Assessment of a method for evaluating renal function based on serum creatinine level in patients with amyotrophic lateral sclerosis.

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  • 筋萎縮性側索硬化症患者における血清クレアチニン値を利用した腎機能評価方法の検討
  • キン イシュクセイ ソクサク コウカショウ カンジャ ニ オケル ケッセイ クレアチニンチ オ リヨウ シタ ジンキノウ ヒョウカ ホウホウ ノ ケントウ

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Abstract

<p>Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by muscle atrophy involving the entire body. Therefore, in ALS patients, a method for evaluating renal function that does not depend on muscle mass, such as the glomerular filtration rate (eGFRcys), estimated by serum cystatin C (CysC), is preferred. However, it is more difficult to use this method than calculation of the estimated glomerular filtration rate (eGFRcreat) or estimated creatinine clearance (eCCr) using serum creatinine (SCr) in clinical practice. The purpose of this study was to determine the most accurate method for estimating eGFRcreat and eCCr compared to eGFRcys in patients with ALS. Among ALS patients who visited Kansai Electric Power Hospital from May 2014 to November 2019, the subjects whose SCr and CysC levels were measured were included in the study. Patients were divided into two groups: modified Rankin Scale (mRS) 0-2 and mRS 3-6 groups. Furthermore, (a) eGFRcreat and eCCr levels obtained by the methods (b) to (f) were compared with eGFRcys.</p><p>(b) Actual SCr value by an enzymatic method, (c) + 0.2 correction method, in which the enzymatic SCr value is converted via the Jaffe rate assay, (d) roundup method, in which the SCr value is adjusted to 1.0 mg/dL if lower than 1.0 mg/dL, (e) Furukubo method, in which the SCr value is adjusted to 0.8 mg/dL if lower than 0.8 mg/dL in males and to 0.6 mg/dL if lower than 0.6 mg/dL in females, and (f) Dooley method, in which the SCr value is rounded up to 0.06 mmol/L if below 0.06 mmol/L. The comparison of prediction accuracy as a percentage of patients with eGFRcreat or eCCr values within ±30% of eGFRcys values showed that group (c) had the highest accuracy with both 100% in the mRS 0-2 group and 71.4% in the mRS 3-6 group. A comparison of eGFRcys and eGFRcreat or eCCr values obtained by different methods showed that consistency between eGFRcreat or eCCr and eGFRcys was the greatest when the SCr value was adjusted by the + 0.2 correction method, adding 0.2 mg/dL to the enzymatically measured SCr value.</p>

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