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Modified Glomerular Filtration Rate Estimating Equation for Chinese Patients with Chronic Kidney Disease

Ying-Chun Ma^*, Li Zuo^*, Jiang-Hua Chen, Qiong Luo, Xue-Qing Yu, Ying Li^||, Jin-Sheng Xu^¶, Song-Min Huang^**, Li-Ning Wang, Wen Huang, Mei Wang^*, Guo-Bin Xu, Hai-Yan Wang^* on behalf of the Chinese eGFR Investigation Collaboration

^* Division of Nephrology and Institute of Nephrology, and Department of Clinical Laboratory, The First Hospital, Peking University, Beijing, Department of Nephrology, The First Hospital, ZheJang Medical College, ZheJiang, Department of Nephrology, ShenZhen Hospital, Peking University, ShenZhen, Department of Nephrology, The First Hospital, Sun Yat-sen University, GuangZhou, ^|| Department of Nephrology, The Third Hospital, and ^¶ Department of Nephrology, The Fourth Hospital, HeBei Medical University, ShiJia Zhuang, ^** Department of Nephrology, HuaXi Hospital, SiChuan University, ChengDu, Department of Nephrology, The First Hospital, China Medical University, ShenYang, and Department of Nephrology, TongRen Hospital, Capital Medical University, Beijing, China

Address correspondence to: Dr. Li Zuo, Division of Nephrology and Institute of Nephrology, The First Hospital, Peking University, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, PR China. Phone: +86-10-66551122 ext. 2388, +86-10-66551072; Fax: +86-10-66551055, +86-10-66551072; E-mail: zuoli{at}bjmu.edu.cn

Received for publication April 19, 2006. Accepted for publication August 2, 2006.

The Modification of Diet in Renal Disease (MDRD) equations provide a rapid method of assessing GFR in patients with chronic kidney disease (CKD). However, previous research indicated that modification of these equations is necessary for application in Chinese patients with CKD. The objective of this study was to modify MDRD equations on the basis of the data from the Chinese CKD population and compare the diagnostic performance of the modified MDRD equations with that of the original MDRD equations across CKD stages in a multicenter, cross-sectional study of GFR estimation from plasma creatinine, demographic data, and clinical characteristics. A total of 684 adult patients with CKD, from nine geographic regions of China were selected. A random sample of 454 of these patients were included in the training sample set, and the remaining 230 patients were included in the testing sample set. With the use of the dual plasma sampling ^99mTc-DTPA plasma clearance method as a reference for GFR measurement, the original MDRD equations were modified by two methods: First, by adding a racial factor for Chinese in the original MDRD equations, and, second, by applying multiple linear regression to the training sample and modifying the coefficient that is associated with each variable in the original MDRD equations and then validating in the testing sample and comparing it with the original MDRD equations. All modified MDRD equations showed significant performance improvement in bias, precision, and accuracy compared with the original MDRD equations, and the percentage of estimated GFR that did not deviate >30% from the reference GFR was >75%. The modified MDRD equations that were based on the Chinese patients with CKD offered significant advantages in different CKD stages and could be applied in clinical practice, at least in Chinese patients with CKD.

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