The diagnosis of small renal masses(SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal funct...The diagnosis of small renal masses(SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal function. Such patients are at risk for further decline following therapeutic intervention. Renal thermal ablation presents one approach for management of SRMs whereby tumors are treated in situ without need for global renal ischemia. These treatment characteristics contribute to favorable renal function outcomes following kidney tumor ablation particularly in patients with an anatomic or functional solitary renal unit.展开更多
Diabetic nephropathy is the kidney disease that occurs as a result of diabetes.Cardiovascular and renal complications share common risk factors such as blood pressure,blood lipids,and glycemic control.Thus,chronic kid...Diabetic nephropathy is the kidney disease that occurs as a result of diabetes.Cardiovascular and renal complications share common risk factors such as blood pressure,blood lipids,and glycemic control.Thus,chronic kidney disease may predict cardiovascular disease in the general population.The impact of diabetes on renal impairment changes with increasing age.Serum markers of glomerular filtration rate and microalbuminuria identify renal impairment in different segments of the diabetic population,indicating that serum markers as well as microalbuminuria tests should be used in screening for nephropathy in diabetic older people.The American Diabetes Association and the National Institutes of Health recommend Estimated glomerular filtration rate(eGFR) calculated from serum creatinine at least once a year in all people with diabetes for detection of kidney dysfunction.eGFR remains an independent and significant predictor after adjustment for conventional risk factors including age,sex,duration of diabetes,smoking,obesity,blood pressure,and glycemic and lipid control,as well as presence of diabetic retinopathy.Cystatin-C(Cys C) may in future be the preferred marker of diabetic nephropathy due differences in measurements of serum creatinine by various methods.The appropriate reference limit for Cys C in geriatric clinical practice must be defined by further research.Various studies have shown the importance of measurement of albuminuria,eGFR,serum creatinine and hemoglobin level to further enhance the prediction of end stage renal disease.展开更多
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 wer...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.展开更多
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...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.展开更多
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 Re...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.展开更多
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 ...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.展开更多
Background Recently, it has been suggested that the serum uric acid （SUA） level decreased in diabetic patients. The aim of this study was to explore the association between SUA level and different state of glucose m...Background Recently, it has been suggested that the serum uric acid （SUA） level decreased in diabetic patients. The aim of this study was to explore the association between SUA level and different state of glucose metabolism and glomerular filtration rate （GFR） reflected by the simplified Modification of Diet in Renal Disease （MDRD） equation and to test the hypothesis that high MDRD is one of the determinants of SUA level.Methods This cross-sectional study included 2373 subjects in Beijing who underwent a 75 g oral glucose tolerance test （OGTT） for screening of diabetes. According to the states of glucose metabolism, they were divided into normal glucose tolerance, impaired glucose regulation and diabetes.Results Multiple stepwise linear regression analysis showed that adjusted by gender, SUA was positively correlated with body mass index （BMI）, waist/hippo ratio, systolic blood pressure （SBP） and triglyceride, meanwhile negatively correlated with age, hemoglobin A1c, fasting insulin and MDRD. There was an increasing trend in SUA concentration and a decreasing trend in MDRD when the levels of fasting plasma glucose （FPG） increased from low to high up to the FPG level of 8.0 mmol/L; thereafter, the SUA concentration started to decrease with further increases in FPG levels, and the MDRD started to increase with further increases in FPG levels.Conclusion This study confirmed the previous finding that SUA decreased in diabetes and provided the supporting evidence that the increased MDRD might contribute to the fall of SUA.展开更多
文摘The diagnosis of small renal masses(SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal function. Such patients are at risk for further decline following therapeutic intervention. Renal thermal ablation presents one approach for management of SRMs whereby tumors are treated in situ without need for global renal ischemia. These treatment characteristics contribute to favorable renal function outcomes following kidney tumor ablation particularly in patients with an anatomic or functional solitary renal unit.
文摘Diabetic nephropathy is the kidney disease that occurs as a result of diabetes.Cardiovascular and renal complications share common risk factors such as blood pressure,blood lipids,and glycemic control.Thus,chronic kidney disease may predict cardiovascular disease in the general population.The impact of diabetes on renal impairment changes with increasing age.Serum markers of glomerular filtration rate and microalbuminuria identify renal impairment in different segments of the diabetic population,indicating that serum markers as well as microalbuminuria tests should be used in screening for nephropathy in diabetic older people.The American Diabetes Association and the National Institutes of Health recommend Estimated glomerular filtration rate(eGFR) calculated from serum creatinine at least once a year in all people with diabetes for detection of kidney dysfunction.eGFR remains an independent and significant predictor after adjustment for conventional risk factors including age,sex,duration of diabetes,smoking,obesity,blood pressure,and glycemic and lipid control,as well as presence of diabetic retinopathy.Cystatin-C(Cys C) may in future be the preferred marker of diabetic nephropathy due differences in measurements of serum creatinine by various methods.The appropriate reference limit for Cys C in geriatric clinical practice must be defined by further research.Various studies have shown the importance of measurement of albuminuria,eGFR,serum creatinine and hemoglobin level to further enhance the prediction of end stage renal disease.
文摘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.
文摘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.
文摘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.
基金National Key R&D Program of China (No.2016YFC1305500)Key Research and Development Program of Hainan (Nos.ZDYF2016135 and ZDYF2017095)+2 种基金the National Natural Science Foundation of China (Nos.61471399,61671479,and 81670663)the National Key Research and Development Program (No. 2016YFC1305404)the Joint Funds of National Natural Science Foundation of China and Henan province (No.U1604284).
文摘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.
文摘Background Recently, it has been suggested that the serum uric acid （SUA） level decreased in diabetic patients. The aim of this study was to explore the association between SUA level and different state of glucose metabolism and glomerular filtration rate （GFR） reflected by the simplified Modification of Diet in Renal Disease （MDRD） equation and to test the hypothesis that high MDRD is one of the determinants of SUA level.Methods This cross-sectional study included 2373 subjects in Beijing who underwent a 75 g oral glucose tolerance test （OGTT） for screening of diabetes. According to the states of glucose metabolism, they were divided into normal glucose tolerance, impaired glucose regulation and diabetes.Results Multiple stepwise linear regression analysis showed that adjusted by gender, SUA was positively correlated with body mass index （BMI）, waist/hippo ratio, systolic blood pressure （SBP） and triglyceride, meanwhile negatively correlated with age, hemoglobin A1c, fasting insulin and MDRD. There was an increasing trend in SUA concentration and a decreasing trend in MDRD when the levels of fasting plasma glucose （FPG） increased from low to high up to the FPG level of 8.0 mmol/L; thereafter, the SUA concentration started to decrease with further increases in FPG levels, and the MDRD started to increase with further increases in FPG levels.Conclusion This study confirmed the previous finding that SUA decreased in diabetes and provided the supporting evidence that the increased MDRD might contribute to the fall of SUA.
