입원환자에 대한 사구체 여과율 예측식의 비교
Comparison of GFR prediction equations For Korean hospitalized patients
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Accurate estimation of the glomerular filtration rate (GFR) is crucial for therapeutic interventions, especially in guiding the dose adjustment of the medication for patients diagnosed with renal insufficiency. Various methods such as Cockcroft-gault (CG), Modification of Diet in Renal Disease (MDRD) and Sanaka equation are widely used to estimate GFR, especially MDRD is the most frequently used method. However, the accuracy would be affected by race, age and diseases the patients have and CG or MDRD are limited to apply for Asian. The objective of the study is to find the appropriate renal function prediction factor in the dose adjustment of the medication through comparing the performance of the CG, MDRD and Sanaka methods based on creatinine clearance measured with 24hr urine collection. 1186 patients who had their creatinine clearance measured by 24hr urine collection from 1 May 2003 to 31 July 2008 were selected excluding any patients who have factors which might affect their renal function. The accuracy of the GFR predication by these above three methods was compared against each other, taking into consideration each patient renal function stage and age. The MDRD equation preformed better than the CG or Sanaka formula in total patients with respect to accuracy within 30% (49.7, 71, and 49.2%, respectively). Similar results are with respect to accuracy within 30% (64.2, 70.7, 68.6%, respectively) in patients with chronic renal diseases and with respect to that (42.1, 71.6, 51.2% and 38.9, 75.0, 56.0% respectively) in elderly patients and very elderly patients. In total patients through the MDRD, CG and Sanaka, 45.1%, 59.2% and 42.6% of patients were classified as exact stage of chronic renal disease that is used for dosage adjustment. The result from this study shows the renal function estimation by MDRD is more accurate than by CG and Sanaka, and MDRD adjusted by body surface area showed performance improvement compared with the original MDRD equation. Therefore GFR estimation through MDRD adjusted by body surface area is recommended in the dose adjustment of the medication.
Abstract
Accurate estimation of the glomerular filtration rate (GFR) is crucial for therapeutic interventions, especially in guiding the dose adjustment of the medication for patients diagnosed with renal insufficiency. Various methods such as Cockcroft-gault (CG), Modification of Diet in Renal Disease (MDRD) and Sanaka equation are widely used to estimate GFR, especially MDRD is the most frequently used method. However, the accuracy would be affected by race, age and diseases the patients have and CG or MDRD are limited to apply for Asian. The objective of the study is to find the appropriate renal function prediction factor in the dose adjustment of the medication through comparing the performance of the CG, MDRD and Sanaka methods based on creatinine clearance measured with 24hr urine collection. 1186 patients who had their creatinine clearance measured by 24hr urine collection from 1 May 2003 to 31 July 2008 were selected excluding any patients who have factors which might affect their renal function. The accuracy of the GFR predication by these above three methods was compared against each other, taking into consideration each patient renal function stage and age. The MDRD equation preformed better than the CG or Sanaka formula in total patients with respect to accuracy within 30% (49.7, 71, and 49.2%, respectively). Similar results are with respect to accuracy within 30% (64.2, 70.7, 68.6%, respectively) in patients with chronic renal diseases and with respect to that (42.1, 71.6, 51.2% and 38.9, 75.0, 56.0% respectively) in elderly patients and very elderly patients. In total patients through the MDRD, CG and Sanaka, 45.1%, 59.2% and 42.6% of patients were classified as exact stage of chronic renal disease that is used for dosage adjustment. The result from this study shows the renal function estimation by MDRD is more accurate than by CG and Sanaka, and MDRD adjusted by body surface area showed performance improvement compared with the original MDRD equation. Therefore GFR estimation through MDRD adjusted by body surface area is recommended in the dose adjustment of the medication.
참고문헌 (18)
- Fleming JS, "Guidelines for the measurement of glomerular filtration rate using plasma sampling", Nucl Med Commun, 25, pp.759~769 (2004)
- Cockcroft DW, "Prediction of creatinine clearance from serum creati-nine", Nephron, 16, pp.31~41 (1976)
- Gault MH., "Predicting glomerular function from adjusted serum creatinine", Nephron, 62, pp.249~256 (1992)
- Levey AS, "A more accurate method to estimate glomerular filtration rate from serum creatinine: A new pre-diction equation. Modification of Diet in Renal Disease Study Group", Ann Intern Med, 130, pp.461~470 (1999)
- Levey AS, "A simplified equation to predict glomerular filtration rate from serum creatinine", J Am Soc Nephrol, 11(155A) (2000)
- Sanaka M, "Serum albumin for estimating creatinine clearance in the elderly with muscle atrophy", Nephron, 73, pp.137~144 (1996)
- National Kidney Foundation, "K", DOQI Clinical practice guideline to define chronic kidney disease : Evaluation, clas-sification and stratification, 2002, pp.39(1), S1~S266
- Berman., Nathaniel, "Comparing the Cockcroft-gault equations and MDRD equations for calculation of GFR and drug doses in the elderly", National Clinical Practice Nephrology, 3(12), pp.644~645 (2007)
- 이용수, "고령자에서 계산공식에 의한 사구체 여과율의 평가", Kidney Research and Clinical Practice, 25(5), pp.745~752 (2006), 대한신장학회
- 강우현, "한국인에서 혈청 크레아티닌을 이용한 크레아티닌 청소율의 예측", 대한신장학회지, 17(6), pp.866~871 (1998)
- Enyu Imai, "Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease", Clin Exp Nephrol, 11, pp.41~50 (2007)
- Davila E, "Clinical value of the creatinine clearance before the administation of chemotherapy with cis-platin", Cancer, 60(20), pp.161~164 (1987)
- Terry K. Rosborough, "selecting an equation to estimate glomerular fil-tration rate for use in renal dosage adjustment of drugs in electronic patient record system", Pharmacotherapy, 25, pp.823~835 (2005)
- Reichley RM, "Analysis of various creatinine clearance formulas in predicting gentamicin delimi-nation in patients with low serum crea-tinine", Pharmacotherapy, 15(5), pp.625~630 (1995)
- DuBois D, "A formula to estimate the approximate surface area if height and weight be known", Arch Intern Med, 17, pp.863~871 (1916)
- Stevens L.A, "Assessing Kidney Function - Measured and Estimated Glomerular Filtration Rate", N Engl J Med, 354, pp.2473~2483 (2006)
- Tazeen H. Jafar, "Serum creatinine as marker of kidney function in south Asians: A study of reduced GFR in adults in Pakistan", Jam Soc Nephrol, 16, pp.1413~1419 (2005)
- Enyu Imai, "Estimation of glomerular filtra-tion rate by the MDRD study equation modified for Japanese patients with chronic kidney disease", Clin Exp Nephrol, 11, pp.41~50 (2007)