| Objective The CKD-EPI equation,EPI-Asian equation,CG(Cockcroft-Gault)equation,MDRD(Modification of Diet in Renal Disease)equation and the modified MDRD equation had been used to estimate glomerular filtration rate widely.However,their agreement with the GFR with 99 m Tc-DTPA(the reference standard)in diabetic nephropathy patients of Chinese are barely studied.In our study,we try to evaluate the applicability of the CKD-EPI equation,EPI-Asian equation,CG(CockcroftGault)equation,MDRD(Modification of Diet in Renal Disease)equation and the modified MDRD equation for Chinese people in diabetic nephropathy patients of Chinese.Methods Based on GFR obtained with 99 m Tc-DTPA renal dynamic imaging and standardized by body surface area(BSA),343 Chinese patients with Type 2 diabetes in Endocrinology department,the Second Affiliated Hospital of Nanchang University from December 2015 to February 2017 were enrolled in this study.The GFR was estimated by five creatinine-based equations(the CKD-EPI equation,EPI-Asian equation,CG(Cockcroft-Gault)equation,MDRD equation and the modified MDRD equation for Chinese people).The e GFR were compared with the GFR.Performance in four indexes of difference,mean squared predication residual,linear correlation,Bland-Altman plot analysis,receiver operating characteristic(ROC)curve,accuracies of these equations were assessed in the patients of Type 2 diabetes.Results1.In 343 cases of Chinese patients with Type 2 diabetes,the median in the four indexes of difference was smaller(P<0.001)in e GFR1 than other e GFR.The e GFR1 has the smaller of mean squared predication residual and the higher of linear correlation.The slope of x-axis and the intercept of regression line on y-axis estimated by e GFR1 were smaller than other e GFR.In this study,we used Bland-Altman analysis for conformance assessment.The results showed that the consistency of GFR and GFR estimated by all equations was poor.The consistency limits of GFR and GFR estimated by all equations exceeded the value of 60 mlˇmin-1(1.73 m2)-1,in which the consistency of GFR and e GFR1 was the best one.In all equations,the GFR 30% compliance rate was the highest in the e GFR1(P<0.001),and the GFR 30% compliance rate was more than 70% only in the e GFR1,the GFR30% compliance rate was less than 70% in the all e GFR(P>0.001).The ROC curve showed that the maximum diagnostic accuracy of all the equations for the diagnosis of mild [GFR < 90 mlˇmin-1(1.73 m2)-1] was GFR1 and GFR3.The maximum diagnostic accuracy of all the equations for the moderate renal failure [GFR < 60mlˇmin-1(1.73 m2)-1] was not statistically significant(P>0.05).2.In group 1,the median in the four indexes of difference was smaller in e GFR1 than other e GFR.The GFR 15% and 30% compliance rates were not statistically significant(P>0.05).In group 2,the median in the four indexes of difference was smaller in e GFR3 than other e GFR.The GFR 15% and 30% compliance rates were not statistically significant(P > 0.05).In group 3,the median absolute percentage difference was smaller in e GFR5 than other e GFR.The GFR 30% compliance rate was not statistically significant(P>0.05).In all equations,the GFR 30% compliance rate was the highest in the e GFR4,the second was e GFR2(P<0.001).In group 4,the median absolute percentage difference was smaller in e GFR3 than other e GFR.The GFR 15% and 30% compliance rates were low and had not statistically significant(P>0.05).Conclusions:1.In the all patients with Type 2 diabetes: CKD-EPI equation was better than other equations in the aspects of deviation,correlation,15% accuracy,30% accuracy,95% consistency limits.The maximum diagnostic accuracy of CKD-EPI equation for the diagnosis of the mild decline of GFR and moderate renal failure was not inferior to other equations.The modified MDRD equation for Chinese people was inferior to other equations in the aspects of deviation,correlation,15% accuracy,30% accuracy,95% consistency limits.So we deprecate Modified MDRD equation for Chinese CKD disease using to estimate GFR in the Chinese patients with Type 2 diabetes.We advise to use CKD-EPI equation to estimate GFR in the Chinese patients with Type 2 diabetes when there have no better equations.2.The people with Type 2 diabetes in every group: When GFR ? 90mlˇmin-1(1.73 m2)-1,CKD-EPI equation was not inferior to other equations in the aspects of deviation,15% accuracy and 30% accuracy.When 60?GFR < 90mlˇmin-1(1.73 m2)-1,CG equation was not inferior to other equations in the aspects of deviation,15% accuracy and 30% accuracy.When 30?GFR<60 mlˇmin-1(1.73 m2)-1,the modified MDRD equation for Chinese people had the smaller deviation,but the GFR 15% and 30% compliance rates were lower than other equations.When15?GFR<30 mlˇmin-1(1.73 m2)-1,CG equation had the smaller deviation.But all the equations were failing in the GFR 15% or 30% compliance rates. |
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