| Background:With the iohexol GFR as the gold standard,combined with a variety of endogenous serum markers in patients with chronic kidney disease,we built a new evaluation equation of glomerular filtration rate.Besides,we compared the existing equations in CKD patients with diabetes,and established new evaluation equations of glomerular filtration rateMethods:(1)836 chronic kidney disease patients in renal department of Ruijin Hospital who met the inclusion and exclusion criteria were enrolled between December 2013 and January 2016.With iohexol GFR(mGFR)as the gold standard,we built equations based on creatinine,cystatin C,beta 2 microglobulin,beta trace protein or a combination of several endogenous serum markers of eGFR.We compared the performance of different equations.(2)217 Chronic kidney disease patients with type 2 diabetes mellitus were enrolled.217 CKD patients without diabetes were enrolled as control group.We compared the eGFRs with well-known equations.With iohexol GFR(mGFR)as the gold standard,the bias,precision and accuracy of eGFRs were compared.Bland Altman was used to compare the consistencyof different equations.Accuracy of each equation under different accuracy of CKD staging in patients with type 2 diabetes were compared.(3)CKD patients with type 2 diabetes mellitus,in which 197 in renal department of Ruijin Hospital and 20 in renal department of Dongfang Hospital Affiliated to Tongji University were enrolled.With iohexol GFR(mGFR)as the gold standard,based on beta 2 microglobulin,beta trace protein or a combination of several endogenous serum markers,eGFR equations were built and bias,accuracy and precision of the equations were compared.Accuracy of each equation under different CKD stages in patients with type 2 diabetes were comparedResults:(1)There were no significant differences between two groups for gender,age,diabetes status,hypertension status,concentration of serum creatinine,Cystatin C and beta 2 microglobulin.We established 9 new equations with multivariate linear regression.New3 among the new equations with creatinine and beta trace protein was less biased,more precise and was equal to CKD-EPI in diagnosing the CKD stages(2)There were no significant differences between groups with and without diabetes mellitus for gender,age,mGFR and concentration of serum creatinine.Equations in CKD with diabetes mellitus patients were more biased,less precise and accurate There was no significance in accuracy between patients of diabetic nephropathy and non diabetic nephropathy.In either DKD and NDKD group,eGFR equations are most accurate in CKD stage 1?2,less accurate in CKD stage 3 and least accurate in CKD stage 4?5.Ruijin equation was the most accurate in CKD stage 1?3 and CKD-EPI-SCr-CysC was the most accurate in CKD stage 4?5.(3)There were no significant differences between development and validation groups for gender,age,BMI,mGFR,concentration of serum creatinine,cystatin C,beta 2 microglobulin and beta trace protein and staging of CKD.9 regression equations were established with multivariate linear regression.NewDM6SCr was less biased,more precise and accurate in different CKD stagesConclusions:In the first part,with iohexol GFR as gold standard,we developed 9 eGFR equations with a variety of different endogenous serum markers in Chinese CKD patients.Among these equations,New3 with creatinine and beta trace protein was less biased,more precise than the CKD-EPI equations,and the CKD staging was comparable to the CKD-EPI group in diagnosing the CKD stages.In the second part,we compared eGFR equations in the CKD patients with and without diabetes mellitus,and found that equations in CKD with diabetes mellitus patients were more biased,less precise and accurate.In the third part,with the combination of a variety of different endogenous serum markers,9 regression equations were developed,among which NewDM6scr was the most accurate and equal to CKD-EPI equations in CKD staging,which was worth popularized. |
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