한국인에서 추정사구체여과율의 종족계수에 관한연구

Abstract

Background: Race and ethnicity is influential on estimating glomerular filtration rate (GFR) because of difference in creatinine generation. I aimed to find the racial coefficients of Modification of Diet in Renal Disease (MDRD) study equations for Korean population and to obtain novel proper MDRD equations. Study design: Diagnostic test accuracy. Cross sectional prospective study. Setting & Participants: Chronic kidney disease patients in outpatient department (n=120) and healthy volunteers (n=31) in Seoul National University Hospital. Reference test: Measured GFR computed from systemic inulin clearance. Index test: Estimated GFR using the measured serum creatinine (SCr), recalibrated SCr to CX3 analyzer in Cleveland Clinic Reference Laboratory and to isotope dilution mass spectrometry (IDMS). Modified MDRD and IDMS MDRD study equations with racial coefficients derived. Measurements: Measured serum creatinine levels were recalibrated to CX3 analyzer and isotope dilution mass spectrometry. Racial coefficients of estimated GFR versus measured GFR and performance of equations (intercept, slope, difference, bias, precision, and accuracy) against measured GFR was inspected. Results: Korean coefficients of 4 variable and 6 variable MDRD and IDMS MDRD study equations based on measured SCr by Jaff? method using Hitachi 7600, recalibrated SCr to CX3, and recalibrated SCr to IDMS were 1.09825/ 1.04334, 0.73989/ 0.74254, and 0.99096/ 0.9554. Modified equations showed better slopes and accuracy, and less bias than the original equations. Limitations: Small size of participants, unevenly distributed CKD stages of participants, restricted study population to patients with native kidney disease and without serious comorbid conditions. Conclusion: Modification of original MDRD equations with racial coefficients based on measured SCr and recalibrated SCr to IDMS improved the performance of GFR estimation in overall CKD stages. Furthermore I assert that more studies to find and verify the novel equations based on recalibrated SCr to IDMS for Korea and the rest of Asia should be performed