Comparative evaluation of technetium-99m-diethylenetriaminepentaacetic acid renal dynamic imaging versus the Modification of Diet in Renal Disease equation and the Chronic Kidney Disease Epidemiology Collaboration equation for the estimation of GFR
We compared the performance of technetium-99m-diethylenetriaminepentaacetic acid (99mTc-DTPA) renal dynamic imaging (RDI), the MDRD equation, and the CKD EPI equation to estimate glomerular filtration rate (GFR).
A total of 551 subjects, including CKD patients and healthy individuals, were enrolled in this study. Dual plasma sample clearance method of 99mTc-DTPA was used as the true value for GFR (tGFR). RDI and the MDRD and CKD EPI equations for estimating GFR were compared and evaluated.
Data indicate that RDI and the MDRD equation underestimated GFR and CKD EPI overestimated GFR. RDI was associated with significantly higher bias than the MDRD and CKD EPI equations. The regression coefficient, diagnostic precision, and consistency of RDI were significantly lower than either equation. RDI and the MDRD equation underestimated GFR to a greater degree in subjects with tGFR ≥ 90 ml/min/1.73 m2 compared with the results obtained from all subjects. In the tGFR60-89 ml/min/1.73 m2 group, the precision of RDI was significantly lower than that of both equations. In the tGFR30-59 ml/min/1.73 m2 group, RDI had the least bias, the most precision, and significantly higher accuracy compared with either equation. In tGFR < 30 ml/min/1.73 m2, the three methods had similar performance and were not significantly different.
RDI significantly underestimates GFR and performs no better than MDRD and CKD EPI equations for GFR estimation; thus, it should not be recommended as a reference standard against which other GFR measurement methods are assessed. However, RDI better estimates GFR than either equation for individuals in the tGFR30-59 ml/min/1.73 m2 group and thus may be helpful to distinguish stage 3a and 3b CKD.
KeywordsRenal dynamic imaging (RDI) Glomerular filtration rate (GFR) Modification of Diet in Renal Disease (MDRD) equation Chronic Kidney Disease Epidemiology Collaboration (CKD EPI) equation
This work was supported by the grants from the Major State Basic Research Development Program of China (2013CB530800), National Natural Science Foundation of China (81270819), National Key Technology R&D Program (2011BAI10B00). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
- 4.Xie P, Huang JM, Liu XM, Wu WJ, Pan LP, Lin HY (2013) (99m)Tc-DTPA renal dynamic imaging method may be unsuitable to be used as the reference method in investigating the validity of CDK-EPI equation for determining glomerular filtration rate. PLoS ONE 8:e62328CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Goates JJ, Morton KA, Whooten WW, Greenberg HE, Datz FL, Handy JE et al (1990) Comparison of methods for calculating glomerular filtration rate: technetium-99m-DTPA scintigraphic analysis, protein-free and whole-plasma clearance of technetium-99m-DTPA and iodine-125-iothalamate clearance. J Nucl Med 31:424–429PubMedGoogle Scholar
- 11.Li JT, Xun C, Cui CL, Wang HF, Wu YT, Yun AH et al (2012) Relative performance of two equations for estimation of glomerular filtration rate in a Chinese population having chronic kidney disease. Chin Med J (Engl) 125:599–603Google Scholar
- 15.Foundation National Kidney, Initiative Kidney Disease Outcomes Quality (2002) Clinical practice guidelines for chronic kidney disease: evaluation classification, and stratification. Am J Kidney Dis 39:S1–S266Google Scholar
- 18.Stevens LA, Schmid CH, Greene T, Zhang YL, Beck GJ, Froissart M et al (2010) Comparative performance of the CKD Epidemiology Collaboration (CKD EPI) and the Modification of Diet in Renal Disease (MDRD) Study equations for estimating GFR levels above 60 ml/min/1.73 m2. Am J Kidney Dis 56:486–495CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Assadi M, Eftekhari M, Hozhabrosadati M, Saghari M, Ebrahimi A, Nabipour I et al (2008) Comparison of methods for determination of glomerular filtration rate: low and high-dose Tc-99m-DTPA renography, predicted creatinine clearance method, and plasma sample method. Int Urol Nephrol 40:1059–1065CrossRefPubMedGoogle Scholar
- 36.Matsushita K, Mahmoodi BK, Woodward M, Emberson JR, Jafar TH, Jee SH et al (2012) Chronic Kidney Disease Prognosis Consortium. Comparison of risk prediction using the CKD EPI equation and the MDRD study equation for estimated glomerular filtration rate. JAMA 307:1941–1951CrossRefPubMedGoogle Scholar
- 37.Matsushita K, Selvin E, Bash LD, Astor BC, Coresh J (2010) Risk implications of the new CKD Epidemiology Collaboration (CKD EPI) equation compared with the MDRD Study equation for estimated GFR: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 55:648–659CrossRefPubMedPubMedCentralGoogle Scholar
- 38.White SL, Polkinghorne KR, Atkins RC, Chadban SJ (2010) Comparison of the prevalence and mortality risk of CKD in Australia using the CKD Epidemiology Collaboration (CKD EPI) and Modification of Diet in Renal Disease (MDRD) Study GFR estimating equations: the AusDiab (Australian Diabetes, Obesity and Lifestyle) Study. Am J Kidney Dis 55:660–670CrossRefPubMedGoogle Scholar