Application evaluation of different equations for estimated glomerular filtration rate in the solitary functioning kidney population
SUN Han1 ZHAO Weihong2 WU Shuhua1 KE Cong3 ZHANG Yuan1▲
1.Department of Geriatrics, the Second Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou 215000, China;
2.Department of Geriatric Nephrology, the First Affiliated Hospital With Nanjing Medical University, Jiangsu Province, Nanjing 210029, China;
3.Department of General Surgery, the Second Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou 215000, China
Abstract：Objective To evaluate the efficacy of different equations for estimated glomerular filtration rate in the solitary functioning kidney subjects. Methods A total of 258 patients with solitary functioning kidney who underwent kidney dynamic imaging to evaluate kidney function in the Second Affiliated Hospital of Soochow University from January 2009 to December 2018 were included. The accuracy and precision of 9 glomerular filtration rate (GFR) evaluation equationes (MDRD, Peking, Macisaac, Steven 1, Steven 2, Steven 3, CKD-EPIScr, CKD-EPIScys C and CKD-EPIScr-Scys C) were measured by using the indexes of bias, interquartile interval of difference, and misclassification. Results The three estimation equations based on serum creatinine (Scr) at least overestimated the glomerular filtration rate of reference (rGFR) 10 mL/(min·1.73m2) in the whole cohort, especially Peking equation precision and accuracy are poor, the bias is 33.8 mL/(min·1.73m2). All three equations overestimated the estimated glomerular filtration rate (eGFR) at CKDl-3 phase, and underestimated eGFR at CKD4-5 phase. The two prediction equations of combined by Cys C and serum cystatin C (Scys C) showed good accuracy and consistency. The absolute value of median bias of CKD-EPIScr-Scys C equation was the smallest in the overall cohort, severe impaired kidney function, and acquired isolated kidney subjects, which were 11.1, 7.3 and 11.1 mL/ (min·1.73m2), respectively. And it had the highest accuracy which were 76.7%, 85.7% and 81.8%, respectively, and P ＜ 0.001 compared with rGFR. Conclusion In this study, CKD-EPIScr-Scys C equation is recommended as the first choice for kidney function evaluation in the solitary functioning kidney subjects. The accuracy of GFR estimation equation may be related to GFR level and kidney function markers, but not to solitary functioning kidney type.
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2019, Vol. 16 
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