IDF21-0493 Calibrating estimated glomerular filtration rate cut points in adults with diabetes

Background: Accurate estimation of glomerular filtration rate (GFR) is pivotal in managing diabetic kidney disease. Aim: To assess the performance modification diet renal disease (MDRD), and chronic epidemiology collaboration (CKD-EPI) estimated GFR for diagnosing clinically significant cut-points adults with diabetes. Method: Data from 1487 participants (86% type 2 diabetes) 2703 measurements plasma clearance 99mTc-diethylenetriamine-pentaacetic acid (99mTc-DTPA) as reference test was analysed. Area under receiver operating characteristic curve (AUC) MDRD CKD-EPI equations well their sensitivity, specificity, AUC at were investigated <15mL/min/1.73m2 (threshold CKD stage5), GFR<30 stage4), GFR<45 stage3b), GFR<60 stage3a), GFR<90 stage2) GFR≥120mL/min/1.73m2 (signifying a state hyperfiltration). The above-mentioned calibrated using Youden index. Results: Mean (SD) 99mTc-DTPA measured 66 (25)ml/min/1.73m2. proportion different (ml/min/1.73m2) thresholds <15: 0.5%, <30: 7%, <45: 22%, <60:43 %, <90: 83%, ≥120: 3%. general ranged between 0.87 0.98. However, AUCs cut points <0.82 both equations. Increasing stage 5, 4, 3 cut-point decreasing hyperfiltration increased sensitivities by approximately 15–60%. Similarly CKD-EPI, increasing 3, resulted 1-65% increase (Table). Table. Sensitivity, established relevant GFRs suggested maximising equationsTabled 1Existing (mL/min/1.73 m2)Suggested m2)SensitivitySpecificityAUC cut-pointSensitivitySpecificityAUC cut-pointMDRD15311000.65 (0.52, 0.78)3792920.92 (0.85, 1.00)3040990.70 (0.66, 0.73)4385930.89 (0.87, 0.92)4557970.77 (0.75, 0.79)6190840.87 (0.86, 0.89)6066960.81 (0.80, 0.82)6881850.83 (0.82, 0.85)9086660.76 (0.73, 0.78)8277800.78 (0.76, 0.80)12036980.67 (0.61, 0.72)10373910.82 (0.77, 0.87)CKD-EPI15381000.69 (0.55, 0.83)3485940.90 (0.79, 1.00)3045990.72 (0.68, 0.76)4488920.90 (0.88, 0.92)4556970.76 (0.74, 0.79)5885900.87 0.89)6062970.80 (0.78, 0.81)7081890.85 (0.83, 0.86)9082810.82 0.83)9183790.81 0.83)12020990.59 0.64)10084880.86 0.90) Open table new tab Discussion: When assessed continuously, have excellent discriminatory power identifying cut-points. sensitivity determining determined direct low. There major discordance stages those that optimised estimates GFR. This work highlights need to improve current methods estimating people