A Comparison of the Performances of an Artificial Neural Network and a Regression Model for GFR Estimation

Background Accurate estimation of glomerular filtration rate (GFR) is important in clinical practice. Current models derived from regression are limited by the imprecision of GFR estimates. We hypothesized that an artificial neural network (ANN) might improve the precision of GFR estimates. Study Design A study of diagnostic test accuracy. Setting & Participants 1,230 patients with chronic kidney disease were enrolled, including the development cohort (n = 581), internal validation cohort (n = 278), and external validation cohort (n = 371). Index Tests Estimated GFR (eGFR) using a new ANN model and a new regression model using age, sex, and standardized serum creatinine level derived in the development and internal validation cohort, and the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) 2009 creatinine equation. Reference Test Measured GFR (mGFR). Other Measurements GFR was measured using a diethylenetriaminepentaacetic acid renal dynamic imaging method. Serum creatinine was measured with an enzymatic method traceable to isotope-dilution mass spectrometry. Results In the external validation cohort, mean mGFR was 49 ± 27 (SD) mL/min/1.73 m2 and biases (median difference between mGFR and eGFR) for the CKD-EPI, new regression, and new ANN models were 0.4, 1.5, and −0.5 mL/min/1.73 m2 , respectively ( P < 0.001 and P = 0.02 compared to CKD-EPI and P < 0.001 comparing the new regression and ANN models). Precisions (IQRs for the difference) were 22.6, 14.9, and 15.6 mL/min/1.73 m2 , respectively ( P < 0.001 for both compared to CKD-EPI and P < 0.001 comparing the new ANN and new regression models). Accuracies (proportions of eGFRs not deviating >30% from mGFR) were 50.9%, 77.4%, and 78.7%, respectively ( P < 0.001 for both compared to CKD-EPI and P = 0.5 comparing the new ANN and new regression models). Limitations Different methods for measuring GFR were a source of systematic bias in comparisons of new models to CKD-EPI, and both the derivation and validation cohorts consisted of a group of patients who were referred to the same institution. Conclusions An ANN model using 3 variables did not perform better than a new regression model. Whether ANN can improve GFR estimation using more variables requires further investigation.