Abstract: Objective　To evaluate the consistency between three chronic kidney disease epidemiology collaboration（CKD-EPI）equations and modified modification of diet in renal disease（MDRD）equation for estimated glomerular filtration rate（eGFR）.Methods　From December 2014 to October 2015，178 adult patients with type 2 diabetes mellitus admitted to Department of Endocrinology，Chengdu Military General Hospital were recruited.The eGFR was calculated using CKD-EPI2009Scr，CKD-EPI2012Cys-C，CKD-EPI2012Scr-Cys-C and modified MDRD equations，respectively.Consistency between the three CKD-EPI and modified MDRD equations was evaluated.Chronic kidney disease（CKD）was staged according to eGFR calculated using modified MDRD equation.The differences were compared among CKD-EPI2009Scr，CKD-EPI2012Cys-C，CKD-EPI2012Scr-Cys-C and modified MDRD equations.Diabetic kidney disease was defined as eGFR less than 60 ml·min-1·（1.73 m2）-1，calculated using modified MDRD equation.The cut points of CKD-EPI2009Scr，CKD-EPI2012Cys-C and CKD-EPI2012Scr-Cys-C for diagnosing diabetic kidney disease were evaluated by receiver operating characteristic（ROC）curve.Results　The eGFR calculated using CKD-EPI2009Scr，CKD-EPI2012Cys-C，CKD-EPI2012Scr-Cys-C and modified MDRD equations were（88±29）ml·min-1·（1.73 m2）-1，（85±33）ml·min-1·（1.73 m2）-1，（88±32）ml·min-1·（1.73 m2）-1and （112±49）ml·min-1·（1.73 m2）-1，respectively.There were statitically significant difference between the eGFR calculated using CKD-EPI2009Scr，CKD-EPI2012Cys-C and CKD-EPI2012Scr-Cys-C and modified MDRD equations（t=5.564，5.945，5.267，P<0.001）.Bland-Altman plots illustrated the eGFR calculated by the three CKD-EPI equations had poor agreement with modified MDRD equation.The difference between modified MDRD and three CKD-EPI equations in calculating eGFR reduced with elevating serum creatine（Scr）（R2=0.239，0.186，0.195）.There were statistically significant difference among eGFR calculated by the 4 equations in CKD stage 1 and stage 2（P<0.05）.The eGFR determined by modified MDRD equation was higher than the three CKD-EPI equations，respetively（P<0.05）.There were no statistically significant difference among eGFR calculated by the 4 equations in CKD stage 3，stage 4 and stage 5（P>0.05）.Diagnostic cut points of CKD-EPI2009Scr，CKD-EPI2012Cys-C，CKD-EPI2012Scr-Cys-C were 61，65，61 ml·min-1·（1.73 m2）-1.Area under ROC curve were 0.992，0.937 and 0.977，respectively.Conclusion　The three CKD-EPI equations are found to underestimate eGFR when compared with modified MDRD equation.The difference between modified MDRD and CKD-EPI equations decreased with elevated Scr.More diabetic kidney disease is diagnosed by eGFR calculated using CKD-EPI equations than modified MDRD equation.

Key words: Diabetic nephropathies, Glomerular filtration rate, CKD-EPI equation, Modified MDRD equation

摘要： 目的　评价3种慢性肾脏病流行病学合作组（CKD-EPI）公式和改良MDRD公式计算估算肾小球滤过率（eGFR）的一致性。方法　选取2014年12月—2015年10月在中国人民解放军成都军区总医院内分泌科住院的178例2型糖尿病患者，分别采用CKD-EPI2009Scr、CKD-EPI2012Cys-C、CKD-EPI2012Scr-Cys-C公式和改良MDRD公式计算eGFR，评估3种CKD-EPI公式与改良MDRD公式计算eGFR的一致性。采用改良MDRD公式计算的eGFR进行慢性肾脏病（CKD）分期，比较CKD 1～5期CKD-EPI2009Scr、CKD-EPI2012Cys-C、CKD-EPI2012Scr-Cys-C公式和改良MDRD公式的差异。以改良MDRD公式eGFR<60 ml·min-1·（1.73 m2）-1诊断糖尿病肾病，利用受试者工作特征（ROC）曲线评估3种CKD-EPI公式诊断糖尿病肾病的eGFR截点。结果　4种公式计算的eGFR分别为：CKD-EPI2009Scr公式为（88±29）ml·min-1·（1.73 m2）-1，CKD-EPI2012Cys-C公式为（85±33）ml·min-1·（1.73 m2）-1，CKD-EPI2012Scr-Cys-C公式为（88±32）ml·min-1·（1.73 m2）-1，改良MDRD公式为（112±49）ml·min-1·（1.73 m2）-1。改良MDRD公式计算的eGFR分别与3种CKD-EPI公式计算的eGFR比较，差异均有统计学意义（t=5.564、5.945、5.267，P<0.001）。改良MDRD公式与CKD-EPI公式计算的eGFR的Bland-Altman分析图显示CKD-EPI公式与改良MDRD公式计算的eGFR一致性欠佳。改良MDRD公式分别与3种CKD-EPI公式计算的eGFR的差值随血肌酐（Scr）水平的升高逐渐缩小（R2=0.239、0.186、0.195）。CKD 1期和CKD 2期4种公式计算的eGFR比较，差异均有统计学意义（P<0.001）；其中改良MDRD公式计算的eGFR均分别高于3种CKD-EPI公式（P<0.05）。CKD 3期、CKD 4期和CKD 5期4种公式计算的eGFR比较，差异均无统计学意义（P>0.05）。CKD-EPI2009Scr、CKD-EPI2012Cys-C、CKD-EPI2012Scr-Cys-C公式诊断糖尿病肾病的eGFR截点分别为61、65、61 ml·min-1·（1.73 m2）-1，ROC曲线下面积分别为0.992、0.937、0.977。结论　与改良MDRD公式相比，3种CKD-EPI公式会造成eGFR的低估，但是随着Scr水平的升高，二者之间的差异逐渐缩小。利用CKD-EPI公式计算eGFR可能会获得更高的糖尿病肾病诊断率。

关键词: 糖尿病肾病, 肾小球滤过率, CKD-EPI公式, 改良MDRD公式