La ecuación CKD-EPI es la más fiable para estimar la función renal en pacientes con lupus eritematoso sistémico

Martínez-Martínez, Marco U.; Martínez-Martínez, Marco Ulises; Mandeville, Peter; Llamazares-Azuara, Lilia; Llamazares-Azuara, Lilia; Abud-Mendoza, Carlos

doi:10.3265/Nefrologia.pre2012.Jun.11101

Article information

Antecedentes: Ningún estudio ha podido determinar cuál es la mejor ecuación para calcular la función renal en pacientes con lupus eritematoso sistémico (LES) partiendo del análisis de una evaluación de referencia. Objetivo: Evaluar el rendimiento de las ecuaciones basadas en cistatina/creatinina en la estimación de la función renal en pacientes con LES. Métodos: Realizamos el estudio en dos fases: la primera incluía 14 pacientes en los que el aclaramiento de yotalamato se utilizó para determinar la tasa de filtración glomerular (FG) y se comparó con diferentes ecuaciones basadas en cistatina C y/o creatinina En la segunda fase, utilizamos la mejor ecuación (basada en cistatina y creatinina) como «estándar de referencia» para comparar 5 ecuaciones basadas en creatinina en 55 pacientes con LES. Resultados: En la primera fase, la ecuación desarrollada por Stevens et al. (basada en creatinina y cistatina C) fue considerada la mejor. En la fase dos, la ecuación CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) fue considerada la mejor con una desviación de –2,1 ml/min/1,73, exactitud (P30 %) del 94,5 % y precisión (rango intercuartílico de las diferencias ) de –2,1 ml/min/1,73. Conclusiones: Nuestros datos sugieren que la ecuación CKD-EPI es la mejor ecuación basada en creatinina para estimar la FG en pacientes con LES.

Palabras clave:

Ecuaciones de estimación del filtrado glomerular

Palabras clave:

Lupus eritematoso sistémico

Palabras clave:

Tasa de filtración glomerular

Background: No study has determined the best equation for estimating renal function in patients with systemic lupus erythematosus (SLE), starting from a gold standard test. Objective: To evaluate the performance of cistatin/creatinine based equations for estimating renal function in patients with SLE. Methods: We conducted two phases: the first phase included 14 patients in which iothalamate clearance was used to determine the glomerular filtration rate (GFR) and compared with different equations based on cystatin C and/or creatinine. In the second phase, we used the best equation (a cystatin and creatinine-based equation) as “reference standard” to compare 5 creatinine-based equations in 55 patients with SLE. Results: In the first phase the equation developed by Stevens and colleagues (based on creatinine and cystatin C), was the best equation. In phase 2, the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation was the best equation with bias of -2.1ml/min/1.73, accuracy (P30) of 94.5% and precision (interquartile range of differences) of -2.1 ml/min/1.73. Conclusions: Our data suggest that CKD-EPI is the best creatinine-based equation to estimate GFR in patients with SLE.

Keywords:

Equations

Keywords:

Systemic erythematosus lupus

Keywords:

Glomerular filtration rate

Full text is only aviable in PDF

Bibliografía

[1]

Rahman A. Management of cardiovascular risk factors in patients with systemic lupus erythematosus. Acta Reumatol Port 2008;33(1):13-5. [Pubmed]

[2]

Manjunath G, Sarnak MJ, Levey AS. Prediction equations to estimate glomerular filtration rate: an update. Curr Opin Nephrol Hypertens 2001;10(6):785-92. [Pubmed]

[3]

Fawaz A, Badr KF. Measuring filtration function in clinical practice. Curr Opin Nephrol Hypertens 2006;15(6):643-7. [Pubmed]

[4]

Coresh J, Stevens LA. Kidney function estimating equations: where do we stand? Curr Opin Nephrol Hypertens 2006;15(3):276-84. [Pubmed]

[5]

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150(9):604-12. [Pubmed]

[6]

K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1-266. [Pubmed]

[7]

Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139(2):137-47. [Pubmed]

[8]

Gordon C, Jayne D, Pusey C, Adu D, Amoura Z, Aringer M, et al. European consensus statement on the terminology used in the management of lupus glomerulonephritis. Lupus 2009;18(3):257-63. [Pubmed]

[9]

Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function--measured and estimated glomerular filtration rate. N Engl J Med 2006;354(23):2473-83. [Pubmed]

[10]

Stevens LA, Manzi J, Levey AS, Chen J, Deysher AE, Greene T. et al. Impact of creatinine calibration on performance of GFR estimating equations in a pooled individual patient database. Am J Kidney Dis 2007;50(1):21-35. [Pubmed]

[11]

Stevens LA, Coresh J, Schmid CH, Feldman HI, Froissart M, Kusek J, et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis 2008;51(3):395-406. [Pubmed]

[12]

Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16(1):31-41. [Pubmed]

[13]

Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med 2008;358(9):929-39. [Pubmed]

[14]

Bravo Ramírez A, Martínez-Martínez MU, Hurtado Torres GF, Abud-Mendoza C. Bioelectrical impedance vector analysis in an adult female Mexican population with systemic lupus erythematosus Nutr Clin Pract 2011;26(1):Abstract N17.

[15]

Martinez-Martinez MU, Borjas-Garcia JA, Magana-Aquino M, Cuevas-Orta E, Llamazares-Azuara L, Abud-Mendoza C. Renal function assessment in patients with systemic lupus erythematosus. Rheumatol Int 2012;32(8):2293-9. [Pubmed]

[16]

Kasitanon N, Fine DM, Haas M, Magder LS, Petri M. Estimating renal function in lupus nephritis: comparison of the Modification of Diet in Renal Disease and Cockcroft Gault equations. Lupus 2007;16(11):887-95. [Pubmed]

[17]

Leung YY, Lo KM, Tam LS, Szeto CC, Li EK, Kun EW. Estimation of glomerular filtration rate in patients with systemic lupus erythematosus. Lupus 2006;15(5):276-81. [Pubmed]

[18]

Martínez-Martínez MU, Abud-Mendoza C. Economic impact of estimating renal function in patients with systemic lupus erythematosus. Nefrologia 2012;32(1):122-3. [Pubmed]

[19]

Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982;25(11):1271-7. [Pubmed]

[20]

Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997;40(9):1725. [Pubmed]

[21]

Uribe AG, Vila LM, McGwin G, Jr., Sanchez ML, Reveille JD, Alarcon GS. The Systemic Lupus Activity Measure-revised, the Mexican Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and a modified SLEDAI-2K are adequate instruments to measure disease activity in systemic lupus erythematosus. J Rheumatol 2004;31(10):1934-40. [Pubmed]

[22]

Robinson JD, Lupkiewicz SM, Palenik L, Lopez LM, Ariet M. Determination of ideal body weight for drug dosage calculations. Am J Hosp Pharm 1983;40(6):1016-9. [Pubmed]

[23]

Verbraecken J, Van de Heyning P, De Backer W, Van Gaal L. Body surface area in normal-weight, overweight, and obese adults. A comparison study. Metabolism 2006;55(4):515-24. [Pubmed]

[24]

Rule AD, Bergstralh EJ, Slezak JM, Bergert J, Larson TS. Glomerular filtration rate estimated by cystatin C among different clinical presentations. Kidney Int 2006;69(2):399-405. [Pubmed]

[25]

Macisaac RJ, Tsalamandris C, Thomas MC, Premaratne E, Panagiotopoulos S, Smith TJ, et al. Estimating glomerular filtration rate in diabetes: a comparison of cystatin-C- and creatinine-based methods. Diabetologia 2006;49(7):1686-9. [Pubmed]

[26]

Larsson A, Malm J, Grubb A, Hansson LO. Calculation of glomerular filtration rate expressed in mL/min from plasma cystatin C values in mg/L. Scand J Clin Lab Invest 2004;64(1):25-30.

[27]

Ma YC, Zuo L, Chen JH, Luo Q, Yu XQ, Li Y, et al. Improved GFR estimation by combined creatinine and cystatin C measurements. Kidney Int 2007;72(12):1535-42. [Pubmed]

[28]

Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 2004;141(12):929-37. [Pubmed]

[29]

Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, et al. Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007;53(4):766-72. [Pubmed]

[30]

Wilson DM, Bergert JH, Larson TS, Liedtke RR. GFR determined by nonradiolabeled iothalamate using capillary electrophoresis. Am J Kidney Dis 1997;30(5):646-52. [Pubmed]

[31]

Caravaca F. [Cystatin C: yes, but...]. Nefrologia 2006;26(4):421-5. [Pubmed]

[32]

Martínez-Martínez MU, Abud-Mendoza C. Serum cystatin C as a marker of renal function in patients with systemic lupus erythematosus. Reumatol Clin 2012;8(3):158-9. [Pubmed]

[33]

Mak A, Mok CC, Chu WP, To CH, Wong SN, Au TC. Renal damage in systemic lupus erythematosus: a comparative analysis of different age groups. Lupus 2007;16(1):28-34. [Pubmed]

[34]

Mak SK, Lo KY, Lo MW, Chan SF, Tong GM, Wong PN, et al. Efficacy of enteric-coated mycophenolate sodium in patients with active lupus nephritis. Nephrology (Carlton) 2008;13(4):331-6.

[35]

F L, Y T, X P, L W, H W, Z S, et al. A prospective multicentre study of mycophenolate mofetil combined with prednisolone as induction therapy in 213 patients with active lupus nephritis. Lupus 2008;17(7):622-9. [Pubmed]

Indexed in:

Follow us:

Indexed in:

Follow us:

Subscribe to our newsletter