Comparison Of Renal Function Assessment In Elderly Patients With Hypertension With Four Different Formulas For Estimating Glomerular Filtration Rate

Objective: To compare the performance differences and applicability of four different estimated glomerular filtration rate(eGFR)formulas for renal function assessment in elderly patients with hypertension.To find a more suitable method for the assessment of renal injury in elderly patients with hypertension.Methods:1.Clinical data of 68 elderly patients with essential hypertension(>70years)hospitalized in the Department of Cardiology and Geriatrics,Hebei General Hospital from September 2019 to November 2020 were collected.Fasting serum and morning urine were collected to detect serum creatinine(Scr),blood urea nitrogen(BUN),serum uric acid(SUA),triglyceride and total cholesterol levels.Serum cystatin C(CysC)levels were determined by enzyme-linked immunosorbent assay.2.Patients were divided into two groups according to Scr,BUN,serum CysC and proteinuria.Abnormal results of any one or more of the four factors were treated as hypertensive renal injury group(positive group,n=32),and those with no abnormal results were treated as simple hypertension group(negative group,n=36).The eGFR values of patients were calculated using Modification of diet in renal disease(MDRD),Chronic kidney disease epidemiology collaboration(CKD-EPI),Berlin initiative study(BIS)and Full age spectrum(FAS)estimation formulas.Meanwhile,we drawn respectively the Receiver operating characteristic(ROC)curves of the four estimation formulas,and compared the area under the curve of each formula corresponding to the curve.Results: 1.There was a statistical difference in age between the two groups,the age of the positive group was higher than that of the negative group(P<0.05).There was no significant difference in gender,Body mass index(BMI),total cholesterol(TC),triglyceride(TG),onset time of hypertension,or hypertension grades(P>0.05).2.EGFR(MDRD)、eGFR(CKD-EPI-Cr)、 eGFR(CKD-EPI-CysC)、eGFR(CKD-EPI-Cr-CysC)、eGFR(BIS-Cr)、eGFR(BIS-Cr-CysC)、eGFR(FAS-Cr)、eGFR(FAS-CysC)and eGFR(FAS-Cr-CysC)in the positive group were significantly lower than those in the negative group,with statistically significant differences(P<0.05).3.Comparison of relevant data of ROC curves of four different GFR estimation formulas showed that: the largest values of area under the ROC curve of the four GFR estimation formulas based only on Cr were the eGFR(CKD-EPI-Cr)group and the eGFR(FAS-Cr)group.The eGFR(FAS-CysC)group had the largest area under the ROC curve of theGFR estimation formula based only on CysC.The large area under the ROC curve of the threeGFR estimation formulas based on Cr combined with CysC were the eGFR(FAS-Cr-CysC)group and the eGFR(CKD-EPI-Cr-CysC)group.In addition,the threeGFR estimation formulas based on Cr combined with CysC(CKD-EPI-Cr-CysC、BIS-Cr-CysC and FAS-Cr-CysC)were found to have greater area under the curve than those based on Cr or CysC alone.Conclusions:1.Among theGFR estimation formulas based only on Cr/CysC and Cr combined with CysC,the FAS formula has the best efficacy in assessing renal injury in elderly patients with hypertension.2.FAS formula can more effectively identify renal injury in elderly patients with hypertension.