Glomerular filtration rate estimation in patients with type 2 diabetes: creatinine- or cystatin C-based equations?

被引:52
作者
Iliadis, F. [1 ]
Didangelos, T. [1 ]
Ntemka, A. [1 ]
Makedou, A. [2 ]
Moralidis, E. [3 ]
Gotzamani-Psarakou, A. [3 ]
Kouloukourgiotou, T. [1 ]
Grekas, D. [1 ]
机构
[1] Univ Gen Hosp AHEPA, Propedeut Dept Internal Med 1, Thessaloniki 54636, Greece
[2] Aristotle Univ Thessaloniki, AHEPA Hosp, Paediat Dept 2, Lab Lipids, GR-54006 Thessaloniki, Greece
[3] Aristotle Univ Thessaloniki, AHEPA Hosp, Dept Nucl Med, GR-54006 Thessaloniki, Greece
关键词
Cystatin C; Glomerular filtration rate; Type; 2; diabetes; RENAL-DISEASE; SERUM CREATININE; PLASMA-CREATININE; DIET; GFR; PERFORMANCE; PREDICTION; COMBINATION; CALIBRATION; VALUES;
D O I
10.1007/s00125-011-2307-1
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims/hypothesis It is argued that GFR estimation (eGFR) using cystatin C-based equations (eGFRcys) is superior to that using creatinine-based equations (eGFRcre). We investigated whether eGFRcys are superior to eGFRcre in patients with type 2 diabetes. Methods GFR was measured in 448 type 2 diabetic patients using Cr-51-EDTA-measured GFR (mGFR) as the reference standard. Bias, precision and accuracy of eGFRcys and eGFRcre were compared. Results The most accurate eGFRcre equation (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), which produced the highest proportion of estimates that were within 30% and 10% of the reference standard (80.7% and 38.0% of samples, respectively) had a bias of 7.1 and precision of 12.0 ml min(-1) 1.73 m(-2). The calibrated eGFRcys with the highest accuracy (Tan-C), which produced the highest proportion of estimates that were within 30% (78.8%) and within 10% (39.0%) of the reference standard had a bias of -3.5 and precision of 18.0 ml min(-1) 1.73 m(-2). Moreover, the areas under the receiver operating curve were higher with eGFRcre (CKD-EPI and Modification of Diet in Renal Disease [MDRD]) than with eGFRcys for the diagnosis of mild (mGFR <90 ml min(-1) 1.73 m(-2)) and moderate (mGFR <60 ml min(-1) 1.73 m(-2)) chronic kidney disease. In patients with mGFR >= 90 ml min(-1) 1.73 m(-2), CKD-EPI was the least biased, the most precise and the most accurate equation. Conclusions/interpretation In patients with type 2 diabetes, eGFRcys do not currently provide better eGFR than eGFRcre. At present, compared with eGFRcys, eGFRcre are better at predicting the stage of chronic kidney disease. In addition, CKD-EPI seems to be the best equation for eGFR in patients with normal renal function.
引用
收藏
页码:2987 / 2994
页数:8
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