Melbourne Medical School, University of Melbourne, Austin Health, Melbourne, Victoria, Australia.
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia.
J Clin Endocrinol Metab. 2021 Jan 1;106(1):e61-e73. doi: 10.1210/clinem/dgaa722.
To evaluate diagnostic performance of glomerular filtration rate (GFR) estimated by modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), full age spectrum (FAS), and revised Lund-Malmö (r-LM) equations in adults with diabetes.
Individuals were included in this cross-sectional study if they had at least 1 measurement of technetium-99m diethylenetriamine-pentaacetic acid (99mTc-DTPA) GFR (mGFR) and serum creatinine (1487 patients with 2703 measures). GFR calculated by estimation equations was compared with mGFR. Diagnostic performance was assessed using concordance correlation coefficient (CCC), bias, precision, accuracy, reduced major axis regression (RMAR), and Bland-Altman plot. Analysis was repeated in subgroups based on sex, diabetes type, Hemoglobin A1C, and GFR level.
Of all patients, 1189 (86%) had type 2 diabetes. Mean mGFR, MDRD, CKD-EPI, FAS, and revised Lund-Malmö eGFR were 66, 72, 74, 71, and 67 mL/min/1.73m2, respectively. Overall, the r-LM had the highest CCC (0.83), lowest bias (-1.4 mL/min/1.73 m2), highest precision (16.2 mL/min/1.73 m2), and highest accuracy (P10 = 39%). The RMAR (slope, intercept) in r-LM, FAS, MDRD, and CKD-EPI was 1.18, -13.35; 0.97, -2.9; 1, -6.4, and 1.04, -11.3, respectively. The Bland-Altman plot showed that r-LM had the lowest mean difference and the narrowest 95% limit of agreement (-1.0, 54.1 mL/min/1.73 m2), while mean difference was more than 5-fold higher in FAS, MDRD, and CKD-EPI (-5.2, -6.3, and -8.2, respectively).
In adults with diabetes the revised Lund-Malmö performs better than MDRD, CKD-EPI, and FAS in calculating point estimates of GFR.
评估改良肾脏病饮食法（MDRD）、慢性肾脏病流行病学合作（CKD-EPI）、全年龄谱（FAS）和修订版隆德-马尔默（r-LM）公式在糖尿病患者中估算肾小球滤过率（GFR）的诊断性能。
本横断面研究纳入至少有 1 次 99mTc-DTPA GFR（mGFR）和血清肌酐测量值的个体（1487 例患者，共 2703 个测量值）。比较估算方程计算的 GFR 与 mGFR。使用一致性相关系数（CCC）、偏倚、精密度、准确性、简化回归直线（RMAR）和 Bland-Altman 图评估诊断性能。根据性别、糖尿病类型、糖化血红蛋白（HbA1C）和 GFR 水平对亚组进行重复分析。
所有患者中，1189 例（86%）患有 2 型糖尿病。平均 mGFR、MDRD、CKD-EPI、FAS 和 r-LM eGFR 分别为 66、72、74、71 和 67 mL/min/1.73m2。总体而言，r-LM 的 CCC 最高（0.83），偏倚最低（-1.4 mL/min/1.73 m2），精密度最高（16.2 mL/min/1.73 m2），准确性最高（P10=39%）。r-LM、FAS、MDRD 和 CKD-EPI 的 RMAR（斜率、截距）分别为 1.18、-13.35；0.97、-2.9；1、-6.4 和 1.04、-11.3。Bland-Altman 图显示 r-LM 的平均差异最小，95%一致性界限最窄（-1.0，54.1 mL/min/1.73 m2），而 FAS、MDRD 和 CKD-EPI 的平均差异则高出 5 倍以上（-5.2、-6.3 和-8.2）。
在糖尿病患者中，与 MDRD、CKD-EPI 和 FAS 相比，r-LM 更能准确估算 GFR 点估计值。
