Utilización de las ecuaciones predictivas de la tasa de filtrado glomerular y depuración de creatinina endógena en pacientes ecuatorianos con insuficiencia renal crónica
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2016
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Universidad de Guayaquil. Facultad de Ciencias Químicas
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Determinar la tasa de filtrado glomerular (TFG) utilizando ecuaciones se ha convertido en una práctica muy común. Este trabajo buscó determinar si son aplicables las ecuaciones predictivas de TFG, Cockcroft y Gault (CyG), CKD-EPI y MDRD, conjuntamente con la depuración de creatinina (DPCr) endógena para la estimación de la función renal en pacientes ecuatorianos con sospecha de enfermedad renal que acudieron al laboratorio clínico del Hospital General Pablo Arturo Suárez. Se realizó un estudio observacional de corte transversal, descriptivo, no experimental para determinar la validez (en términos de sensibilidad, especificidad, VPP, VPN, RVP, RVN) y concordancia (coeficiente Kappa) de las tres ecuaciones de frente a la DPCr como estándar. Se recogieron los datos de 132 pacientes durante los meses de marzo a agosto del 2016. La ecuación de CyG evidenció una sensibilidad del 95,5%, especificidad del 78,5%, VPP de 82,1%, VPN 94,4%, RVP de 4,44 y RVN 0,06; con un coeficiente Kappa de 0,74. La ecuación CKD-EPI presentó una sensibilidad de 92,5%, especificidad de 84,6%, VPP de 86,1%, VPN de 91,7%, RVP 6,00 y RVN 0,09; con un coeficiente Kappa de 0,77. Finalmente la ecuación MDRD presentó una sensibilidad del 91,0%, especificidad del 81,5%, VPP de 83,6%, VPN de 89,8%, RVP 4,92 y RVN 0,11; con un coeficiente Kappa de 0,73. Las tres ecuaciones presentaron perfil de validez y concordancia similar cuando se las comparó con la depuración de creatinina. Basado en lo anterior, las ecuaciones predictivas de TFG, son válidas para ser aplicadas en la estimación de la función renal en pacientes ecuatorianos con sospecha de enfermedad renal. Sin embargo, ninguna de las ecuaciones presentó la concordancia suficiente para reemplazar a la DPCr como estándar en la determinación de TFG.
Determining the glomerular filtration rate (GFR) using equations has become a very common practice. This study sought to determine if the predictive equations of GFR, Cockcroft and Gault (CyG), CKD-EPI and MDRD, together with endogenous creatinine clearance (CC) for the estimation of renal function in Ecuadorian patients with suspected disease that attended to the laboratory of Pablo Arturo Suárez General Hospital. An observational cross-sectional, descriptive, non-experimental study was performed to determine the validity (in terms of sensitivity, specificity, PPV, NPV, PLR, NLR) and concordance (Kappa coefficient) of the three equations against CC as standard. Data were collected from 132 patients during the months of March to August 2016. The CyG equation showed a sensitivity of 95.5%, specificity of 78.5%, PPV of 82.1%, NPV 94.4% PLR of 4.44 and NLR 0.06; Kappa coefficient of 0.74. The CKD-EPI equation showed a sensitivity of 92.5%, specificity of 84.6%, PPV of 86.1%, NPV of 91.7%, PLR 6.00 and NLR 0.09; Kappa coefficient of 0.77. Finally, the MDRD equation showed a sensitivity of 91.0%, specificity of 81.5%, PPV of 83.6%, NPV of 89.8%, PLR 4.92 and NLR 0.11; Kappa coefficient of 0.73. The three equations presented similar validity and concordance profile when compared with CC. Based on the above, the predictive equations of GFR are valid to be applied in the estimation of renal function in Ecuadorian patients with suspected renal disease. However, none of the equations presented sufficient concordance to replace the CC as a standard in the determination of GFR.
Determining the glomerular filtration rate (GFR) using equations has become a very common practice. This study sought to determine if the predictive equations of GFR, Cockcroft and Gault (CyG), CKD-EPI and MDRD, together with endogenous creatinine clearance (CC) for the estimation of renal function in Ecuadorian patients with suspected disease that attended to the laboratory of Pablo Arturo Suárez General Hospital. An observational cross-sectional, descriptive, non-experimental study was performed to determine the validity (in terms of sensitivity, specificity, PPV, NPV, PLR, NLR) and concordance (Kappa coefficient) of the three equations against CC as standard. Data were collected from 132 patients during the months of March to August 2016. The CyG equation showed a sensitivity of 95.5%, specificity of 78.5%, PPV of 82.1%, NPV 94.4% PLR of 4.44 and NLR 0.06; Kappa coefficient of 0.74. The CKD-EPI equation showed a sensitivity of 92.5%, specificity of 84.6%, PPV of 86.1%, NPV of 91.7%, PLR 6.00 and NLR 0.09; Kappa coefficient of 0.77. Finally, the MDRD equation showed a sensitivity of 91.0%, specificity of 81.5%, PPV of 83.6%, NPV of 89.8%, PLR 4.92 and NLR 0.11; Kappa coefficient of 0.73. The three equations presented similar validity and concordance profile when compared with CC. Based on the above, the predictive equations of GFR are valid to be applied in the estimation of renal function in Ecuadorian patients with suspected renal disease. However, none of the equations presented sufficient concordance to replace the CC as a standard in the determination of GFR.
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TASA DE FILTRADO GLOMERULAR, ENFERMEDAD RENAL CRÓNICA, ECUACIÓN DE COCKCROFT Y GAULT, ECUACIÓN CKD-EPI, ECUACIÓN MDRD