Development and Validation of Creatinine-Based Estimates of the Glomerular Filtration Rate Equation from 99mTc-DTPA Imaging in the Malaysian Setting

Azrina Md Ralib, Farah Nadia Mohd Hanafiah, Iqbalmunawwir Abd Rashid, Mohamad Shahrir Abd Rahim, Fatimah Dzaharudin, Mohd Basri Mat Nor, Azrina Md Ralib, Farah Nadia Mohd Hanafiah, Iqbalmunawwir Abd Rashid, Mohamad Shahrir Abd Rahim, Fatimah Dzaharudin, Mohd Basri Mat Nor

Abstract

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 99mTc-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 99mTc-DTPA imaging measured GFR.

Methods: This was a cross-sectional study using the existing record of patients who were referred for 99mTc-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 ∗ 0.9935Age ∗ (SCr/23.473)-0.45159. In the validation cohort, both CKD-EPI and the new equation had the highest correlation to 99mTc-DTPA with a correlation coefficient of 0.81 (p < 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.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright © 2021 Azrina Md Ralib et al.

Figures

Figure 1
Figure 1
Flow chart of patients' recruitment.
Figure 2
Figure 2
Linear egression model of glomerular filtration rate and serum creatinine for actual data (blue circle) of 94 patients in the development cohort. A new equation was developed using generalized least square algorithm with the best prediction (orange cross).
Figure 3
Figure 3
Scatter plots of eGFRs and 99mTC-DTPA measured GFRs for (a) eGFRCG, (b) eGFRMDRD, (c) eGFRCKD-EPI, and (d) eGFRNE. The dotted line shows the regression line and 95% confidence interval. 99mTc-DTPA, Technetium-99m-diethylenetriaminepentaacetic acid; eGFR, estimated glomerular filtration rate; CG, Cockcroft–Gault; MDRD, Modification of Diet in Renal Disease; CKD-EPI, Chronic Kidney Disease-Epidemiology Collaboration; and NE: new equation.
Figure 4
Figure 4
Bland–Altman plots of eGFRs and 99mTC-DTPA measured GFRs for (a) eGFRCG, (b) eGFRMDRD, (c) eGFRCKD-EPI, and (d) eGFRNE. The dotted line shows the mean of bias, and the bold dashed line depicts 1.96 SD of the mean bias.

References

    1. Diego E., Castro P., Soy D., Poch E., Nicolás J. M. Predictive performance of glomerular filtration rate estimation equations based on cystatin C versus serum creatinine values in critically ill patients. American Journal of Health-System Pharmacy. 2016;73(4):206–215. doi: 10.2146/ajhp140852.
    1. Bragadottir G., Redfors B., Ricksten S.-E. Assessing glomerular filtration rate (GFR) in critically ill patients with acute kidney injury-true GFR versus urinary creatinine clearance and estimating equations. Critical Care. 2013;17(3):p. R108. doi: 10.1186/cc12777.
    1. Cockcroft D. W., Gault H. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41. doi: 10.1159/000180580.
    1. Levey A. S. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Annals of Internal Medicine. 1999;130(6):p. 461. doi: 10.7326/0003-4819-130-6-199903160-00002.
    1. Levey A. S., Stevens L. A., Schmid C. H., et al. A new equation to estimate glomerular filtration rate. Annals of Internal Medicine. 2009;150:p. 604.
    1. Rule A. D., Teo B. W. GFR estimation in Japan and China: what accounts for the difference? American Journal of Kidney Diseases. 2009;53(6):932–935. doi: 10.1053/j.ajkd.2009.02.011.
    1. Matsuo S., Yasuda Y., Imai E., Horio M. Current status of estimated glomerular filtration rate (eGFR) equations for Asians and an approach to create a common eGFR equation. Nephrology. 2010;15:45–48. doi: 10.1111/j.1440-1797.2010.01313.x.
    1. Zelnick L. R., Leca N., Young B., Bansal N. Association of the estimated glomerular filtration rate with vs without a coefficient for race with time to eligibility for kidney transplant. JAMA Network Open. 2021;4(1) doi: 10.1001/jamanetworkopen.2020.34004.e2034004
    1. Matsuo S., Imai E., Horio M., et al. Revised equations for estimated GFR from serum creatinine in Japan. American Journal of Kidney Diseases. 2009;53(6):982–992. doi: 10.1053/j.ajkd.2008.12.034.
    1. Jeong T.-D., Lee W., Yun Y.-M., Chun S., Song J., Min W.-K. Development and validation of the Korean version of CKD-EPI equation to estimate glomerular filtration rate. Clinical Biochemistry. 2016;49(9):713–719. doi: 10.1016/j.clinbiochem.2016.01.023.
    1. Praditpornsilpa K., Townamchai N., Chaiwatanarat T., et al. The need for robust validation for MDRD-based glomerular filtration rate estimation in various CKD populations. Nephrology Dialysis Transplantation. 2011;26(9):2780–2785. doi: 10.1093/ndt/gfq815.
    1. Assadi M., Eftekhari M., Hozhabrosadati M., et al. 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. International Urology and Nephrology. 2008;40(4):1059–1065. doi: 10.1007/s11255-008-9446-4.
    1. Liu X., Qiu X., Shi C., et al. Modified glomerular filtration rate-estimating equations developed in asiatic population for Chinese patients with type 2 diabetes. International Journal of Endocrinology. 2014;2014:9. doi: 10.1155/2014/521071.521071
    1. Liao Y., Liao W., Liu J., Xu G., Zeng R. Assessment of the CKD-EPI equation to estimate glomerular filtration rate in adults from a Chinese CKD population. Journal of International Medical Research. 2011;39(6):2273–2280. doi: 10.1177/147323001103900624.
    1. Ma Y. C., Zuo L., Zhang C. L., Wang M., Wang R. F., Wang H. Y. Comparison of 99mTc-DTPA renal dynamic imaging with modified MDRD equation for glomerular filtration rate estimation in Chinese patients in different stages of chronic kidney disease. Nephrology Dialysis Transplantation: Official Publication of the European Dialysis and Transplant Association-European Renal Association. 2007;22:417–423. doi: 10.1093/ndt/gfl603.
    1. Madala N. D., Nkwanyana N., Dubula T., Naiker I. P. Predictive performance of eGFR equations in South Africans of African and Indian ancestry compared with 99mTc-DTPA imaging. International Urology and Nephrology. 2012;44(3):847–855. doi: 10.1007/s11255-011-9928-7.
    1. Jalalonmuhali M., Kok Peng N., Soo Kun L. Comparative performance of creatinine-based estimated glomerular filtration rate equations in the Malays: a pilot study in tertiary hospital in Malaysia. International Journal of Nephrology. 2017;2017:7. doi: 10.1155/2017/2901581.2901581
    1. Jalalonmuhali M., Lim S. K., Md Shah M. N., Ng K. P. MDRD vs. CKD-EPI in comparison to 51Chromium EDTA: a cross sectional study of Malaysian CKD cohort. BMC Nephrology. 2017;18:p. 363. doi: 10.1186/s12882-017-0776-2.
    1. Jalalonmuhali M., Elagel S. M. A., Tan M. P., Lim S. K., Ng K. P. Estimating renal function in the elderly Malaysian patients attending medical outpatient clinic: a comparison between creatinine based and cystatin-C based equations. International Journal of Nephrology. 2018;2018:6. doi: 10.1155/2018/3081518.3081518
    1. Teo B. W., Xu H., Wang D., et al. GFR estimating equations in a multiethnic asian population. American Journal of Kidney Diseases. 2011;58(1):56–63. doi: 10.1053/j.ajkd.2011.02.393.
    1. Ma Y.-C., Zuo L., Chen J.-H., et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. Journal of the American Society of Nephrology. 2006;17(10):2937–2944. doi: 10.1681/asn.2006040368.
    1. Chaves A. A. R., Buchpiguel C. A., Praxedes J. N., Bortolotto L. A., Sapienza M. T. Glomerular filtration rate measured by 51Cr-EDTA clearance: evaluation of captopril-induced changes in hypertensive patients with and without renal artery stenosis. Clinics. 2010;65(6):607–612. doi: 10.1590/s1807-59322010000600008.
    1. Petersen L. Glomerular filtration rate estimated from the uptake phase of 99Tc-DTPA renography in chronic renal failure. Nephrology Dialysis Transplantation. 1999;14(7):1673–1678. doi: 10.1093/ndt/14.7.1673.
    1. Boele-Schutte E., Gansevoort R. T. Measured GFR: not a gold, but a gold-plated standard. Nephrology Dialysis Transplantation. 2017;32(2):ii180–ii184. doi: 10.1093/ndt/gfw441.

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