Abstract：
BACKGROUND: Renal dysfunction is a common complication after heart transplantation (Htx). Glomerular filtration rate (GFR) can be assessed by various estimating equations (eGFR). We evaluated the correlation, agreement, and accuracy between eGFR and mGFR and the ability of eGFR to track changes in mGFR early after Htx.
METHODS: A single-center prospective observational study on 55 patients undergoing Htx. Serum creatinine and mGFR (plasma clearance of Cr51-EDTA or iohexol) were measured preoperatively and on the fourth postoperative day. The accuracy of eGFR to predict true mGFR was calculated as the percentage of patients with an eGFR within 30% of mGFR (P30). The agreement between eGFR and mGFR was assessed according to Bland and Altman. A four-quadrant plot was made to evaluate the ability of eGFR to track changes in mGFR.
RESULTS: The accuracy of eGFR to assess mGFR was 52%. The bias was 11.2 ± 17.4 mL/min/1.72 m2. The limits of agreement were -23.0 to 45.4 mL/min/1.72 m2 and the error 58%. The concordance rate between eGFR and mGFR was 72%.
CONCLUSIONS: eGFR underestimated mGFR and the agreement between eGFR and mGFR was low with an unacceptably large between-group error and low accuracy. Furthermore, the ability of eGFR to assess changes in mGFR, postoperatively, was poor. Thus, the use of estimating equations from serum creatinine will not adequately assess renal function early after major heart surgery. To gain adequate information on renal function early after Htx, GFR needs to be measured, not estimated.
METHODS: A single-center prospective observational study on 55 patients undergoing Htx. Serum creatinine and mGFR (plasma clearance of Cr51-EDTA or iohexol) were measured preoperatively and on the fourth postoperative day. The accuracy of eGFR to predict true mGFR was calculated as the percentage of patients with an eGFR within 30% of mGFR (P30). The agreement between eGFR and mGFR was assessed according to Bland and Altman. A four-quadrant plot was made to evaluate the ability of eGFR to track changes in mGFR.
RESULTS: The accuracy of eGFR to assess mGFR was 52%. The bias was 11.2 ± 17.4 mL/min/1.72 m2. The limits of agreement were -23.0 to 45.4 mL/min/1.72 m2 and the error 58%. The concordance rate between eGFR and mGFR was 72%.
CONCLUSIONS: eGFR underestimated mGFR and the agreement between eGFR and mGFR was low with an unacceptably large between-group error and low accuracy. Furthermore, the ability of eGFR to assess changes in mGFR, postoperatively, was poor. Thus, the use of estimating equations from serum creatinine will not adequately assess renal function early after major heart surgery. To gain adequate information on renal function early after Htx, GFR needs to be measured, not estimated.
摘要：
背景：肾功能障碍是心脏移植（Htx）后的常见并发症。肾小球滤过率(GFR)可以通过各种估计方程(eGFR)来评估。我们评估了相关性，协议,eGFR和mGFR之间的准确性以及eGFR在Htx后早期跟踪mGFR变化的能力。
方法：对55例接受Htx的患者进行单中心前瞻性观察研究。术前和术后第4天测量血清肌酐和mGFR（Cr51-EDTA或碘海醇的血浆清除率）。eGFR预测真实mGFR的准确性计算为eGFR在mGFR（P30）的30％以内的患者的百分比。根据Bland和Altman评估eGFR和mGFR之间的一致性。制作四象限图以评估eGFR跟踪mGFR变化的能力。
结果：eGFR评估mGFR的准确度为52%。偏差为11.2±17.4mL/min/1.72m2。一致的界限为-23.0至45.4mL/min/1.72m2,误差为58%。eGFR与mGFR的一致率为72%。
结论：eGFR低估了mGFR，eGFR和mGFR之间的一致性很低，具有不可接受的大组间误差和低准确性。此外，eGFR评估mGFR变化的能力，术后,很穷。因此，使用血清肌酐估算方程不能充分评估心脏大手术后早期的肾功能.为了在Htx术后早期获得足够的肾功能信息，需要测量GFR,没有估计。
方法：对55例接受Htx的患者进行单中心前瞻性观察研究。术前和术后第4天测量血清肌酐和mGFR（Cr51-EDTA或碘海醇的血浆清除率）。eGFR预测真实mGFR的准确性计算为eGFR在mGFR（P30）的30％以内的患者的百分比。根据Bland和Altman评估eGFR和mGFR之间的一致性。制作四象限图以评估eGFR跟踪mGFR变化的能力。
结果：eGFR评估mGFR的准确度为52%。偏差为11.2±17.4mL/min/1.72m2。一致的界限为-23.0至45.4mL/min/1.72m2,误差为58%。eGFR与mGFR的一致率为72%。
结论：eGFR低估了mGFR，eGFR和mGFR之间的一致性很低，具有不可接受的大组间误差和低准确性。此外，eGFR评估mGFR变化的能力，术后,很穷。因此，使用血清肌酐估算方程不能充分评估心脏大手术后早期的肾功能.为了在Htx术后早期获得足够的肾功能信息，需要测量GFR,没有估计。
