Abstract
ObjectiveTo assess the clinical practicability of the ensemble learning model established by Liu et al. in estimating glomerular filtration rate (GFR) and validate whether it is a better model than the Asian modified Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in a cohort of Chinese chronic kidney disease (CKD) patients in an external validation study.MethodsAccording to the ensemble learning model and the Asian modified CKD-EPI equation, we calculated estimated GFRensemble and GFRCKD-EPI, separately. Diagnostic performance of the two models was assessed and compared by correlation coefficient, regression equation, Bland–Altman analysis, bias, precision and P30 under the premise of 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) dual plasma sample clearance method as reference method for GFR measurement (mGFR).ResultsA total of 158 Chinese CKD patients were included in our external validation study. The GFRensemble was highly related with mGFR, with the correlation coefficient of 0.94. However, regression equation of GFRensemble = 0.66*mGFR + 23.05, the regression coefficient was far away from one, and the intercept was wide. Compared with the Asian modified CKD-EPI equation, the diagnostic performance of the ensemble learning model also demonstrated a wider 95% limit of agreement in Bland-Altman analysis (52.6 vs 42.4 ml/min/1.73 m2), a poorer bias (8.0 vs 1.0 ml/min/1.73 m2, P = 0.02), an inferior precision (18.4 vs 12.7 ml/min/1.73 m2, P < 0.001) and a lower P30 (58.9% vs 74.1%, P < 0.001).ConclusionsOur study showed that the ensemble learning model cannot replace the Asian modified CKD-EPI equation for the first choice for GFR estimation in overall Chinese CKD patients.
Highlights
Chronic kidney disease (CKD) is a kind of troublesome disease threatening global human health [1]
Study subjects Those subjects following the criteria were enrolled in the study cohort: (1) Chinese patients meeting the diagnostic standard for CKD according to the National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines [12, 13]; (2) at least 18 years of age
Characteristics of the study populations We collected a total of 192 CKD patients with 99mTcDTPA dual plasma sample clearance method for Glomerular filtration rate (GFR) estimation, whereas 7 patients lacking of serum creatinine concentration (Scr) data, age and weight characteristics, 3 patients less than 18 years, 5 patients undergoing dialysis, 3 patients taking drugs effecting serum creatine value, 4 patients with edema and cardiac insufficiency, and 12 patients belonging to outliers after the outliner analysis
Summary
Chronic kidney disease (CKD) is a kind of troublesome disease threatening global human health [1]. The creatinine-based equations, such as modified diet in renal disease (MDRD) and chronic kidney disease epidemiology collaboration (CKD-EPI) equations, have the highest acceptability because of the simplicity and practicability [5,6,7,8,9]. The CKD-EPI equation developed in 2009 was widely used for GFR assessment and outperformed than the others [5, 6]. This equation could not adjust for racial variation and may underperform among Chinese CKD patients. Previous study showed that the Asian modified CKD-EPI equation could achieve a more accurate GFR estimation than the CKD-EPI equation developed in 2009 in Chinese CKD patients [8, 9]
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