| Objective: Comparison of three kinds of commonly used equations for estimating glomerular filtration rate in the evaluation of chronic kidney disease(CKD)patients with glomerular filtration rate(GFR)of the individual application.Methods : A total of 1513 adult patients with chronic kidney disease were enrolled,who had underwent a GFR measurement by 99 m Tcdiethylenetriamine penta-acetate(99mTc-DTPA)in Nan Chong central Hospital between January 2014 and December 2017.The primary disease of chronic kidney disease include four parts,which are glomerular disease(480 cases),metabolic nephropathy(542 cases),obstructive nephropathy(429 cases)and other kidney disease(62 cases).Then we use the measured GFR(m GFR)by 99mTc-DTPA renal dynamic imaging method as the reference GFR,and the estimated glomerular filtration rate(e GFR)by 8 prediction equations,which are Cockcroft-Gault(CG)formula,4 Modification of Diet in Renal Disease(MDRD)and 3 Chronic formula Kidney Disease Epidemiology Collaboration(CKD-EPI)as the coparison GFR.Analysis the correlation between e GFR and m GFR,and compare the 8 e GFR estimation deviation,precision,accuracy and diagnostic accuracy,obtaine the optimal different crowd in the optimum GFR estimation equation.Results: 1.In the study of the most suitable e GFR equation for CKD patients with glomerular diseases,the correlation between e GFR and m GFR was high in each equation(R: 0.813~0.859,P < 0.01).The results were better(ROCAUC>0.9,p<0.01),and the sensitivity and specificity were higher in the numerical diagnosis of nodes with 60 ml/min/1.73 m2.The CKD-EPI formula based on creatinine and cystatin C had the highest correlation(R=0.859,P < 0.01),diagnostic efficiency(ROCAUC =0.932,P < 0.01)and sensitivity(95.8%).followed by the CKD-EPI equation based on cystatin C.While the relative bias of the e GFR estimated by the CG formula is smaller(-0.73,P < 0.05),the accuracy(21.38,P < 0.05)is higher.In the range of 30%m GFR,CG formula had the highest accuracy(49.6%,P < 0.05),followed by the CKD-EPI equation based on cystatin C.Bland-Altman analysis also showed the highest consistency(95%CI[-38.68,26.40]).In general,the e GFR value estimated by the CKD-EPI equation based on cystatin C is the best numerical diagnostic GFR estimation formula for CKD patients with glomerular diseases.Compared with the MDRD and CKD-EPI formulas,the CG formula had a higher accuracy rate(46.3%)and diagnostic consistency(Kappa[95%CI]: 0.348[0.293,0.400])in the staging of the disease.2.In the study of the most suitable e GFR equation for CKD patients with metabolic nephropathy,the correlation between e GFR and m GFR was high in each equation(R:0.725~ 0.785,P < 0.01).The results were better(ROCAUC>0.897,p<0.01),and the sensitivity and specificity were higher in the numerical diagnosis of nodes with 60 ml/min/1.73 m2.The CKD-EPI formula based on creatinine and cystatin C had the highest correlation(R=0.785,P < 0.01),diagnostic efficiency(ROCAUC =0.909,P < 0.01)and sensitivity.While the relative bias of the e GFR estimated by the CG formula is smaller(-2.2,P < 0.05),the accuracy(20.2,P < 0.05)is higher.Although in the range of 30%m GFR,CG formula had the highest accuracy(48.5%,P < 0.05).while the bland-Altman analysis showed the highest consistency(95%CI[-39.55,25.41])is the CKD-EPI formula based on creatinine and cystatin C,and the the numerical diagnosis was relatively poor.So the CKD-EPI combined formula based on creatinine and cystatin C is the most suitable formula for the numerical value of CKD patients with metabolic nephropathy.The Chinese modified simplified MDRD formula had a higher accuracy rate(38.3%)and diagnostic consistency(Kappa[95%CI]:0.253[0.205,0.303])in the staging of the disease.3.In the study of the most suitable e GFR equation for CKD patients with obstructive nephropathy,the correlation between e GFR and m GFR is high in each equation(R: 0.698~0.735,P < 0.01).The results are better(ROCAUC>0.862,P<0.01),and the sensitivity and specificity are higher in the numerical diagnosis of nodes with 60 ml/min/1.73 m2.The CKD-EPI formula based on creatinine and cystatin C had the highest correlation(R= 0.735,P < 0.01),diagnostic efficiency(ROCAUC = 0.894,P < 0.01),sensitivity(84.2%).While the relative bias of the e GFR estimated by the CKD-EPI formula based on creatinine and cystatin C is smaller(-0.28),the accuracy(21.62)is higher.In the range of 30%m GFR,it has the highest accuracy(65.7%)and consistency(95%CI[-42.66,42.10]).The CKD-EPI formula based on creatinine and cystatin C had a higher accuracy rate(44.4 %)and diagnostic consistency(Kappa[95%CI]:0.256[0.198,0.315])in the staging of the disease.4.In the study of the most suitable e GFR equation for CKD patients with other nephropathies,the correlation between e GFR and m GFR was high in each equation(R>0.8).All e GFR values had high diagnostic efficiency(ROCAUC > 0.9),the sensitivity was 100%,and the specificity was above 78.4%.Therefore,each e GFR value and the m GFR value are as well as others in the diagnosis of other CKD patients.The CKD-EPI formula based on creatinine has a higher correlation(R=0.845,P < 0.01),diagnostic efficiency(ROCAUC = =0.984,P < 0.01),sensitivity(100%)and specificity(90.2%).While the relative bias of the e GFR estimated by modified simplified MDRD formula is smaller(0.04),the accuracy(19.64)is higher.Although in the range of 30%m GFR,it had the highest accuracy(50%),but the numerical diagnosis is relatively poor,and in the bland-Altman analysis,The CKD-EPI formula based on creatinine has a higher consistency(95%CI[-35.49,38.09]).So the CKD-EPI combined formula based on creatinine is the most suitable formula for the numerical value of CKD patients with other nephropathies.The Chinese modified simplified MDRD formula had the highest accuracy rate(38.3%)and diagnostic consistency(Kappa[95%CI]:0.357[0.204,0.504])in the staging of the disease.Conclusions: 1.When evaluate the glomerular filtration rate of CKD patients with glomerular disease,the CKD-EPI formula based on cystatin C has good applicability in the numerical value,while the CG equation is better for staging diagnosis.2.When evaluate glomerular filtration rate of CKD patients with metabolic nephropathy,the CKD-EPI combined formula based on creatinine and cystatin C has best applicability in the numerical value,while China's modified simplified MDRD equation has better applicability for staging diagnosis.3.When evaluating glomerular filtration rate of CKD patients with obstructive nephropathy,the CKD-EPI combined equation based on creatinine and cystatin C has the best applicability not only in the numerical value,but also in the staging diagnosis.4.When evaluating glomerular filtration rate of CKD patients with other nephropathies,the CKD-EPI formula based on creatinine has best applicability in the numerical value,while China's improved simplified MDRD formula has better applicability for staging diagnosis.5.The e GFR equation of CKD patients should be individualized.Different e GFR estimation equations should be used for different etiologies and CKD patients.6.The accuracy rate of the GFR equation for the diagnosis of CKD patients is generally low,especially for the faster progression of G3 and G4 patients,so more accurate equations are needed. |
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