| Objective:Chronic kidney disease(CKD)is common in the world,which has been the globally public health problem.It is a key factor of accurate-estimated renal function to early diagnosis.Glomerular filtration rate(GFR)is the best overall measure of kidney function,that is central to the diagnosis,classification,management and monitoring of CKD.Estimated glomerular filtration equations have been widely used in the clinic for its simple and easy.However there are some defects in the validity and age continuity of the equations.This subject is to assess the performance of the full age spectrum(FAS)equation in comparison to other equations in subjects with chronic kidney disease in the first time in China.Methods:The measured glomerular filtration rate(mGFR)obtained by the 99mTc-diethylene triamine pentaacetic acid renogram was used as the reference standard.To evaluate the performance of the equations,we compared bias,precision and accuracy of the 4 equations.Bias was calculated as eGFR-mGFR.Precision was defined as root mean square error(RMSE).Accuracy was defined as P30,the percentage of GFR(eGFR)values within 30%deviation of the mGFR.Paired T-test and ANOVA were used to compare bias.The chi-square and Kappa tests were employed for classifying agreement between eGFR and mGFR.The Bland-Altman method was also used to evaluate agreement between eGFR and mGFR.Additionally,correlations of eGFR with mGFR and intraclass correlation coefficient(ICC)were assessed using Pearson's correlation and reliability analyses.The ROC curve was drawn to compare the diagnostic accuracy of each equation.Results:465 subjects were enrolled in this study.The precision(root mean square error,RMSE)of the FAS equation was 17.61(95%CI 16.55,18.82)in all participates,better than the corresponding values of MDRD equatlion21.14(95%CI 19.86,22.59)(P<0.05)and CKD-EPI equation17.83(95%CI 16.75,19.05),similar to 16.67(95%CI 15.66,17.81)the combinate equation of CKD-EPI equation and BIS-1 equation(P>0.05).In a sub-analysis,the RMSE of the FAS equation in older adults was 13.64(95%CI 12.24,15.41),similar to 12.58(95%CI 11.29,14.21)of the BIS-1 equation,superior to 19.81(95%CI 17.77,22.37)of the MDRD equation and 16.94(95%CI 15.20,19.13)of the CKD-EPI equation.chronic kidney disease(CKD)-EPI formula 16.94(95%CI,15.20 15.20),especially the MDRD equation,with significance.The MRSE values of the FAS equation in the female group and the mGFR<60 ml/min/1.73m2 group were the smallest,14.62(95%CI 13.12,16.51)and 15.89(95%CI 14.76,17.21)respectively.All the estimated equations overestimated the mGFR(all P<0.05).The bias of FAS equation was 4.04(95%CI 2.47,5.60),higher than that of CKD-EPI + BIS-13.33(95%CI1.84,4.82),and lower than the MDRD equation 5.83(95%CI,3.97 3.97),close to the CKD-EPI euaqtion 3.87(95%CI,2.29 2.29),with no significant difference(P= 0.572).In subgroup analysis,The FAS equation showed the least bias 0.51(95%CI-1.73,2.75)in older adults,comparable to mGFR(P=0.653).For females,bias was-0.51(95%CI-2.91,1.89),P=0.964,no significant difference with mGFR.The FAS equation showed the highest percentage(63.64%)of accuracy 30%in all participants,and was higher than other equations in subgroups.The FAS correctly classified subjects into GFR categories.The correlation between three eGFRs and mGFR was significant(all P<0.01),the correlation coefficients were the MDRD equation 0.77,the CKD-EPI equation 0.80,the CKD-EPI+BIS-1 0.82,and the FAS equation 0.81,respectively.The hightest Kappa value of staging consistency was the FAS equation 0.563,and which was higher than other formulas in the subgroups.The area under the ROC cxirve(AUC)of the FAS equation,greater than 0.90,higher than the MDRD equation(0.878)and the CKD-EPI equation(0.893),with a high diagnostic accuracy.Conclusions:The FAS equation improved the precision and accuracy of eGFR,especially in older adults and females.It also decreased the bias of the estimated GFR.The FAS equation is applicable to adults and may be an alternative method to measuring eGFR in China. |
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