| Objective:To evaluate the accuracy and reliability of glomerular filtration rate(GFR)measured by dynamic renal imaging(Gates)in common renal diseases(chronic kidney disease,hydronephrosis,renal space occupying)according to double plasma method.Methods:From January 2022 to October 2022,589 patients with chronic kidney disease,300 patients with hydronephrosis and 200 patients with renal space occupation were selected for renal dynamic imaging examination in the nuclear medicine department of the First Hospital of Shanxi Medical University.The GFR values(g GFR and d GFR respectively)and related clinical data of the above patients were collected and analyzed by retrospective study.Paired t test was used for comparison of GFR measured by different methods,and Pearson correlation analysis was used for correlation analysis.Bland-Altman consistency test was used for consistency analysis.P < 0.05 was considered statistically significant.Results:1.In patients with chronic kidney disease,the number and proportion of stage CKD1-5 were 16(2.72%),105(17.83%),268(45.50%),130(22.07%),70(11.88%),respectively.(1)The GFR measured by Gates method and double plasma method in patients with stage CKD1-5 were: 85.14±14.42vs102.81±8.51、67.45±15.05vs71.68±8.47、46.79±13.76vs43.29±8.62、27.03±10.62vs22.11±4.36、14.83±8.10vs11.01±3.04.(2)Comparison of g GFR and d GFR in patients of each stage,difference analysis results showed that there were significant statistical differences in the measurement results of the two methods in each stage of CKD(P < 0.05 for all).Taking d GFR as the standard,g GFR underestimated GFR in CKD1 and CKD2,while g GFR overestimated GFR in CKD3,CKD4 and CKD5.(3)Correlation analysis showed that there was no significant correlation between the two methods in stage CKD1 patients(r=0.264,P > 0.322).In CKD2,CKD3,and CKD4 patients,g GFR was moderately correlated with d GFR(r=0.405-0.583,P < 0.001 for all).In CKD5,g GFR was weakly correlated with d GFR(r=0.348,P=0.003).(4)Bland-Altman consistency analysis results showed that the consistency of Gates method and double plasma method in renal dynamic imaging of patients in each stage of CKD was poor.2.Among the patients with hydronephrosis,the overall analysis showed that there was a statistically significant difference between GFR measured by Gates method and double plasma method(61.09±21.57 vs 54.33±20.04,P<0.001),g GFR overestimated the true GFR value,and the correlation between the two methods was good(r=0.706,P<0.001)and the agreement was poor.Based on the imaging data,patients were further classified as having mild,moderate and severe hydropsis.the number and proportion of mild,moderate and severe hydronephrosis were 118(39.33%),143(47.67%)and 39(13%)respectively.(1)GFR measured by Gates method and double plasma method in patients with mild,moderate and severe hydronephrosis were 74.88±18.46 vs 73.56±11.26,57.01±16.63 vs 47.80±7.88 and 34.30±13.66 vs 20.13±5.26,respectively.(2)The difference analysis results are as follows:There was no statistically significant difference between the two methods in mild hydronephrosis patients(t=0.863,P=0.39),while there was statistically significant difference between the two methods in moderate and severe hydronephrosis patients(t=7.724,6.691,both P < 0.001).Taking d GFR as the standard,g GFR in moderate and severe hydronephrosis patients overestimated the true GFR value.(3)Correlation analysis results showed that there was a good correlation between g GFR and d GFR in mild and moderate hydronephrosis patients(r=0.46,0.451,both P<0.001),while there was no significant correlation between g GFR and d GFR in severe hydronephrosis patients(r=0.276,P=0.090).(4)Bland-Altman consistency analysis results showed that the consistency of the two methods was good in mild hydronephrosis patients,and poor in moderate and severe hydronephrosis patients.3.Comparison of g GFR and d GFR in renal space occupying patients,difference analysis results showed that there was significant statistical difference between the two methods in renal space occupying patients(74.46±21.19vs72.18 ±19.07,P < 0.05).Based on d GFR,g GFR overestimates the true GFR value.Correlation analysis results showed that the correlation between g GFR and d GFR was better in renal space occupying patients(r=0.757,P < 0.001).Bland-Altman consistency analysis showed that the consistency between Gates’ method and double plasma method was poor.Conclusion:1.For chronic kidney disease,it is easy to underestimate the true value of GFR by Gates method in CKD1 and 2,and overestimate the true value in CKD3,4 and 5.There is a good correlation between g GFR and d GFR in CKD2,3 and 4,and the accuracy of Gates method is better.In CKD5 stage,the correlation between them is poor.For patients in this stage,we should refer to the double plasma method or the results of this study for comprehensive analysis.2.For patients with hydronephrosis,in patients with moderate and severe hydronephrosis,GFR measured by Gates method is prone to overestimate the true value.Mild and moderate hydronephrosis,g GFR has a good correlation with d GFR,and the accuracy of Gates method is good.For severe moderate hydronephrosis,the correlation and consistency between g GFR and d GFR are poor.For patients at this stage should be analyzed in a comprehensive analysis with reference to the dual plasma method or the results of this study.3.For patients with renal space occupying lesions,GFR measured by Gates method of renal dynamic imaging tends to overestimate the true value,and g GFR has a good correlation with d GFR,which can be comprehensively analyzed by referring to GFR measured by double plasma method or the results of this study. |
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