Abstract

The aim of this study was to establish creatinine growth curves separately for males and females that can be used to adjust childhood levels of serum creatinine to corresponding adult levels. Linear regression with fractional polynomials of age as independent variable was used to construct creatinine growth curves for a reference cohort (n = 83,157 samples from Belgium and Sweden, age 2–40 years). Adjusted creatinine obtained from the growth curves was used to improve accuracy of estimated glomerular filtration rate (eGFR) based on the Lund–Malmö revised (LMR) equation in children. The LMR equation based on creatinine values adjusted to age 18 years was validated against measured GFR (mGFR) in a separate cohort of 4005 children from four different European countries. Validation metrics included median bias, precision, and accuracy expressed as percentage of estimates within ±30% (P₃₀) of mGFR. Remarkable improvements in bias and accuracy were observed; P₃₀ increased from 56% to 74% after creatinine adjustments in children with mGFR <75 mL/min/1.73 m² (n = 932), while P₃₀ was relatively unchanged (89–90%) at mGFR ≥75 mL/min/1.73 m² (n = 3073). The suggested approach with adjusted creatinine makes LMR applicable in children irrespective of their renal function.

摘要

本研究的目的是分别建立男性和女性的肌酐生长曲线，可用于将儿童血清肌酐水平调整为相应的成人水平。使用年龄分数多项式作为自变量的线性回归用于构建参考队列的肌酐增长曲线（n = 83,157 个来自比利时和瑞典的样本，年龄 2-40 岁）。根据 Lund-Malmö 修正 (LMR) 方程，从生长曲线获得的调整后的肌酐用于提高估计肾小球滤过率 (eGFR) 的准确性。在来自四个不同欧洲国家的 4005 名儿童的单独队列中，基于调整到 18 岁的肌酐值的 LMR 方程根据测量的 GFR (mGFR) 进行了验证。验证指标包括中值偏差、精度、₃₀ ) 的 mGFR。观察到偏差和准确性的显着改善；在 mGFR <75 mL/min/1.73 m ² ( n  = 932) 的儿童中，肌酐调整后P ₃₀从 56% 增加到 74% ，而在 mGFR ≥75 mL/min时 P ₃₀相对不变（89-90%） /1.73 m ² (n = 3073)。建议的调整肌酐的方法使 LMR 适用于儿童，无论其肾功能如何。