| Summary: | 碩士 === 高雄醫學大學 === 醫學研究所 === 100 === Background: Chronic kidney disease (CKD) has been considered as a global public health problem in the world. The definition of CKD is based on criteria of proteinuria and level of glomerular filtration rate (GFR). Simplified MDRD equation for estimating GFR is most commonly used in clinics. It is not guaranteed that applying the equation to Taiwanese would not result in bias for GFR. Therefore, Taiwanese MDRD equation and Taiwan-intercept equation had been proved more accurate estimation for GFR. However, the performance of predicting risk through estimated GFR (eGFR) by using these equations was not well evaluated. The aim of the study is to compare the performance of models to predict adverse outcomes (cardiovascular disease hospitalization, dialysis and mortality) in different eGFR that were calculated by various equations.
Materials and methods: Patients, who had CKD and joined an integrated care program from Dec. 2002 through May. 2008 in one medical center, southern Taiwan, were included to this study. We used simplified MDRD equation, CKD-EPI equation, Taiwanese MDRD equation and Taiwan-intercept equation to estimate various GFR at baseline. We followed up occurrence of cardiovascular diseases hospitalization, dialysis, and mortality to 2008. Cox proportion hazard model was used to estimate the risk of adverse outcomes. We used the statistical value regarding goodness of fit, calibration, and reclassification of models to identify the performance of risk prediction. All statistical analyses were performed by SPSS 19.0 and p<0.005 is considered as statistically significant.
Results: Totally, 2,181 patients were included into the study. After excluding the patients joining the integrated care program less than 3 months (n=454), 1,727 patients were followed up regularly. In general, eGFR that were calculated by CKD-EPI equation, Taiwanese MDRD equation and Taiwan-intercept equation respectively provide significant worse risk perdition for dialysis than eGFR that was calculated by simplified MDRD equation. On the contrast, eGFR that was calculated by CKD-EPI equation has significant better reclassification of risk perdition for mortality than simplified MDRD equation. Furthermore, in elderly, female, and diabetes mellitus groups, the eGFR that were calculated by Taiwanese MDRD equation and Taiwan-intercept equation had significant better performance of risk predictions for dialysis than simplified MDRD equation.
Conclusion: Taiwanese MDRD equation and Taiwan-intercept equation provide a better risk predicting models for dialysis in old age, female, and diabetes mellitus groups. Our findings need more large-scale studies to further confirm.
|
|---|
