期刊
AMERICAN JOURNAL OF KIDNEY DISEASES
卷 39, 期 5, 页码 920-929出版社
W B SAUNDERS CO
DOI: 10.1053/ajkd.2002.32765
关键词
glomerular filtration rate (GFR); prediction equations; serum creatinine
资金
- NCRR NIH HHS [RR00722] Funding Source: Medline
- NHLBI NIH HHS [T32HL7024] Funding Source: Medline
- NIDDK NIH HHS [DK48362, UO1 DK35073, R01 DK53869] Funding Source: Medline
Equations using serum creatinine level, age, sex, and other patient characteristics often are used to estimate glomerular filtration rate (GFR) in both clinical practice and research studies. However, the critical dependence of these equations on serum creatinine assay calibration often is overlooked, and the reproducibility of estimated GFR is rarely discussed. We address these issues in frozen samples from 212 Modification of Diet in Renal Disease (MDRD) study participants and 342 Third National Health and Nutrition Examination Survey (NHANES 111) participants assayed for serum creatinine level a second time during November 2000. Variation in serum creatinine level was assessed in 1,919 NHANES III participants who had serum creatinine measured on two visits a median of 17 days apart. Linear regression was used to compare estimates. Calibration of serum creatinine varied substantially across laboratories and time. Data indicate that serum creatinine assays on the same samples were 0.23 mg/dL higher in the NHANES III than MDRD study. Data from the College of American Pathologists suggest that a difference of this magnitude across laboratories is not unusual. Conversely, serum creatinine assays an average of 2 weeks apart have better precision (SD of percentage of difference in estimated GFR, 15%; 90% of estimates within 21%). Errors in calibration make little difference in estimating severely decreased GFR (<30 mL/min/1.73 m(2)), but result in progressively larger differences at higher GFRs. Both clinical and research use of serum creatinine or equations to estimate GFR require knowledge of the calibration of the serum creatinine assay. (C) 2002 by the National Kidney Foundation, Inc.
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