| Objective: Chronic kidney disease (CKD) is a worldwide public problem to the health, and its attack rate has been taking on a progressive tendency. Detecting renal function statedly is very important for diagnosing and treating to CKD. Glomerular filtration rate (GFR) is an important index to estimate renal function. Searching for an accurate convenient and cheap therapeutic regimen not only can make the clinical diagnosis of CKD clearly and select a reasonable therapeutic regimen, but also can lessen patients'burden of economy. The objective of this study is to use the gold standard of 99mTc-diethylene triamine pentaacetic acid (DTPA) plasma clearance by dual plasma sampling method (dual plasma sampling method) to estimate the clinical application of 99mTc-DTPA dynamic renal imaging (Gates method),24-hour clearance rate of creatinine (24hCcr),Cockcroft-Gault equation(C-G equation)in surveying and evaluating the GFR of the patients.Method: The CKD patients in 18～90 years old visiting our hospital from 2005.09 to 2007.01, all the patients that were chose consistent with the chronic renal disease definition of the American CKD and the guide of K/DOQI. And every one of them was without the conditions:the acute kidney disease,acute renal inadequacy,dialysis,cutaneous dropsy,pleural fluid,abdominal dropsy,graveness heart function failure,graveness cacotrophia,deficiency of skeletal limb and using the medicine can influence level of influence such as Cimetidine,trimethoprim. The general state of health and clinical data of patients were recorded. And the data of GFR were evaluated by dual plasma sampling method,Gates method,C-G equation and 24hCcr. (The result was record GFR- dual plasma sampling method,GFR- Gates method,GFR-CG equation,GFR-24hCCr) .The results were standardized by DuBois equation with the unit of ml-1·min-1·(1.73m2)-1 of GFR. The four methods must to be applied in one day. Using the GFR by dual plasma sampling method as reference GFR, according to the staging standard in the guide of K/DOQI, patients were divided into five groups, there were more than 40 patients in every stage. All the data were demonstrated in x±s, using the t-test,correlation analysis and Kappa consistency checking to carry out the statistics analysis. The conclusion was P<0.05 which means that the result has statistical significance.Results:1 General state of health of the patients: 201 patients with CKD including 100 males and 101 females were chosen. The cause of a disease of these CKD patients were renal glomerular disease (108 examples, 53.73 %),Tubulointerstitial disease (58 examples, 28.86%) and others (35 examples, 17.41%). 2 GFR-dual plasma sampling method compared with the others value of GFR coming from Gates method,C-G equation and 24hCcr: There was significant difference when GFR-Gates method compared with GFR-dual plasma sampling method in the full set and stage CKD2,3,4,5(P<0.05), no significant difference in stage CKD1 (P>0.05);There was significant difference when GFR-CG equation compared with GFR-dual plasma sampling method in CKD1,3,4,5, no significant difference in the full set and stage CKD2 (P>0.05);There was significant difference when GFR-24hCcr compared with GFR-dual plasma sampling method in the full set and all of stages (P<0.05).3 The dependability between GFR-dual plasma sampling method with the other values of GFR coming from Gates method,C-G equation and 24hCcr: The scatterplot showed that there was linear correlation between the GFR-dual plasma sampling method with GFR-Gates method,GFR-CG equation and GFR-24hCcr;There was closed correlation between the GFR-Gates method and GFR-dual plasma sampling method in full set and stage CKD2,3,4,5 (P<0.05), no closed correlation in the stage CKD1 (P>0.05); There was closed correlation between the GFR-CG equation,GFR-24hCcr and GFR-dual plasma sampling method in full set and all of stages (P>0.05).4 Absolute deviations of GFR-24hCcr,GFR-CG equation and GFR-Gates method compared with each other:In the full set: There was significant difference when the absolute deviations of GFR-24hCcr,GFR-CG equation compared with the absolute deviation of GFR-Gates method, P=0.000; And there was significant difference when the absolute deviations of GFR-24hCcr compared with the absolute deviation GFR-CG equation, P=0.01;In the stage of the CKD1: There was significant difference when the absolute deviations of GFR-24hCcr compared with the absolute deviation of GFR-Gates method,GFR-CG equation, P=0.002,0.029; But there was no significant difference when the absolute deviations of GFR-Gates method compared with the absolute deviation of GFR-CG equation, P>0.05;In the stage of the CKD2: There was significant difference when the absolute deviations of GFR-Gates method compared with the absolute deviation of GFR-24hCcr,GFR-CG equation, P=0.032,0.047; But there was not significant difference when the absolute deviations of GFR-CG equation compared with the absolute deviation of GFR-24hCcr, P>0.05;In the stage of the CKD3: There was significant difference when the absolute deviations of GFR-Gates method compared with the absolute deviation of GFR-24hCcr,GFR-CG equation, P=0.005,0.000; There was significant difference when the absolute deviations of GFR-CG equation compared with the absolute deviation GFR-24hCcr, P=0.016;In the stage of the CKD4: There was significant difference when the absolute deviations of GFR-Gates method compared with the absolute deviation of GFR-24hCcr,GFR-CG equation, P=0.007,0.001; There was not significant difference when the absolute deviations of GFR-CG equation compared with the absolute deviation of GFR-24hCcr, P>0.05;In the stage of the CKD4: There was significant difference when the absolute deviations of GFR-Gates method compared with the absolute deviation of GFR-24hCcr,GFR-CG equation, P=0.003,0.003;There was not significant difference when the absolute deviations of GFR-CG equation compared with the absolute deviation of GFR-24hCcr, P>0.05.5 The outcome of Kappa consistency checking: The value of Kappa consistency checking of Gates method was 0.465,the value of C-G equation was 0.577,and the value of C-G equation was 0.689. The values of P were all 0.000.Conclusion:1 To all patients, Gates method has better correlation with dual plasma sampling method. Gates method maybe suit to survey and evaluate the GFR of patients with CKD2,3,4; Its precision in CKD5 is lower than the others stages; The measure value used Gates method to survey and evaluate the GFR may be higher than the real GFR in CKD2,3,4,5.2 To all patients, C-G equation has better correlation with dual plasma sampling method; C-G equation can take the place of plasma sampling method to evaluate GFR of CKD patients; The measure value used C-G equation to survey and evaluate the GFR may be lower than the real in CKD1, and its precision in CKD1 is lower than the others stages;Its value may be higher than the real GFR in CKD3,4,5.3 24hCcr has better correlation with dual plasma sampling method in all patients and every stage; It can take the place of plasma sampling method to evaluate GFR of CKD patients however the patient's kidney functions; and its precision in CKD2 is lower than the others stages;.4 To all patients, in aspect of evaluating the GFR for CKD patients, the C-G equation is better than Gates method probably, and the 24hCcr maybe is the best of them.5 In aspect of evaluating the GFR for CKD patients, Gates method,C-G equation and 24hCcr has own forte and influencing factor, so in clinical to chose the method to evaluate GFR for CKD patients should allow for the conditions of patient and the influencing factor of the method, it can help to get the most suitable method to patient.
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