EZSCAN—the Application Research Of The Non-invasive Screening Technique To Evaluate The Diabetes Chronic Kidney Disease

ObjectiveTry to find out the potential relationship between the results of EZSCAN, glomerular filtration rate (GFR) and urine albumin-to-creatinine rate (ACR), because EZSCAN is a non-invasive technique to screen to evaluate the risk of type2diabetes mellitus, and discuss about the diagnostic value of EZSCAN in diabetes chronic kidney disease.MethodsThe general information of the type2diabetes mellitus patients who were admitted in endocrinology department in Huashan Hospital, Shanghai from August2011to May2012and part of the type2diabetes mellitus patients from Baoshan District in Shanghai were collected and input. The participants accepted the physical examinations and the lab examinations. The isotope GFR (iGFR) measured by "TC-DTPA radionuclide renal dynamic imaging (Gates’ measurement) is the gold standard. We compared the Cockcroft-Gault equation (cg-GFR), abbreviative MDRD equation (mdrd-GFR) and CKD-EPI equation (epi-GFR) with the results of EZSCAN for GFR, and then we evaluated the correlation, accuracy, conformity and the efficacy between them. At the same time, the EZSCAN results were evaluated if it has a good diagnose value to distinguish the patients who are diagnosed the diabetic chronical kidney diease by urine albumin-to-creatinine rate (ACR). In this way, we can assess the appilicability of EZSCAN for clinical screening. ResultsA total of202participants were involved in this research, including104males and98females, mainly between the age from50to70years old.1. Comparison between the estimated GFR (eGFR), ez-GFR and iGFR(1) ez-GFR, cg-GFR, mdrd-GFR and epi-GFR were all positive correlated with iGFR (p<0.001).(2) The30%relative accuracy of these four methods was50%,50.5%68.3%and66.3%, but when iGFR<60ml·min-1·(1.73m2)-1, the50%relative accuracy of ez-GFR was the highest (86.6%).(3) The bias ot the four methods were-19.82,-15.59,12.27and14.45ml·min-1·(1.73m2)-1. When iGFR<60ml·min-1·(1.73m2)-1, ez-GFR hat the smallest bias (-1.32ml·min-1·(1.73m2)-1). When iGFR≥90and60-89.9ml·min-1·(1.73m2)-1, MDRD equation had the smallest bias (6.93and11.56ml·min-1·(1.73m2)-1).(4) Making the Bland-Altman Plots for the four methods, the limits of agreements (LOA) were40.72,44.04,54.56and61.94ml·min-1·(1.73m2)-1. Meanwhile, we can observe that ez-GFR on the whole underestimates the iGFR, and it underestimated more when iGFR is in a high level. The three eGFRs all overestimated the iGFR in the high level but underestimated the iGFR in the low level. The different area under curve (AUC) of the ROC curve were0.706,0.757,0.780and0.787. The cut-off point of ez-GFR was52.5ml·min-1·(1.73m2)-1, at this point the sensitivity was0.732and the specificity was0.590. Compared with the cut-off points of other methods, the EZSCAN cut-off point had a higher.sensitivity but a lower specificity. CKD-EPI equation had the highest specificity (0.938). 2. Comparison between the results of EZSCAN and ACR(1) The participants were divided into two groups according to the ACR level (ACR≥30mg/g). There were43people in the DKD group and159people in the control group. Making the independent-sample T test, we can observe that the age of the DKD group is higher than the control group, while the ez-GFR is lower. The other results have no significant difference between the two groups.(2) According to the ROC curve with ACR, the AUC of3eGFR is about0.55, lower than the AUC of EZSCAN (0.645). The cut-off point of EZSCAN is57.5, and the sensitivity is0.860and the specificity is0.286.(3) The AUC of EZSCAN was increased with the exaltation of the ACR. If we define that ACR≥55mg/g is the diagnostic criteria of diabetes chronic kidney disease, the AUC would be0.686, and the cut-off point would be48.5ml·min-1·(1.73m2)-1, with sensitivity of0.65and specificity of0.665.3. Conprehensive assessment of the relationship between EZSCAN, iGFR and ACRWe compared the Youden index summation of the two ROC curves with iGFR and ACR, when ez-GFR was57.5ml·min-1·(1.73m2)-1, the maximum value of0.494was achieved, at the same time, the summation of AUC was1.246.When we estimated the performance of EZSCAN to diagnose the diabetes chronic kidney disease, it had a acceptable correlation with GFR, and a better accuracy than eGFR among the people with decreased GFR. Meanwhile, the sensitivity of EZSCAN also performed quite well with both GFR and ACR, especially for the people with moderate decreased GFR, it was not easy to misdiagnose. In the clinical screening procedure, EZSCAN can be conbined with ACR or CKD-EPI equation to improve the process, help the doctors to diagnose and choose the further treatments, also help the patients to understand the progress of the disease and improve the lifestyle. Conclusion1. EZSCAN has a good sensitivity to detect the diabetes chronic kidney disease. It can warn the patients the progress of the disease, to have more accurate examination of the renal function and recieve timely treatment.2. As a non-invasive technique to dectect the diabetes chronic kidney disease, EZSCAN is suitable for clinical screening.