International Urology and Nephrology

, Volume 51, Issue 4, pp 677–690 | Cite as

How to estimate renal function in patients with liver disease: choosing the most suitable equation

  • Song Ren
  • Yue Chang
  • Qing Zhang
  • Xiang Wang
  • Haiyan Niu
  • Linyan Chen
  • Chengjiao Lv
  • Zhengyun Zhang
  • Xiaohui Xiang
  • Limin Zhu
  • Hai LiEmail author
Nephrology - Original Paper



Hepatitis B virus (HBV) infection is a public health challenge, especially in China. In clinical practice, HBV infection is associated with nephropathy. Impaired renal function is frequently observed in compensated Chronic Hepatitis B (CHB) and cirrhosis (LC). Thus, renal function must be monitored to avoid nephrotoxic effects before and during nucleoside analog treatment. Investigating the predictive markers of early renal dysfunction is essential. New GFR-predicting equations, based on Pcr and/or CystC, have been recently recommended in the general population, but their performance in liver disease patients has been rarely studied. In this study, we will discuss how to detect renal dysfunction in patients with HBV infection.


A total of 16 LC patients and 23 CHB patients were enrolled in this study, and we collected and compared the clinical data of the two groups. The estimated glomerular filtration rates (eGFRs) were also calculated by several equations. All patients received 99mTc-DTPA dynamic radionuclide imaging examinations to obtain mGFRs as the reference standard. To evaluate the performance of any equation in the CHB and LC groups, paired t test, Pearson’s correlation, Kappa analysis and Bland–Altman plots were utilized. Moreover, all 39 subjects were divided into two groups (according to GFR > 90 mL/min/1.73 m2). We compared the serum and urinary markers of kidney injury between the two groups and selected the indicators of renal injury by univariate analysis.


The mGFR was 72.26 ± 20.69 mL/min/1.73 m2 in the LC group, and 87.49 ± 25.91 mL/min/1.73 m2 in the CHB group. The paired t test results of eGFR and mGFR showed no difference between eGFR (estimated by the CHINAcr-cys equation) and mGFR (p > 0.05) in the compensated LC and CHB groups. The difference between mGFR and eGFR estimated by other methods was obvious (p < 0.05). Comparing the eGFRs (estimated by 5 different equations) with mGFR in the compensated LC and CHB groups, Pearson’s correlation showed that only eGFR (estimated by the CHINAcr-cys equation) had a significant correlation coefficient in CHB (r = 0.678, p = 0.000) and had the highest R2 (R2 = 0.459) among all other measures. The kappa consistency test showed that eGFR from CHINAscr-cys had poor consistency with mGFR in the compensated LC group but moderate consistency in the CHB group. Bland–Altman consistency analysis showed that in the CHB group, the CHINAcr-cys and CKD-EPIcr equations presented narrower acceptable limits than did the aMDRD, c-aMDRD, and CKD-EPIcr-cys equations (62.8, 56.1 vs .85.7, 102.9, 93.6 mL/min per 1.73 m2). In the compensated LC group, the CHINAcr-cys and CKD-EPIcr equations presented narrower acceptable limits than did the aMDRD, c-aMDRD, and CKD-EPIcr-cys equations (83.6, 81.3 vs. 98, 113.5, 106.3 mL/min per 1.73 m2). Serum or urinary markers were compared with renal function (GFR > 90 mL/min/1.73 m2) and showed International normalized ratio (INR) (p = 0.009), creatinine (p = 0.006), urine N-acetyl-β-glucosaminidase (NAG) (p = 0.001) and serum cystatin C (CysC) (p = 0.044).


The CHINAcr-cys equation may be more suitable for the estimation of GFR in Chinese patients with CHB or compensated cirrhosis. INR, creatinine, NAG, and CysC are proper biomarkers for screening renal dysfunction in Chinese patients with CHB or compensated LC.


Hepatitis B virus Hepatic fibrosis Renal injury Glomerular filtration rate 



Supported by the National Science and Technology Major Project (2016ZX10002011).

Author Contributions

SR, LZ and HL provided the ideas, and SR, HL and YC drafted the report. YC, QZ, XW, HN, LC, CL, ZZ and XX delivered experimental data. All authors have read and contributed to editing this manuscript and agree with the content and presentation of the paper.

Compliance with ethical standards

Conflict of interest

No conflicts of interest, financial or otherwise, are declared by the authors.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinPeople’s Republic of China
  2. 2.Department of Hepatopancreatobiliary and Splenic Medicine, Affiliated HospitalLogistics University of People’s Armed Police ForceTianjinPeople’s Republic of China
  3. 3.Department of UltrasonographyThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anPeople’s Republic of China

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