입원환자에 대한 사구체 여과율 예측식의 비교 (Comparison of GFR prediction equations For Korean hospitalized patients)

서지정보

· 발행기관 : 한국병원약사회
· 수록지 정보 : 병원약사회지 / 26권 / 1호 / 55 ~ 65페이지
· 저자명 : 이선영, 최경숙, 이은숙, 신완균, 진호준

초록

Accurate estimation of the glomerular filtration rate (GFR) is crucial for therapeutic interventions, especially in guiding the dose adjustment of the medication for patients diagnosed with renal insufficiency. Various methods such as Cockcroft-gault (CG), Modification of Diet in Renal Disease (MDRD) and Sanaka equation are widely used to estimate GFR, especially MDRD is the most frequently used method. However, the accuracy would be affected by race, age and diseases the patients have and CG or MDRD are limited to apply for Asian. The objective of the study is to find the appropriate renal function prediction factor in the dose adjustment of the medication through comparing the performance of the CG, MDRD and Sanaka methods based on creatinine clearance measured with 24hr urine collection. 1186 patients who had their creatinine clearance measured by 24hr urine collection from 1 May 2003 to 31 July 2008 were selected excluding any patients who have factors which might affect their renal function. The accuracy of the GFR predication by these above three methods was compared against each other, taking into consideration each patient renal function stage and age. The MDRD equation preformed better than the CG or Sanaka formula in total patients with respect to accuracy within 30% (49.7, 71, and 49.2%, respectively). Similar results are with respect to accuracy within 30% (64.2, 70.7, 68.6%, respectively) in patients with chronic renal diseases and with respect to that (42.1, 71.6, 51.2% and 38.9, 75.0, 56.0% respectively) in elderly patients and very elderly patients. In total patients through the MDRD, CG and Sanaka, 45.1%, 59.2% and 42.6% of patients were classified as exact stage of chronic renal disease that is used for dosage adjustment. The result from this study shows the renal function estimation by MDRD is more accurate than by CG and Sanaka, and MDRD adjusted by body surface area showed performance improvement compared with the original MDRD equation. Therefore GFR estimation through MDRD adjusted by body surface area is recommended in the dose adjustment of the medication.

영어초록

Accurate estimation of the glomerular filtration rate (GFR) is crucial for therapeutic interventions, especially in guiding the dose adjustment of the medication for patients diagnosed with renal insufficiency. Various methods such as Cockcroft-gault (CG), Modification of Diet in Renal Disease (MDRD) and Sanaka equation are widely used to estimate GFR, especially MDRD is the most frequently used method. However, the accuracy would be affected by race, age and diseases the patients have and CG or MDRD are limited to apply for Asian. The objective of the study is to find the appropriate renal function prediction factor in the dose adjustment of the medication through comparing the performance of the CG, MDRD and Sanaka methods based on creatinine clearance measured with 24hr urine collection. 1186 patients who had their creatinine clearance measured by 24hr urine collection from 1 May 2003 to 31 July 2008 were selected excluding any patients who have factors which might affect their renal function. The accuracy of the GFR predication by these above three methods was compared against each other, taking into consideration each patient renal function stage and age. The MDRD equation preformed better than the CG or Sanaka formula in total patients with respect to accuracy within 30% (49.7, 71, and 49.2%, respectively). Similar results are with respect to accuracy within 30% (64.2, 70.7, 68.6%, respectively) in patients with chronic renal diseases and with respect to that (42.1, 71.6, 51.2% and 38.9, 75.0, 56.0% respectively) in elderly patients and very elderly patients. In total patients through the MDRD, CG and Sanaka, 45.1%, 59.2% and 42.6% of patients were classified as exact stage of chronic renal disease that is used for dosage adjustment. The result from this study shows the renal function estimation by MDRD is more accurate than by CG and Sanaka, and MDRD adjusted by body surface area showed performance improvement compared with the original MDRD equation. Therefore GFR estimation through MDRD adjusted by body surface area is recommended in the dose adjustment of the medication.

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