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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Endocrinol. | doi: 10.3389/fendo.2019.00581

A validation study on eGFR equations in Chinese patients with diabetic or non-diabetic CKD

 Danshu Xie1, Hao Shi1, Wen Zhang1,  Jingyuan Xie1, Liyan Ni1, Ying Ding1, Yifan Wu2,  Yimin Lu3, Bing Chen4, Hongrui Wang5, Hong Ren1, Weiming Wang1, Na Liu5 and  Nan Chen1*
  • 1Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, China
  • 2Biomedical and Health informatics, University of Washington, United States
  • 3Université de Lausanne, Switzerland
  • 4Department of Pharmacy, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, China
  • 5Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, China

Aims
It remains controversial to choose the optimal equation to estimate glomerular filtration rate (GFR) in chronic kidney disease (CKD) patients with diabetes.
Materials and Methods
215 diabetic CKD patients and 192 non-diabetic CKD patients were enrolled in this study. Iohexol GFR, serum creatinine (SCr) and Cystatin C(CysC) were measured simultaneously for each patient. SCr- and CysC-based estimated GFR (eGFR) were calculated through eight equations, including three CKD-EPI equations, Revised Lund-Malmö study equation (RLM), CAPA equation and three Full Age Spectrum (FAS) equations. Bias, precision and accuracy were compared among eGFR equations with iohexol-GFR serving as measured GFR (mGFR). Independent predictive factors of accuracy were explored using multivariate logistic regression analysis.
Results
In the diabetic group, CKD-EPISCr-CysC showed the best performance among three CKD-EPI equations (interquartile range of 13.88 ml/min/1.73m2 and 30% accuracy of 72.56%). Compared to CKD-EPISCr-CysC, the other five equations did not significantly improve the performance of GFR estimates. Mostly, eGFR equations were less accurate in diabetic group than in non-diabetic group. Significant differences were found in different mGFR range (P<0.001). The multivariate logistic regression analysis identified that BMI, mGFR and diabetic kidney disease (DKD) status were independent predictors of accuracy of three equations in diabetic group. HbA1c was a predictor of accuracy of CKD-EPISCr and CKD-EPICysC in diabetic group.
Conclusions
This study showed that eGFR equations were less accurate in diabetic group than in non-diabetic group. CKD-EPIScr-CysC had the best performance among CKD-EPI equations in Chinese diabetic CKD patients. The other five equations did not significantly improve the performance of GFR estimates. BMI, mGFR, DKD status and HbA1c were independent factors associated with accuracy in eGFR equations.

Keywords: diabetes, Chronic kidney diseas (CKD), diabetic kidney disease, Glomerular filteration rate, CKD-EPI

Received: 20 Feb 2019; Accepted: 08 Aug 2019.

Edited by:

Jan Polák, Charles University, Czechia

Reviewed by:

Robert Ekart, University Clinical Centre Maribor, Slovenia
Pierre DELANAYE, University of Liège, Belgium
Sebastjan Bevc, University Clinical Centre Maribor, Slovenia  

Copyright: © 2019 Xie, Shi, Zhang, Xie, Ni, Ding, Wu, Lu, Chen, Wang, Ren, Wang, Liu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Nan Chen, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Department of Nephrology, Shanghai, China, cnrj100@126.com