Beş farklı eGFR denkleminin karşılaştırmalı teşhis performanslarının yeni analizi: Gözden geçirilmiş 2021 CKD-EPI ve dört eski denklem

Amaç: 2021 yılında Kronik Böbrek Hastalığı Epidemiyoloji İşbirliği (CKD-EPI) ve Ulusal Diyabet&Sindirim ve Böbrek Hastalıkları Enstitüsü (NIDDK) tarafından CKD-EPI-kreatinin ve CKD-EPI-kreatinin-sistatin-C kombine formülü yeniden revize edilmiş ve doğruluğunun arttırıldığı bildirilmiştir. Bu çalışmanın temel amacı daha iyi bir öngörü sağlamak için 2009 CKD-EPI eGFRcr, 2012 CKD-EPI eGFRCysC, 2012 CKD-EPI eGFRcr-CysC, MDRD ve revize edilmiş 2021 CKD-EPI'nin tanısal doğruluk ve performansını karşılaştırmaktır. Gereç ve Yöntem: Çalışma tasarımı prospektifti. Örneklem, nefroloji kliniğine başvuran 111 KBH hastası ve 35 sağlıklı bireyden oluşmaktaydı. Tüm katılımcılar bir nefrolog tarafından değerlendirildi. Katılımcılar KDIGO sınıflandırmalarına göre çalışma gruplarına ayrılmıştır. Yaş, ırk, cinsiyet, serum kreatinin ve serum sistatin-C olmak üzere beş değişken kullanılmıştır. Bulgular: 2012 CKD-EPI eGFR sistatin-C, doğruluk, özgüllük ve duyarlılık açısından mevcut denklemlerden daha iyi performans gösterdi (AUC:0.988). Revize edilmiş 2021 CKD-EPI denklemleriyle karşılaştırıldığında, eGFR sistatin-c, üç performans metriğinin hepsinde sürekli olarak daha iyi performans gösterdi. Ayrıca, bir denkleme hem kreatinin hem de sistatin-C dahil edildiğinde, yalnızca kreatinin içeren formüllere göre tanısal değerleri tutarlı bir şekilde iyileştirir (2009CKD-EPI eGFRcr AUC:0.953, 2012CKD-EPI eGFRcr-CysC AUC: 0.985, 2021CKD-EPI eGFRcr AUC:0.954, MDRD AUC: 0.953, 2021CKD-EPI eGFRcr-CysC AUC: 0.985). Sonuç: Yeni formülün, özellikle daha yüksek kronik böbrek hastalığı seviyelerinde eGFR değerlerini öngörme yeteneği bakımından diğer denklemlerden üstün olduğu doğrulanmamıştır. Mevcut denklemler karşılaştırıldığında 2012 CKD-EPI eGFRCysC daha yüksek özgüllüğe ve duyarlılığa sahipti. Her iki kan testini içeren birleşik formüller, sadece kreatinin içeren denklemlerden daha yüksek tanısal değerlerine sahipti. Sonuçlarımız, böbrek fonksiyon taramasında daha iyi tahmin için hangi denklemlerin kullanılacağı konusunda bilgi vermede yardımcı olabilir.

Anahtar Kelimeler:

Glomerular filtrasyon hızı, Ckd-Epi, kronik böbrek hastalığı, sistatin C, kreatinin

New analysis of the comparative diagnostic performances of five different eGFR equations: The revised 2021 CKD-EPI eGFR, and the four older equations

Purpose: In 2021, the CKD-EPI-creatinine and CKD-EPI-creatinine-cystatin-C combined equations were revised again by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and the National Institute of Diabetes & Digestive and Kidney Diseases (NIDDK) and it was reported that its accuracy was increased. The main object of this study is to compare the diagnostic accuracy and performance of 2009 CKD-EPI eGFRcr, 2012 CKD-EPI eGFRCysC, 2012 CKD-EPI eGFRcr-CysC, MDRD, and revised 2021 CKD-EPI to provide a better estimation. Materials and Methods: The study design was prospective. The sample consisted of 111 CKD patients and 35 healthy individuals who applied to the nephrology clinic. All participants were evaluated by a nephrologist. The participants were divided into study groups according to their KDIGO classification. Five variables were used: age, race, gender, serum creatinine, and serum cystatin-C. Results: 2012 CKD-EPI eGFR cystatin-C out performed existing equations in terms of accuracy, specificity, and sensitivity (AUC:0.988). Furthermore, when both creatinine and cystatin-C are included in an equation, it consistently improves diagnostic values over formulas containing only creatinine (2009CKD-EPI eGFRcr AUC:0.953, 2012CKD-EPI eGFRcr-CysC AUC: 0.985, 2021CKD-EPI eGFRcr AUC:0.954, MDRD AUC: 0.953, 2021CKD-EPI eGFRcr-CysC AUC: 0.985). Conclusion: The new formula has not been confirmed to be superior to other equations in its ability to estimate eGFR values, particularly at higher levels of chronic kidney disease. When compared with existing equations, 2012 CKD-EPI eGFRCysC had higher specificity and sensitivity. Combined formulas containing both blood tests had higher diagnostic values than equations containing only creatinine. Our results can help inform which equations to use for better estimation in renal function screening.

Keywords:

eGFR, renal disease, cystatin C, creatinine Glomerular filtrasyon hızı, Ckd-Epi, kronik böbrek hastalığı, sistatin C, kreatinin,

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