Comparisons of Five Equations Used for Estimating the Glomerular Filtrations Rate in Chinese Adults
We aimed to assess the performance of revised MDRD, CKD-EPI, BIS, FAS and XiangYa equation in Chinese adults
We collected blood biochemical data of 623 chinese adult hospitalised patients within 48 hours before they underwent 99m Tc-DTPA GFR measurement. We computed the bias (mGFR-eGFR), the precision (IQR) ,the accuray (P30)and root mean square error (RMSE) relative to mGFR of each equation to evaluate performance. The ROC curves, Kappa value of McNemar test, Bland-Altman plot and the Intraclass correlation coefficient (ICC) were used to evaluate diagnostic accuracy and concordance.
Totally, the FAS combined Scr and cysC equation performed supreme accuracy(P30=57.5%, RMSE=19.26), the cysC-based equation performed superior to Scr-based equation. Detailed P30 of the CKD-EPI cysC , FAS cysC , MDRD, CKD-EPI Scr-cysC , CKD-EPI Scr , FAS Scr , XiangYa was 56.7%, 56.0%, 53.5%, 52.2%, 48.8%, 51.4%, 43.0%. The CKD-EPI cysC equation showed the lowest bias and the highest accuracy(bias=-2.23, P30=57.4%) in GFR<60ml/min/1.73m 2 , followed by the FASscr-cysC equation(bias=-6.89, P30=55.4%). The XiangYa equation perfomed best in GFR≥60ml/min/1.73m 2 while worst in GFR<60 ml/min/1.73m 2 with bias(-5.79 vs -19.05), IQR(18.21 vs 10.85), P30(86.2% vs 21.1%), RMSE(16.68 vs 21.34). The CKD-EPI cysC equation had the lowest bias and the best accuracy(bias=-2.23, P30=59.4%) in age ≥70 years adults, followed by the FAS Scr-cysC equation equivalented to BIS-2 Scr-cysC equation(bias -5.33 vs -4.90, P30=57.3%), while the XiangYa equation performed worstly (bias=-20.39, P30=26.6%). Best ROC AUC was gaven by the FAS Scr-cysC equation(0.951),so was it had the highest Kappa value(0.364). The lowest Bias showed in Bland-Altman plot was the CKD-EPI cysC equation(bias=7.46). The highest ICC value was gaven by the FAS Scr-cysC equation(0.921). Secondly, it was the XiangYa equation with the ICC of 0.912.
The FAS Scr-cysC equation is verified most suitable and simpler applied to Chinese population. The CKD-EPI cysC equation is appropriate used in moderately and severely injured GFR(CKD3-5stage) and Seniors over 70 years old. The XiangYa equation performed perfectly in slightly injured GFR (CKD1-2stage), while further verification of XiangYa equation in multiple region need to carried out especially in moderately and severely injured GFR and older adults.
Publisher URL: https://www.researchsquare.com/article/rs-17896/v1