Article Figures & Data
Figures
- Figure 1.
Bland-Altman plot showing the disagreement between estimated GFR (eGFR; including aGFR, c-aGFR1, and c-aGFR2) and reference GFR (rGFR). Solid line represents the regression line of difference between methods against average of methods, dashed lines represent 95% confidence intervals for the regression line, and dotted lines represent 95% limits of agreement. aGFR, eGFR (ml/min per 1.73 m2) by original abbreviated Modification of Diet in Renal Disease (MDRD) equation; c-aGFR1, eGFR (ml/min per 1.73 m2) by modified abbreviated MDRD equation by adding a racial factor for Chinese; c-aGFR2, eGFR (ml/min per 1.73 m2) by modified abbreviated MDRD equation based on the result of multiple linear regression from data of Chinese patients with chronic kidney disease (CKD). (A) Disagreement between aGFR and average of aGFR and rGFR. (B) Disagreement between c-aGFR1 and average of c-aGFR1 and rGFR. (C) Disagreement between c-aGFR2 and average of c-aGFR2 and rGFR.
- Figure 2.
Comparison of equations: Difference between eGFR and rGFR. The differences between equations 3 through 6 eGFR and rGFR were significantly less than those between equations 1 and 2 eGFR and rGFR in each CKD stage (P < 0.05 for all).
- Figure 3.
Comparison of equations: Absolute difference between eGFR and rGFR. The absolute differences between equations 3 through 6 eGFR and rGFR were significantly less than those between equations 1 and 2 eGFR and rGFR in CKD stages 1 and 2 (P < 0.05 for all). The absolute differences of equations 3 through 6 were also less than those of equations 1 and 2 in CKD stage 3 but without statistical significance. The absolute differences of the six equations were similar in stages 4 and 5.
- Figure 4.
Comparison of equations: 15, 30, and 50% accuracy of equations in various stages of CKD. In CKD stages 1 and 2, equations 3 through 6 showed significant improvements in 15 and 30% accuracy compared with equations 1 and 2 (P < 0.05 for all); significant 15% accuracy were achieved comparing equations 3 and 5 with equations 1 and 2 in CKD stage 3 (P < 0.05 for both); some improvement was achieved comparing equations 4 and 6 with equations 1 and 2 in CKD stage 3 without statistical significance. In CKD stages 4 and 5, 15% accuracy improvements of equations 3 through 6 was gained without statistical significance. The 15 and 30% accuracy among equations 3 through 6 were not significantly different. The 50% accuracy of the six equations was not significantly different in each stage of CKD.
Tables
Characteristic (n = 684) Mean ± SD (Median) or n (%) Female (n [%]) 332 (48.53) Age (yr) 49.9 ± 15.8 (49.0) Height (cm) 164.7 ± 8.3 (165.0) Weight (kg) 64.5 ± 12.4 (63.0) BSA (m2) 1.7 ± 0.18 (1.7) BMI (kg/m2) 23.6 ± 3.6 (23.4) Plasma creatinine (mg/dl) 2.0 ± 1.8 (1.3) Plasma urea nitrogen (mg/dl) 28.4 ± 19.9 (21.5) Plasma albumin (g/dl) 3.99 ± 0.6 (4.1) rGFR (ml/min per 1.73 m2) 55.1 ± 35.1 (49.9) Causes of CKD primary or secondary glomerular disease 264 (38.6) hypertension 102 (14.9) obstructive kidney disease 92 (13.5) renovascular disease 89 (13.0) chronic tubulointerstitial disease 44 (6.4) diabetic nephropathy 37 (5.4) polycystic kidney disease 18 (2.6) other causes or causes unknown 38 (5.6) CKD stages 1 125 (18.3) 2 161 (23.6) 3 197 (28.8) 4 101 (14.7) 5 100 (14.6) ↵a BMI, body mass index; BSA, body surface area; CKD, chronic kidney disease; rGFR, reference GFR.
- Table 2.
Overall performance of eGFR equations compared with rGFR: Difference, absolute difference, bias, precision, and accuracya
Parameter Equation 1 Equation 2 Equation 3 Equation 4 Equation 5 Equation 6 Intercept (95% CI) 6.45 (3.78 to 9.84) 6.58 (3.75 to 9.39) 7.76 (4.54 to 10.98) 8.06 (4.61 to 11.53) 8.55 (5.45 to 11.64) 9.54 (6.26 to 12.81) Slope (95% CI) 0.69 (0.65 to 0.74) 0.68 (0.64 to 0.72) 0.84b (0.78 to 0.88) 0.83b (0.78 to 0.88) 0.82b (0.77 to 0.87) 0.81b (0.76 to 0.85) R 0.91 0.90 0.91 0.90 0.92 0.91 R2 0.84 0.81 0.84 0.81 0.84 0.82 Median of difference (ml/min per 1.73 m2; 25%, 75% percentile) −7.4 (−19.5, −1.3) −7.8 (−21.5, −1.8) −0.3b (−8.5, 6.3) −0.9b (−9.6, 7.4) −0.8b (−9.7, 7.4) −0.8b (−9.7, 7.4) Median of absolute difference (ml/min per 1.73 m2; 25%, 75% percentile) 8.7 (3.7, 19.5) 9.4 (4.2, 21.5) 7.3b (2.7, 15.1) 8.8b (3.3, 15.2) 7.1b (2.7, 15.6) 7.9b (3.3, 15.6) Bias (arbitrary units) 2133.9 2175.0 605.8 543.0 685.6 677.2 Precision (ml/min per 1.73 m2; %) 57.6 60.7 54 57.5 53.2 56.5 15% accuracy 32.6 30.0 50.4b 48.7b 47.4b 46.9b 30% accuracy 70.4 66.1 76.1 77.8b 79.6b 79.6b 50% accuracy 95.2 93.9 93.9 92.2 93.5 93.0 ↵a The estimated GFR (eGFR) that resulted from these six equations all were significantly correlated with rGFR. Linear regressions were made using eGFR against rGFR. The six intercepts were much similar, but the slopes of equations 3 through 6 were significantly closer to the identical line compared with the slopes of equations 1 and 2. CI, confidence interval.
↵b P < 0.05 compared with equations 1 and 2.
- Table 3.
Percentages of CKD stage misclassification by original and modified equations in CKD stages 1 and 2a
Classification Based on: CKD Stage Based on rGFR 1 2 Equation 1 CKD stage 1 28.6 0 CKD stage 2 71.4 40 CKD stage 3 0 60 Equation 2 CKD stage 1 26.2 1.7 CKD stage 2 73.8 31.7 CKD stage 3 0 66.6 Equation 3 CKD stage 1 52.4 8.3 CKD stage 2 47.6 70 CKD stage 3 0 21.7 Equation 4 CKD stage 1 54.8 13.3 CKD stage 2 45.2 68.3 CKD stage 3 0 18.4 Equation 5 CKD stage 1 45.2 10 CKD stage 2 54.8 68.3 CKD stage 3 0 21.7 Equation 6 CKD stage 1 47.6 11.7 CKD stage 2 52.4 68.3 CKD stage 3 0 20 ↵a In CKD stage 1, equations 3 through 6 showed lower percentages of misclassification than equations 1 and 2 (P < 0.05 for equations 3 and 4; NS for equations 5 and 6). In CKD stage 2, equations 3 through 6 achieved lower percentages of misclassification than equations 1 and 2 (P < 0.05 for all).
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