다양한 복막투석액과 크레아티닌 측정 시스템에 따른 포도당에 의한 크레아티닌 간섭의 비교 평가
Comparative Evaluation of Creatinine Interferences by Glucose in Various Dialysates Based on Creatinine Measurement Methods
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배경: 복막평형검사는 복막투석 환자의 복막 이동능을 반정량적 결과로 평가하는 검사로서 복막투석의 적정성 여부와 환자의 예후 및 다른 신대체요법으로의 변경 등을 결정하는데 유용하다. 복막투석액의 크레아티닌을 측정할 때 복막투석액의 고농도의 포도당은 크레아티닌 값에 양성 오차를 일으키므로 이를 교정하는 교정인자가 필요하다. 본 연구에서는 몇 가지 종류의 복막투석액과 측정기기에 따라 세분화된 교정인자를 구하고 평가하였다. 방법: 3개 제조사 복막투석액에서 크레아티닌을 검사 원리 및 측정기기에 따라 5개 검사 시스템으로 나누어 각각 측정하고 포도당 농도에 따라 A방법(Twardowski) 및 B방법(선형회귀분석)에 의한 새로운 교정인자를 구하였다. 복막투석액의 종류에 따른 교정인자를 통해, 실제 2년간 3개 병원에서 시행한 복막평형검사 반정량적 이동능 결과를 후향적으로 분석하여 검사 결과에 어떤 차이를 보이는지 확인하였다. 결과: 복막투석액 종류, 크레아티닌 측정기기 및 원리에 따라 A방법의 교정인자는 0.000051183–0.000221729 범위의 결과 값을 보였으며, B방법의 교정인자 기울기 값은 0.000106270–0.000285902의 범위를 보였고 절편 값은 –0.248825054에서 –0.08519815까지 사이로 측정기기 및 복막투석용액에 따른 차이가 있었다. 새로운 교정인자를 2년간의 204회의 임상 증례에 후향적으로 적용하여 복막평형검사 결과 차이를 확인하였을 때, A교정방법의 경우 매우 높은 일치도(weighted kappa=0.95)를 보였으며 B교정방법의 경우에도 높은 일치도(weighted kappa=0.82)를 보였으나 시스템 별로는 일치도가 달랐다. 결론: 크레아티닌 측정법과 복막투석액의 종류에 따라 복막평형검사의 교정인자에 차이가 있었고, 비록 실제 복막평형검사의 반정량적 평가 결과에 미치는 영향은 크지 않았지만, 일부 시스템에서 서로 다른 결과를 보여 크레아티닌 검사법 변경 시에는 새로운 교정인자 산출이 필요하다.
Abstract
Background: The peritoneal equilibrium test (PET), a semi-quantitative assessment for peritoneal dialysis patients, helps evaluate suitability, prognosis, and modality changes. High glucose concentrations in peritoneal dialysates (PD) can interfere with creatinine assays, necessitating a correction factor (CF). We calculated the CF for various PD and creatinine measurement methods. Methods: Creatinine and glucose levels in the PD from three manufacturers were determined using five systems of measurement principles and analyzers. New CFs were calculated using method A (Twardowski) or B (linear regression). We retrospectively evaluated the equivalence of the 204 PET semiquantitative transfer results obtained over two years using the new and old CFs. Results: The calculated CF of method A ranged from 0.000051183 to 0.000221729, depending on the type of PD and creatinine measurement system. The CF of method B had a slope ranging from 0.000106270 to 0.000285902 and an intercept ranging from -0.248825054 to -0.08519815 for each combination. We found very good agreement between the PET results obtained by applying the new CFs and those obtained by applying the old CFs (weighted kappa=0.95) with method A and a substantial agreement (weighted kappa=0.82) with method B, with variations according to the systems. Conclusions: The CF of PD differed according to the creatinine measurement systems and PD types. Although there was good agreement in PET results between new and old CFs, we propose the application of the new calculated CFs with the new creatinine measurement method because some cases showed less agreement.
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