KDIGO2012Clinical Practice Guideline ckd classification rules out creati-
高中英语nine clearance24hours urine collection?
A.Ognibene,G.Grandi,M.Lorubbio,S.Rapi,
B.Salvadori, A.Ter-
reni,F.Veroni
PII:S0009-9120(15)00310-0
DOI:doi:10.1016/j.clinbiochem.2015.07.030
Reference:CLB9097
To appear in:Clinical Biochemistry
Received date:11February2015
Revid date:12July2015
Accepted date:26July2015
Plea cite this article as:Ognibene A,Grandi G,Lorubbio M,Rapi S,Salvadori B, Terreni A,Veroni F,KDIGO2012Clinical Practice Guideline ckd classification rules out creatinine clearance24hours urine collection?,Clinical Biochemistry(2015),doi: 10.1016/j.clinbiochem.2015.07.030
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KDIGO
2012 C LINICAL P RACTICE G UIDELINE CKD CLASSIFICATION RULES OUT CREATININE
CLEARANCE 24 HOURS URINE COLLECTION ?
Ognibene A., Grandi G., Lorubbio M., Rapi S., Salvadori B., Terreni A., Veroni F. Laboratorio Generale – Azienda Ospedaliero-Universitaria Careggi - Firenze Italy
Corresponding author: Agostino ibene@med.unifi.it Phone: +39 3403460965
Azienda Ospedaliero-Universitaria Careggi
Largo Brambilla, 3 50134 Firenze Italy
Abbreviations: Creatinine Clearance (CrCl); Chronic Kidney Dia (CKD); Glomerular Filtration Rate (GFR); Chronic Kidney Dia Epidemiology Collaboration equations (CKD-EPI); estimation Glomerular Filtration Rate (eGFR); Modification of Diet in Renal Dia equation (MDRD).
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英语b级成绩查询入口Abstract
Objectives: The recent guideline for the Evaluation and Management of Chronic Kidney Dia recommends asssing GFR employing equations bad on rum creatinine; despite this, creatinine clearance 24-hours urine collection is ud routinely in many ttings. In this study we compared the classification assd from CrCl (creatinine clearance 24h urine collection) and e-GFR calculated with CKD-EPI or MDRD formulas.
Design and Methods: In this retrospective study we analyze concutive laboratory data:
creatinine clearance 24h urine collection, rum creatinine and demographic data such as x and age from 15777 patients >18 years of age collected from 2011 to 2013 in our laboratory at Careggi H
ospital. The results were then compared to the estimated GFR calculated with the equations according to the recent treatment guidelines. Concutive and retrospective laboratory data (creatinine clearance 24h urine collection, rum creatinine and, demographic data such as x and age) from 15777 patients >18 years of age en at Careggi Hospital were collected.
Results: Comparison between e-GFR calculated with CKD-EPI or MDRD formulas and GFR according CrCl determinations, bias [95% CI] were 11.34 [-47,4/70.1] and 11.4 [-50.2/73] respectively. The concordance for 18/65 years aged group when compared e-GFR classification between MDRD vs CKDEPI, MDRD vs CrCl and CKD-EPI vs CrCl were 0.78, 0.34, and 0.41 respectively, while in the 65/110 years aged group the concordance Kappa were 0.84, 0.38, and 0.36 respectively.
Conclusions: The u of CrCl provides a different classification than the estimation of GFR using a prediction equation. The CrCl is unreliable when it is necessary to identify CKD subjects with decrea of GFR of 5 ml/min/1.73 m 2/year.
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Key words: Glomerular Filtration Rate, Creatinine, MDRD, CKD-EPI, Creatinine Clearance, Chronic Kidney Dia, estimation GFR.
Introduction
Glomerular Filtration Rate (GFR) is widely accepted as the best indicator of kidney function, yet in clinical practice except nephrology it is infrequently utilid moreover the GFR so calculated is a very mediocre to u as diagnostic test. GFR calculated by the clearance of exogenous markers such
as iothalamate, or iohexol and inulin is considerably time-consuming, expensive, and requires the
mars是什么意思administration of substances not feasible in routine monitoring [1].
GFR can be obtained also by the clearance of endogenous substances, very often urinary clearance of creatinine, computed from 24 hours urine collection (CrCl) [2]. Unfortunately, timed urinary collections are cumbersome and susceptible to error, making the 24 hour urine collections for the measurement of creatinine clearance no longer recommended routinely to estimate the level of kidney function [3].
During the last decades, rum creatinine has been the most frequently employed marker to estimate GFR and rial measurements of creatinine are very uful for determining changes in kidney function. The K/DOQI guidelines emphasize the necessity to asss GFR employing equations bad on rum creatinine and not to rely on rum creatinine concentration alone [1]. Specifically in the last few years, attention has been focud on two creatinine-bad equations that are widely studied and applied, the Modification of Diet in Renal Dia (MDRD) [4] and Chronic Kidney Dia Epidemiology Collaboration (CKD-EPI) equations [5]. The first one, the MDRD formula, was developed in 1999 and re-expresd in 2007; it estimates GFR adjusted for body-surface area using age and gender as variables and using a standardized method for
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the measurement of rum creatinine [6]. The cond one, the CKD-EPI equation, was developed in order to create a more accurate and preci formula than the MDRD, especially when actual GFR is > 60 mL/min per 1.73 m2 [7,8,9].
陕西师范大学研究生院GFR estimation became of extreme importance especially after the publication of the guidelines by KDIGO 2012, Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Dia (CKD) that updates the 2002 KDOQI Clinical Practice Guidelines for Chronic Kidney Dia [1, 10]. Particular emphasize is given to the change from 5 to 6 categories bad on GFR levels to predict risk for outcomes of CKD. In this retrospective study we analyze data collected
during three years (2011-13) in our laboratory. Specifically, from the databa of the laboratory
were extracted all CrCl tests performed during the above period of time. The results were then compared to the equations estimated GFR (e-GFR) in order to verify the concordance between methods, following the recent classification of CKD.
Material and methods Study population
Concutive and retrospective laboratory data such as creatinine clearance 24h urine collection (CrCl), rum creatinine (Scr) and demographic data such as x and age from 15777 patients >18 years of age en at Careggi Hospital between January 2011 and December 2013 were collected. The data were imported into Microsoft Excel, which was ud to perform the eGFR (CKD-EPI and MDRD) calculations. Laboratory assay
All rum and urine creatinine were measured by IDMS-traceable assay on the ADVIA 2400 systems (Siemens Diagnostics) using a creatinina/creatina bad enzymatic method (ECRE_2, Siemens Diagnostics). eGFR algorithms
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GFR was estimated using the MDRD study equation (175 × standardized Scr −1.154 × age −0.203 ×1.212 [if patient is black] × 0.742 [if patient is female]) and the CKD-EPI equation (CKD-EPI = 141 × min(Scr/k, 1)α × max(Scr/k,1)-1.209 × 0.993age × 1.018 [if patient is female] × 1.159 [if patient is black], where age is in years, k is 0.7 for females and 0.9 for males, α is −0.329 for females and −0.411 for males, min indicates the minimum of Scr/k or 1, and max indicates the maximum of Scr/k or 1). GFR is expresd in ml/min/1.73 m 2[5,6]. CrCl was calculated from urinary creatinine × urinary volume (24h) / rum creatinine. To allow comparison, CrCl were normalized to standard values of 1.73 m 2 BSA, and expresd in ml/min/1.73 m 2.
凯利日记第二季Six GFR category according to KDIGO 2012 Clinical Practice Guideline for the Evaluation and
Management of Chronic Kidney Dia were: G1 (>90 ml/min/1.73 m 2), G2 (60-89 ml/min/1.73 m
2), G3a (45-59 ml/min/1.73 m 2), G3b (30-44 ml/min/1.73 m 2), G4 (15-29 ml/min/1.73 m 2), G5 (<15 ml/min/1.73 m 2) [10]. Statistical analysis
To compare the effectiveness of the two equations studied we ud a Bland and Altman plot. In particular the method calculates the mean difference between two methods of measurement and the 95% limits of agreement as the mean difference (1.96 SD) [11]. Paired-Samples T Test was ud to compare the means; Cohen's and Fleiss Kappa were ud measuring agreement between classifications [12]. An α <0.05 was considered statistically significant. The statistical analys were performed with SPSS version 11.0. Results
Table 1 shows the main characteristic of the study population, all parameters were statistically significant between two xes except CrCl. Figure 1 shows Bland Altman plots for the comparison between e-GFR calculated with CKD-EPI or MDRD formulas and GFR according to CrCl determinations; mean bias [95% CI] were 11.34[-47.4, 70.1] and 11.4[-50.2, 73] respectively. Moreover when compared differences between e-GFR calculated with CKD-EPI or MDRD
