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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

  • Nephrology - Original Paper
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Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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.

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Funding

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.

Author information

Authors and Affiliations

  1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, 100853, China

    Qi Huang, Yunshuang Chen, Min Zhang, Weiguang Zhang, Guangyan Cai, Xiangmei Chen & Xuefeng Sun

  2. Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Qi Huang

  3. Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH, USA

    Sihe Wang

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  1. Qi Huang
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  2. Yunshuang Chen
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Corresponding author

Correspondence to Xuefeng Sun.

Appendix

Appendix

See Table 5.

Table 5 The evaluating equations of GFR (eGFR)
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Huang, Q., Chen, Y., Zhang, M. et al. 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. Int Urol Nephrol 50, 733–743 (2018). https://doi.org/10.1007/s11255-018-1811-3

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