Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Evaluation of Various Formulae for Glomerular Filtration Rate Estimation and Proposal of New Formulae for the Korean Population

  • Cho, Chi-Hyun (Department of Laboratory Medicine, Korea University College of Medicine) ;
  • Roh, Kyoung-Ho (Department of Laboratory Medicine, Korea University College of Medicine) ;
  • Nam, Myung-Hyun (Department of Laboratory Medicine, Korea University College of Medicine) ;
  • Kim, Jang-Su (Department of Laboratory Medicine, Korea University College of Medicine) ;
  • Lim, Chae-Seung (Department of Laboratory Medicine, Korea University College of Medicine) ;
  • Lee, Chang-Kyu (Department of Laboratory Medicine, Korea University College of Medicine) ;
  • Lee, Kap-No (Department of Laboratory Medicine, Korea University College of Medicine) ;
  • Kim, Young-Kee (Department of Laboratory Medicine, Korea University College of Medicine)
  • Received : 2010.03.02
  • Accepted : 2010.11.09
  • Published : 2010.12.01
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Abstract

Background : Some researchers have questioned the necessity of adjusting glomerular filtration rate (GFR) by body surface area (BSA). We compared the relationship between estimated GFR (eGFR) and radionuclide GFR (rGFR) with or without BSA adjustment by comparing the results obtained using various formulae with those obtained using 2 new proposed formulae. Methods : A retrospective study was performed using 204 Korean individuals whose GFR had been estimated by the $^{99m}Tc$-diethylenetriaminepentaacetic acid method between March 2004 and July 2008. We used the modification of diet in renal disease (MDRD) II formula, Mayo clinic quadratic (MCQ) formula, Cockcroft-Gault (CG) formula, and lean body mass-adjusted CG formula. Two new formulae, skeletal muscle mass index (SMI)-adjusted CG formula and $SMI{\times}3.4$/SCr, were proposed by us. We analyzed each parameter with Pearson's correlation coefficient and also obtained the bias values. Results : BSA did not satisfy the fundamental prerequisites of an adjustment factor for rGFR. MDRD II and MCQ GFR estimates demonstrated higher Pearson's correlation coefficient with BSA-unadjusted rGFR than they did with BSA-adjusted rGFR. The other GFR formulae estimates showed better correlation with rGFR and more favorable bias (P<0.001) when both GFR estimates and rGFR values were BSA-unadjusted. SMI-adjusted CG and $SMI{\times}3.4$/SCr GFR estimates demonstrated correlation with rGFR and bias values similar to those of the MDRD II and CG GFR estimates. Conclusions : We suggest that absolute, non-corrected GFR and GFR estimate be preferred in daily practice. The absolute, non-corrected GFR and GFR estimate are considered helpful for patients with eGFR${\leq}$60 mL/min/1.73 $m^2$. We also recommend the clinical use of the new formulae, SMIadjusted CG and $SMI{\times}3.4$/SCr (BSA-unadjusted).

배경 : 신사구체 여과율(glomerular filtration rate, GFR) 측정법 및 GFR 추정 공식을 체표면적(body suface area)으로 보정하는 방식이 임상에서 흔히 이용되고 있으나 이에 대한 타당성에는 논란이 있다. 저자들은 한국인에서 체표면적 보정의 타당성을 평가한 후 체표면적 보정 없는 GFR 추정치로 체표면적 보정없는 rGFR을 추정하는 방법과, 체표면적 보정한 GFR 추정치로 체표면적 보정한 rGFR을 추정하는 방법을 비교 평가하고자 하였다. 이와 함께 저자들이 도출한 새 공식도 평가하고자 하였다. 방법 : $^{99m}Tc$-DTPA GFR 검사 및 크레아티닌 검사를 동일한 날 시행한, 체질량 지수 30 kg/$m^2$ 미만의 성인 204명을 대상으로 다음 방법으로 GFR을 평가하였다. GFR 추정치(mL/min/1.73 $m^2$)는 modification of diet in renal disease (MDRD II), Mayo clinic quadratic (MCQ), Cockcroft-Gault (CG), 제지방 체중으로 치환된 CG 및 저자들이 도출한 새로운 식 skeletal muscle mass index (SMI) adjusted CG와 $SMI{\times}3.4$/SCr 공식을 이용한 일곱 가지로 계산하였다. 체표면적 보정 유무에 따라, rGFR 추정 방법의 우수성을 평가하기 위해 상관성과(rGFR-GFR 추정값)의 평균인 오차를 비교하였다. 결과 : 체표면적은 보정인자로서 조건에 합당하지 않았다. MDRD II, MCQ GFR 추정치는 체표면적 보정한 rGFR에 비해 체표면적 보정 없는 rGFR과 상관성이 더 높았다. 다른 공식들에 대해서, 오차는 체표면적으로 보정하지 않았을 때, 체표면적으로 보정한 경우와 비교해 유사하거나 우수하였고(P<0.001), rGFR에 대한 상관성은 체표면적으로 보정하지 않았을 때 증가하였다. SMI-adjusted CG, $SMI{\times}3.4$/SCr GFR 추정치가 MDRD II, CG GFR 추정치와 유사한 rGFR과의 상관성, 오차를 나타냈으며(P<0.05), 특히 SMI-adjusted CG 공식은 GFR이 정상에 가까운 경우 rGFR과 높은 상관성을 나타냈다. 결론 : 체표면적 보정 없는 GFR 추정치로 체표면적 보정 없는 rGFR을 추정하는 것이 체표면적 보정한 방법에 비해 유용하리라 사료되었다. 체표면적 보정하지 않는, rGFR이나 GFR 추정치는 eGFR이 60 미만인 환자들에서 특히 유용할 것이다. SMI-adjusted CG, $SMI{\times}3.4$/SCr 공식이 MDRD II, CG 공식과 유사한 상관성, 오차를 보였으며 임상에서 사용할 수 있는, 새로운 공식으로 제안하는 바이다.

Keywords

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