Exploration Of A New Noninvasive Screening Technique In Renal Dysfunction In Patients With Diabetes Mellitus

ObjectivesTo study the screening ability of Glomerular filtration rate by eZscan(?) in the patients with diabetes. To analysis the risk factors of diabetic impaired renal function. To prove the eZscan(?) can be used as a noninvasive appropriate technology to promote.Methods1. We made a random cluster sampling of the residents between the age of40to80years old who live in Baoshan district of Shanghai, conducted a cross-sectional ion to them.2. We screened259diabetic patients from the investigative population, conducted questionnaire surveys, physical examinations, and biochemical tests to them, calculated their eGFR, used the eZscan(?) to determine their GFR expressed with EZSCAN.3.81diabetic patients were undergone99Tcm-DTPA radionuclide renal dynamic imaging to determine rGFR.4. According to the CKD stage table, we selected the GFR80mL/min/1.73m2as the normal or abnormal criterion value of the renal function:if someone’s eGFR or rGFR<80mL/min/1.73m2, he or she may be scheduled for the renal insufficiency case group, and if their eGFR or rGFR^80mL/min/1.73m2, they may be selected as the control group. In the second part we added eGFR<60mL/min/1.73m2as the case group who’s renal function had been significantly impaired, and the control group, eGFR was>80mL/min/1.73m2. The positive and negative numbers with eZscan(?) in each group were detected.5. SPSS19.0statistical analysis software was used for statistical analysis.ResultsPart1The comparison between EZSCAN and eGFRIn accordance with eGFR80mL/min/1.73m2demarcation point, we divided259research objects into the case group (n=211) and the control group (n=48). Compared with the control group, people with higher serum creatinine and lower EZSCAN in the case group are older (P<0.05, the difference was statistically significant). EZSCAN and eGFR values are densely distributed between60and80mL/min/1.73m2.Using eGFR as a diagnostic criterion, we drew the ROC curve. EZSCAN’s AUC is0.775, and its sensitivity was91.04%, specificity is40.43%, authenticity is81.85%, positive predictive value is87.33%, negative predictive value is50%, positive likelihood ratio is1.528, and negative likelihood ratio is0.222.Part2The detection of eZscan(?) at the different renal insufficiency stagesIn accordance with eGFR60mL/min/1.73m2demarcation point, we divided259research objects into the case group (n=37) and the control group (n=222). Compared with the control group, people with higher postprandial plasma glucose, serum creatinine, urinary albumin-creatinine ratio and lower EZSCAN in the case group are older (P<0.05, the difference was statistically significant).The two kinds of detection’s Kappa values calculated using eGFR60mL/min/1.73m2and≥80mL/min/1.73m2as the standard was0.256and0.34respectively. It prompte that the two tests’observed consistent rates are closed in different renal hypofunction phase, their consistency are good.Part3The comparison between EZSCAN and rGFRAccording to demarcation point rGFR80mL/min/1.73m", we divided81research objects into the case group (n=49) and the control group (n=32). Compared with the control group, people with higher serum creatinine, lower eGFR and EZSCAN in the case group are older (P<0.05, the difference was statistically significant). EZSCAN and rGFR values are densely distributed between60and80mL/min/1.73m2.Using rGFR as the diagnostic criterion, we drew the ROC curve. EZSCAN’s AUC is0.726, and its sensitivity is91.8%, specificity is21.9%, authenticity is64.2%, positive predictive value is91.84%, negative predictive value is21.88%, positive likelihood ratio is1.176, and negative likelihood ratio is0.373.Part4Comparison the advantages and disadvantages of the three different screening methodsWe took rGFR as diagnostic standard to draw the EZSCAN’s and eGFR’s ROC curve. EZSCAN’s AUC is0.726, with91.8%sensitivity,21.9%specificity,64.2%authenticity, while eGFR’s AUC is0.881, its sensitivity is97.95%, specificity is34.38%, and authenticity is72.84%.But because of eZscan(?)’s advantages, such as more simple operation, short time-consuming, no trauma, simple data analysis, high sensitivity, few influence factors, and may be used for large-scale population screening, EZSCAN might be a good indicator to measure GFR in the absence of testing conditions.When we combined EZSCAN with eGFR to test GFR, the joint sensitivity was99.83%. Therefore, the misdiagnosis case by eZscan(?) will be reduced when both eZscan(?) and eGFR are used for screening GFR.Conclusions1. eZscan(?) can be used as a new noninvasive screening technology for diabetic renal insufficiency.2. Age is an independent risk factor of CKD, postprandial hyperglycemia and massive proteinuria are risk factors of CKDⅡand CKDⅢstage.3. eZscan(?) is worth widely applying in many places such as community health centers, medical centers, hospital outpatients and so on. It will become a noninvasive appropriate technology, to facilitate the community residents’health care.