Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease

被引：464

作者：

Imai E. ^{[1
]}

Horio M. ^{[2
]}

Nitta K. ^{[3
]}

Yamagata K. ^{[4
]}

Iseki K. ^{[5
]}

Hara S. ^{[6
]}

Ura N. ^{[7
]}

Kiyohara Y. ^{[8
]}

Hirakata H. ^{[9
]}

Watanabe T. ^{[10
]}

Moriyama T. ^{[11
]}

Ando Y. ^{[12
]}

Inaguma D. ^{[13
]}

Narita I. ^{[14
]}

Iso H. ^{[15
]}

Wakai K. ^{[16
]}

Yasuda Y. ^{[17
]}

Tsukamoto Y. ^{[18
]}

Ito S. ^{[19
]}

Makino H. ^{[20
]}

Hishida A. ^{[21
]}

Matsuo S. ^{[17
]}

机构：

[1] Department of Nephrology, Osaka University Graduate School of Medicine, Suita

[2] Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, Suita, Osaka

[3] Fourth Department of Medicine, Tokyo Women's University of Medicine, Tokyo

[4] Department of Nephrology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki

[5] Dialysis Unit, University Hospital of the Ryukyus, Okinawa

[6] Health Medical Center, Toranomon Hospital, Tokyo

[7] Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Hokkaido

[8] Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka

[9] Nephrology and Dialysis Center, Fukuoka Red Cross Hospital, Fukuoka

[10] Third Department of Medicine, Fukushima Medical University, Fukushima

[11] Healthcare Center, Osaka University, Osaka

[12] Department of Nephrology, Jichi Medical School, Tochigi

[13] Tosei Hospital, Aichi

[14] Division of Nephrology and Rheumatology, Niigata University, Niigata

[15] Department of Public Health, Osaka University Graduate School of Medicine, Osaka

[16] Aichi Cancer Institute, Aichi

[17] Department of Nephrology, Nagoya University Graduate School of Medicine, Aichi

[18] Syuwa General Hospital, Saitama

[19] Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Miyagai

[20] Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama

[21] First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka

来源：

Clinical and Experimental Nephrology | 2007年 / 11卷 / 1期

关键词：

Chronic kidney disease; Glomerular filtration rate; Inulin clearance; Serum creatinine;

D O I：

10.1007/s10157-006-0453-4

中图分类号：

学科分类号：

摘要：

Background. Accurate estimation of the glomerular filtration rate (GFR) is crucial for the detection of chronic kidney disease (CKD). In clinical practice, GFR is estimated from serum creatinine using the Modification of Diet in Renal Disease (MDRD) study equation or the Cockcroft-Gault (CG) equation instead of the time-consuming method of measured clearance for exogenous markers such as inulin. In the present study, the equations originally developed for a Caucasian population were tested in Japanese CKD patients, and modified with the Japanese coefficient determined by the data. Methods. The abbreviated MDRD study and CG equations were tested in 248 Japanese CKD patients and compared with measured inulin clearance (Cin) and estimated GFR (eGFR). The Japanese coefficient was determined by minimizing the sum of squared errors between eGFR and Cin. Serum creatinine values of the enzyme method in the present study were calibrated to values of the noncompensated Jaffé method by adding 0.207 mg/dl, because the original MDRD study equation was determined by the data for serum creatinine values measured by the noncompensated Jaffé method. The abbreviated MDRD study equation modified with the Japanese coefficient was validated in another set of 269 CKD patients. Results. There was a significant discrepancy between measured Cin and eGFR by the 1.0 x MDRD or CG equations. The MDRD study equation modified with the Japanese coefficient (0.881 x MDRD) determined for Japanese CKD patients yielded lower mean difference and higher accuracy for GFR estimation. In particular, in Cin 30-59 ml/min per 1.73 m2, the mean difference was significantly smaller with the 0.881 x MDRD equation than that with the 1.0 x MDRD study equation (1.9 vs 7.9 ml/min per 1.73 m2; P < 0.01), and the accuracy was significantly higher, with 60% vs 39% of the points deviating within 15%, and 97% vs 87% of points within 50%, respectively (both P < 0.01). Validation with the different data set showed the correlation between eGFR and Cin was better with the 0.881 x MDRD equation than with the 1.0 x MDRD study equation. In Cin less than 60 ml/min per 1.73 m 2, the accuracy was significantly higher, with 85% vs 69% of the points deviating within 50% (P < 0.01), respectively. The mean difference was also significantly smaller (P < 0.01). However, GFR values calculated by the 0.881 × MDRD equation were still underestimated in the range of Cin over 60 ml/min per 1.73 m2. Conclusions. Although the Japanese coefficient improves the accuracy of GFR estimation of the original MDRD study equation, a new equation is needed for more accurate estimation of GFR in Japanese patients with CKD stages 3 and 4. © 2007 Japanese Society of Nephrology.

引用

页码：41 / 50

页数：9

共 21 条

[1]

K/DOQI Clinical practice guidelines for chronic kidney disease: Evaluation, classification and stratification, Am J Kidney Dis, 39, (2002)

[2]

Levey A., Eckardt K., Tsukamoto Y., Levin A., Coresh J., Rossert J., Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO), Kidney Int, 67, pp. 2089-100, (2005)

[3]

Coresh J., Astor B., Greene T., Eknoyan G., Levey A., Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey, Am J Kidney Dis, 41, pp. 1-2, (2003)

[4]

Levey A., Bosch J., Lewis J., Green T., Rogers N., Roth D., A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation, Ann Intern Med, 130, pp. 461-70, (1999)

[5]

Lewis J., Agodoa L., Cheek D., Green T., Middleton J., O'Connor D., Comparison of cross-sectional renal function measurements in African-Americans with hypertensive nephrosclerosis and of primary formulas for estimating glomerular filtration rate, Am J Kidney Dis, 38, pp. 744-53, (2001)

[6]

Poggio E., Wang X., Greene T., Van Lente F., Hall P., Performance of the modification of diet in renal disease and Cockcroft-Gault equations in the estimation of GFR in health and in chronic kidney disease, J Am Soc Nephrol, 16, pp. 459-66, (2005)

[7]

Rule A., Larson T., Bergstralh E., Slezak J., Jacobsen S., Cosio F., Using serum creatinine to estimate glomerular filtration rate: Accuracy in good health and in chronic kidney disease, Ann Intern Med, 141, pp. 929-37, (2004)

[8]

Stevens L., Coresh J., Greene T., Levey A., Assessing kidney function, N Engl J Med, 354, pp. 2473-83, (2006)

[9]

Orita Y., Gejyo F., Sakatsume M., Shiigai T., Maeda Y., Imai E., Estimation of glomerular filtration rate by inulin clearance: Comparison with creatinine clearance, Jpn J Nephrol, 47, pp. 804-12, (2005)

[10]

Coresh J., Astor B.C., McQuillan G., Kusek J., Greene T., Van Lente F., Levery A.S., Calibration and random variation of the serum creatine assay as critical elements of using Equations to estimate glomerular filtration rate, Am J Kidney Dis, 39, pp. 920-2, (2002)

← 1 2 3 →