■在患有急性或慢性疾病的人群中,基于肌酐的GFR估计(eGFRcr)方程可能不准确。在这些人群中,使用胱抑素C(eGFRcys)或肌酐-胱抑素C(eGFRcr-cys)的GFR方程的准确性没有得到很好的研究。
■对从PubMed和专家来源确定的原始文章进行系统审查。两名审稿人独立筛选了文章,并确定了符合纳入标准的文章。
■患有急性或慢性疾病的成人和儿童。
■自2011年以来发表的比较eGFR表现的研究,eGFRcys,和eGFRcr-cys相对于测量的GFR(mGFR),使用肌酐或胱抑素C的标准化测定法,并使用使用此类测定开发的eGFR方程。非卧床临床人群的研究或只有CKD的人群的研究,肾移植受者,只有糖尿病,肾脏捐赠者候选人,以社区为基础的队列被排除在外.
■摘自全文的数据。
■评估了eGFR的mGFR(P30)与mGFR相比的30%以内的估计值的偏差和百分比。
■在179篇引文中,26项研究符合纳入标准:在癌症临床人群中,成人24项,儿童2项(n=5),HIV(n=5),肝硬化(n=3),肝移植(n=3),心力衰竭(n=2),神经肌肉疾病(n=1)危重病(n=5),和肥胖(n=2)。总的来说,在癌症研究人群中,eGFRcr-cys的准确性高于eGFRcr或eGFRcys方程,艾滋病毒,肥胖,但在肝硬化中并没有表现得更好,肝移植,心力衰竭,神经肌肉疾病,和危重的疾病。
■选择参与者是因为担心eGFR不准确,这可能会使结果产生偏差。大多数研究的样本量都很小,限制了泛化性。
■eGFRcr-cys改善了患有各种急性和慢性疾病的人群的GFR估计,为胱抑素C测量提供指征。在许多研究中表现不佳,提示需要更频繁的mGFR。
■肾功能,特别是肾小球滤过率(GFR),在急性和慢性疾病患者中,使用肌酐(eGFRcr)进行估计通常不准确.在这些人群中,单独使用胱抑素C(eGFRcys)或与肌酐(eGFRcr-cys)一起使用的估计值的准确性没有得到很好的研究。我们进行了系统的审查,以解决知识差距。在审查的179篇论文中,我们确定了26项研究,这些研究涉及以下临床人群:癌症(n=5);HIV(n=5);肝硬化(n=3);肝移植(n=3);心力衰竭(n=2);神经肌肉疾病(n=1);危重症(n=5);肥胖(n=2).总的来说,eGFRcr-cys改善了HIV的GFR估计,癌症,肥胖,为胱抑素C测量提供指征。在许多研究中表现不佳,提示需要更频繁地测量GFR。
UNASSIGNED: Creatinine-based GFR estimating (eGFRcr) equations may be inaccurate in populations with acute or chronic illness. The accuracy of GFR equations that use cystatin C (eGFRcys) or creatinine-cystatin C (eGFRcr-cys) is not well studied in these populations.
UNASSIGNED: A systematic
review of original articles identified from PubMed and expert sources. Two reviewers screened articles independently and identified those meeting inclusion criteria.
UNASSIGNED: Adults and children with acute or chronic illness.
UNASSIGNED: Studies published since 2011 that compared performance of eGFRcr, eGFRcys, and eGFRcr-cys relative to measured GFR (mGFR), used standardized assays for creatinine or cystatin C, and used eGFR equations developed using such assays. Studies of ambulatory clinical populations or research studies in populations with only CKD, kidney transplant recipients, only diabetes, kidney donor candidates, and community-based cohorts were excluded.
UNASSIGNED: Data extracted from full text.
UNASSIGNED: Bias and percentages of estimates within 30% of mGFR (P30) of eGFR compared with mGFR were evaluated.
UNASSIGNED: Of the 179 citations, 26 studies met the inclusion criteria: 24 in adults and 2 in children in clinical populations with cancer (n=5), HIV (n=5), cirrhosis (n=3), liver transplant (n=3), heart failure (n=2), neuromuscular diseases (n=1) critical illness (n=5), and obesity (n=2). In general, eGFRcr-cys had greater accuracy than eGFRcr or eGFRcys equations among study populations with cancer, HIV, and obesity, but did not perform consistently better in cirrhosis, liver transplant, heart failure, neuromuscular disease, and critical illness.
UNASSIGNED: Participants were selected because of concern for inaccurate eGFRcr, which may bias results. Most studies had small sample sizes, limiting generalizability.
UNASSIGNED: eGFRcr-cys improves GFR estimation in populations with a variety of acute and chronic illnesses, providing indications for cystatin C measurement. Performance was poor in many studies, suggesting the need for more frequent mGFR.
UNASSIGNED: Kidney function, specifically glomerular filtration rate (GFR), estimated using creatinine (eGFRcr) is often inaccurate in people with acute and chronic illness. The accuracy of estimates using cystatin C alone (eGFRcys) or together with creatinine (eGFRcr-cys) is not well studied in these populations. We conducted a systematic
review to address the knowledge gap. Of the 179 papers reviewed, we identified 26 studies in clinical populations with cancer (n=5); HIV (n=5); cirrhosis (n=3); liver transplant (n=3); heart failure (n=2); neuromuscular disease (n=1); critical illness (n=5); and obesity (n=2). In general, eGFRcr-cys improved the GFR estimation in HIV, cancer, and obesity, providing indications for cystatin C measurement. Performance was poor in many studies, suggesting the need for more frequent measured GFR.