Zusammenfassung
Eine korrekte Bestimmung der glomerulären Filtrationsrate (GFR) ist gleichermaßen notwendig und schwierig. Goldstandardmethoden wie die Messung der Inulin-Clearance sind für den klinischen Gebrauch nicht praktikabel, sodass die Nierenfunktion mithilfe leichter messbarer endogener Biomarker abgeschätzt werden muss. Die Plasmakonzentrationen der Filtrationsmarker Kreatinin und Cystatin C lassen allein keine einfache Aussage über die Nierenfunktion zu, da ihre Konzentrationen nicht linear mit und auch nicht ausschließlich von der GFR abhängen. Daher versuchen Formeln, die GFR mathematisch anhand einfach verfügbarer Parameter abzuschätzen. Aktuell am gebräuchlichsten ist die Formel MDRD (nach der Modification of Diet in Renal Disease Study) oder CKD-EPI (nach der Chronic Kidney Disease Epidemiology Collaboration). Für ältere Menschen stehen u. a. die Formeln BIS‑1 und BIS‑2 (nach der Berlin Initiative Study) zur Verfügung. Inwieweit die geschätzte („estimated“) Filtrationsrate (eGFR) der wahren GFR nahekommt, hängt von verschiedenen Faktoren ab. Die Genauigkeit der Formeln ist geringer bei GFR-Werten über 60 ml/min · 1,73 m2KOF, akuten Schwankungen der GFR und bei extremen individuellen Körpermerkmalen, insbesondere bei sehr hoher oder sehr geringer Muskelmasse. Eine eGFR um oder knapp unter 60 ml/min · 1,73 m2KOF allein kann bei älteren Individuen nicht sicher zwischen alters- und krankheitsbedingtem GFR-Verlust diskriminieren. Renal eliminierte Medikamente sollten dennoch anhand der eGFR dosiert werden.
Abstract
A correct determination of the glomerular filtration rate (GFR) is necessary and at the same time difficult. Using gold standard methods, such as measurement of inulin clearance, are not feasible in clinical practice raising the need for methods to estimate GFR using easy to measure endogenous biomarkers. Plasma concentrations of the filtration markers creatinine and cystatin C alone are not adequate to easily calculate kidney function. This is mainly due to a non-linear relationship between plasma concentrations and GFR and GFR-independent factors influencing the plasma concentrations. Therefore, formulae have been developed to estimate GFR using easily available variables. Currently, the most useful formulae are those developed by the modification of diet in renal disease (MDRD) study and more recently by the chronic kidney disease epidemiology (CKD-EPI) collaboration. For older individuals some specifically validated formulae were developed some years ago, among them the Berlin initiative study 1 (BIS-1) and BIS‑2 formulae. The accuracy of the estimated filtration rate (eGFR) with respect to the true GFR depends on various factors. The accuracy of the formula is especially low in the GFR range above 60 ml/min · 1.73 m2, during recent or rapid changes of GFR and in the case of extreme physical traits, especially a very high or low muscle mass. In older individuals an eGFR around 60 ml/min · 1.73 m2 alone is not sufficient to discriminate between age-related and disease-related decline in GFR. Nonetheless dosing of medications with predominantly renal excretion should be made according to the eGFR.
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C. Weingart und G.H. Wirnsberger geben an, dass kein Interessenkonflikt besteht.
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Weingart, C., Wirnsberger, G.H. Klinische Implikationen der geschätzten glomerulären Filtrationsrate. Z Gerontol Geriat 54, 205–210 (2021). https://doi.org/10.1007/s00391-021-01839-1
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DOI: https://doi.org/10.1007/s00391-021-01839-1