Development and Validation of Creatinine-Based Estimates of the Glomerular Filtration Rate Equation from Tc-DTPA Imaging in the Malaysian Setting.

INTRODUCTION

Accurate assessment of glomerular filtration rate (GFR) is very important for diagnostic and therapeutic intervention. Clinically, GFR is estimated from plasma creatinine using equations such as Cockcroft-Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equations. However, these were developed in the Western population. To the best of our knowledge, there was no equation that has been developed specifically in our population.

OBJECTIVES

We developed a new equation based on the gold standard of Tc-DTPA imaging measured GFR. We then performed an internal validation by comparing the bias, precision, and accuracy of the new equation and the other equations with the gold standard of Tc-DTPA imaging measured GFR.

METHODS

This was a cross-sectional study using the existing record of patients who were referred for Tc-DTPA imaging at the Nuclear Medicine Centre, International Islamic University Malaysia. As this is a retrospective study utilising routinely collected data from the existing pool of data, the ethical committee has waived the need for informed consent.

RESULTS

Data of 187 patients were analysed from January 2016 to March 2021. Of these, 94 were randomised to the development cohort and 93 to the validation cohort. A new equation of eGFR was determined as 16.637 ∗ 0.9935 ∗ (SCr/23.473). In the validation cohort, both CKD-EPI and the new equation had the highest correlation to Tc-DTPA with a correlation coefficient of 0.81 ( < 0.0001). However, the new equation had the least bias and was the most precise (mean bias of -3.58 ± 12.01) and accurate (P30 of 64.5% and P50 of 84.9%) compared to the other equations.

CONCLUSION

The new equation which was developed specifically using our local data population was the most accurate and precise, with less bias compared to the other equations. Further study validating this equation in the perioperative and intensive care patients is needed.