CKD-EPI公式对慢性肾脏疾病患者分期价值的比较

目的:评价、比较肾动态显像法与CKD-EPI方程法在慢性肾脏病(chronic kidney disease,CKD)患者分期中的准确率,确定临床实践中首选的分期方法。方法:对121例CKD患者同时采用99mTc标记的亚锡喷替酸(99mTc-diethylene triamine pentaacetic acid,99mTc-DTPA)双血浆清除率法、99mTc-DTPA肾动态显像法与CKD-EPI方程法测定肾小球滤过率(glomerular filtration rate,GFR),以双血浆清除率法测定的GFR为“金标准”,对患者进行分期,统计分析肾动态显像法与CKD-EPI方程法在CKD患者分期中的准确率。结果:在纳入的121例CKD患者中,肾动态显像法分期的准确率为65.29%,而CKD-EPI方程法分期的准确率为84.29%,二者的差异有统计学意义(P=0.001<0.05),这主要体现在对重度下降期和肾衰竭期的患者(肾功能重度下降期:54.55%VS 86.36%,P=0.016;肾衰竭期:50%VS 83.33%,P=0.031)。而两种方法对肾功能正常期、轻度下降期和中度下降期的分期的准确性则无明显差异。结论:CKD-EPI方程法对CKD患者的分期的准确率优于肾动态显像法,主要体现在肾功能重度下降期和肾衰竭期;同时由于CKD-EPI方程法更加简便、经济,临床实践中对CKD患者进行分期应首选CKD-EPI方程法。

以双血浆法为标准评估肾动态显像法与CKD-EPI公式法测定老年慢性肾病患者肾小球滤过率的临床应用研究

目的对比分析^(99)Tc^m-DTPA肾动态显像法(Gate's法)与CKD-EPI SCr公式法判定老年患者GFR的临床适用性,探索性地建立基于双血浆法以及不同检查方法的回归模型。方法收集我院2011年4月至2013年1月行双血浆法(tGFR)以及Gate's测量GFR的老年患者资料72例,以双血浆法为参考标准,对比分析CKD-EPI Scr公式(eGFR)以及Gate's法(g GFR)测量GFR的准确性。结果 tGFR与gGFR的相关性较好(r=0.724),与eGFR的相关性较差(r=0.632),差异具有统计学意义(P<0.05)。3~5期老年CKD患者的tGFR与eGFR和gGFR之间均具有较好相关性,相关系数分别为0.736和0.749(P<0.05)。结论 Gate's法在老年CKD患者GFR的评估中显示出了较为准确的结果,但仍不推荐作为各种临床公式评估GFR的参考标准。Gate's法和CKD-EPI Scr均可以对3~4期老年CKD患者的GFR进行准确评估,但老年CKD患者GFR的评估仍需要以患者实际情况为基础,进行综合判断。

CKD-EPI方程和Gate’s法在测量高龄老年人肾小球滤过率的适用性比较

目的探讨联合肌酐和胱抑素C的慢性肾脏病流行病合作组方程和Gate’s法计算高龄(年龄≥80岁)老年人肾小球滤过率的适用性。方法收集99例一般高龄老年人的临床资料,以双血浆法所测得肾小球滤过率为标准,分别用慢性肾脏病流行病合作组方程和Gate’s法计算肾小球滤过率,比较两者的估计偏差、精确性、准确性和95%的一致性。结果慢性肾脏病流行病合作组方程比Gate’s法降低了偏差(P=0.000),提高了精确度,15%、30%和50%准确性(P=0.000、0.000、0.004)以及95%一致性,差异有统计学意义。结论对于高龄老年人,在不需要了解双肾形态、血流灌注状态及单侧肾功能的情况下,慢性肾脏病流行病合作组方程可能是较好的选择。

胱抑素C与CKD-EPI 2012在老年高血压肾损伤患者中的研究进展

肾损伤是老年高血压患者的常见并发症之一。相比传统肾损伤标记物及常规肾小球滤过率估算公式,研究发现胱抑素C与美国慢性肾脏病流行病学合作组(CKD-EPI)2012公式对老年人肾功能有着更好的评估效能。本文现对相关研究进行阐述,并探索胱抑素C与CKD-EPI 2012公式在老年高血压肾损伤患者中的诊断价值。

验证四种基于肌酐的肾小球滤过率估算方程的性能

【目的】评估四个基于肌酐(Cr)的估算肾小球滤过率(eGFR)方程的预测性能:2012慢性肾脏病流行工作组(CKD-EPIcr)方程、2021CKD-EPIcr方程、湘雅方程和欧洲肾功能协会(EKFC)方程。【方法】本研究纳入198名来自中山大学附属第三医院和澳门镜湖医院的的慢性肾脏病患者。所有参与者通过碘海醇血浆清除率测定肾小球滤过率(mGFR)。eGFR方程计算的结果和mGFR进行对比。研究通过Bland-Altman图、一致性相关系数(CCC)、覆盖概率(CP)和总偏差指数(TDI)描述mGFR和eGFR间的一致性。通过偏差、精确度、均方根误差(RSME)和测量GFR30%偏差范围内的估计百分比(P_(30))评估eGFR方程的估算能力。通过2000次自助抽样的方法获得偏差、IQR、RSME以及P_(30)的95%置信区间(CI)。初步选择最优的eGFR方程后,其他方程和该方程进行统计学检验。统计检验方法如下:①偏差通过Wilcoxon符号秩检验;②P_(30)通过McNemar-Bowker检验;③RMSE和IQR在自助抽样获得2000个样本后,通过独立样本t检验比较组间差异。【结果】总体人群中mGFR和四个eGFR方程(EKFC、2012CKD-EPIcr、2021CKD-EPIcr和湘雅方程)中位数分别是56.2 mL·min^(-1)·(1.73m^(2))^(-1)、67.1 mL·min^(-1)·(1.73m^(2))^(-1)、73.0 mL·min^(-1)·(1.73m^(2))^(-1)、66.9 mL·min^(-1)·(1.73m^(2))^(-1)和63.8 mL·min^(-1)·(1.73m^(2))^(-1)。总体人群中的一致性比较中,Bland-Alt⁃man图表明,EKFC方程的最低平均差和最窄的95%一致性区间。EKFC方程有最优的CCC、TDI和CP,值分别为0.90、24.41和0.50。总体上,EKFC的偏差、精确度、P_(30)和RSME分别为-0.99、14.64、0.80和14.68,95%CI的范围分别为(-2.53,0.94)、(11.82,17.35)、(0.73,0.85)和(12.69,17.35),全面优于其他三个eGFR方程,差异有统计学意义,所有P值均<0.05。mGFR亚组中的结果基本和总体情况一致。【结论】EKFC方程的预测性能全面超越2012CKD-EPIcr方程、2021CKD-EPIcr方程和湘雅方程,且该方程的P_(30)>75%,可以满足临床的诊疗需求。所以推荐EKFC方程用于中国人群的GFR估算,但需要纳入更多的参与者去进一步证明这个结论。

三种常用公式对糖尿病肾病合并高血压患者肾小球滤过率估算的准确性比较

目的比较慢性肾脏病流行病学协作组(CKD-EPI)开发方程(CKD-EPIcr和CKD-EPIcys)和肾脏病膳食改良(MDRD)简化公式对糖尿病肾病(DN)合并高血压患者肾小球滤过率(GFR)估算的准确性。方法收集2015年1月至2017年12月在山西医科大学附属人民医院确诊为DN,已行肾动态显像检查的89例住院患者的临床资料。按是否合并高血压分为DN不合并高血压组(24例)和DN合并高血压组(65例),每组按年龄分为2个亚组(≥60岁和18～59岁)。分别以CKD-EPIcr、CKD-EPIcys、简化MDRD估算其GFR(eGFR)值,分析该人群中不同eGFR公式的诊断准确性。结果以肾动态显像结果为参考标准,≥60岁亚组DN患者不论是否合并高血压,其CKD-EPIcr、CKD-EPIcys、简化MDRD各公式计算eGFR值准确性一致,与标准值差异无统计学意义(P> 0. 05)。18～59岁亚组DN患者DN不合并高血压组,CKD-EPIcys公式计算eGFR值较CKD-EPIcr、简化MDRD公式更为准确(P> 0. 05);相反,DN合并高血压组,CKD-EPIcr、简化MDRD公式计算eGFR值较CKD-EPIcys公式更准确(P> 0. 05)。≥60岁亚组不论是否合并高血压,肾图及各公式计算eGFR结果组间差异无统计学意义(P=0. 347、0. 977)。18～59岁亚组不论是否合并高血压,肾图及各公式计算eGFR结果组间比较差异均有统计学意义(均P <0. 005)。结论 60岁及以上人群中,是否合并高血压对各估算公式影响不大。60岁以下人群中,DN不合并高血压者,CKD-EPIcys公式估算eGFR值更为准确; DN合并高血压者,简化MDRD、CKD-EPIcr公式估算准确性更高。

慢性肾脏病流行病合作工作组方程在慢性肾脏病2～3期老年患者肾功能评估中的意义

目的评价3种慢性肾脏病流行病合作工作组(the chronic kidney disease epidemiology collaboration,CKD-EPI)方程在慢性肾脏病(chronic kidney disease,CKD)2~3期老年患者肾小球滤过率(glomerular filtration rate,GFR)评估中的意义。方法回顾分析2010年1月至2015年1月在江苏省中医院住院的老年CKD2~3期患者81例,收集临床资料,以3种CKD-EPI方程估算GFR,记录为EPI-血肌酐(EPI-serum creatinine,EPI-SCr)、EPI-胱抑素C(EPI-cystatin C,EPI-CysC)和EPI-肌酐联合胱抑素C(EPI-serum creatinine-cystatin C,EPI-SCr-CysC),以锝[99mTc]标记的喷替酸盐(Technetium[99mTc]Pentetate,99mTc-DTPA)肾动态显像为金标准,比较3种方程评价CKD2~3期老年患者GFR水平的适应性、灵敏度及准确度。结果 CKD2~3期老年人群中,与EPI-SCr方程相比,EPI-CysC及EPI-SCr-CysC方程提高了适用性,且其优势主要体现在CKD3期;依据EPI-CysC及EPI-SCr-CysC方程结果对老年患者进行CKD分组,其灵敏度(39.22%比90.20%比86.27%,P<0.001)及准确度(55.56%比82.72%比82.72%,P<0.001)更高,但三个方程特异度之间差异无统计学意义(83.88%比70.00%比76.67%,P=0.475)。结论联合CysC的CKD-EPI方程对CKD2~3期老年患者GFR评估和CKD分期更具指导意义。

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.

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

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。

不同肾小球滤过率公式对接受经皮冠状动脉介入治疗急性心肌梗死患者全因死亡事件预测价值

目的探讨肾病饮食改良(MDRD)简化公式与慢性肾病流行病学合作研究(CKD-EPI)公式估算的肾小球滤过率(GFR)对接受经皮冠状动脉介入(PCI)治疗的急性心肌梗死(AMI)患者全因死亡事件的预测价值。方法选取北部战区总医院心血管内科自2016年3月至2019年3月收治的2488例接受PCI治疗的AMI患者为研究对象。所有患者分别采用MDRD简化公式与CKD-EPI公式估算GFR值。研究终点为12个月内的全因死亡事件。对所有患者进行电话或门诊随访,记录两种公式估算的GFR结果、患者冠状动脉造影病变基线特征、出院用药情况及临床结局。比较两种公式估算的各GFR分层全因死亡发生率。结果MDRD简化公式、CKD-EPI公式估算的GFR分别为(86.07±25.36)ml/(min·1.73 m^(2))、(84.78±23.60)ml/(min·1.73 m^(2))。出院后12个月,105例(4.22%)患者出现全因死亡,85例(3.42%)患者出现心源性死亡,26例(1.05%)患者出现心肌梗死,15例(0.60%)患者出现脑卒中。MDRD简化公式、CKD-EPI公式估算的GFR不同分层的全因死亡发生率比较,差异均有统计学意义(P<0.05)。CKD-EPI公式的统计量大于MDRD简化公式(9.3545比8.9565)。结论接受PCI治疗的AMI患者中,CKD-EPI公式与MDRD简化公式估算的GFR对出院后12个月全因死亡事件均有一定预测价值,CKD-EPI公式预测准确度优于MDRD简化公式。