Details

Autor(en) / Beteiligte

• Matsushita, Kunihiro, MD, PhD
• Selvin, Elizabeth, PhD, MPH
• Bash, Lori D., MPH, PhD
• Astor, Brad C., PhD, MPH
• Coresh, Josef, MD, PhD

Titel

Risk Implications of the New CKD Epidemiology Collaboration (CKD-EPI) Equation Compared With the MDRD Study Equation for Estimated GFR: The Atherosclerosis Risk in Communities (ARIC) Study

Ist Teil von

• American journal of kidney diseases, 2010-04, Vol.55 (4), p.648-659

Ort / Verlag

New York, NY: Elsevier Inc

Erscheinungsjahr

2010

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Background The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recently published an equation for estimated glomerular filtration rate (eGFR) using the same variables (serum creatinine level, age, sex, and race) as the Modification of Diet in Renal Disease (MDRD) Study equation. Although the CKD-EPI equation estimates GFR more precisely compared with the MDRD Study equation, whether this equation improves risk prediction is unknown. Study Design Prospective cohort study, the Atherosclerosis Risk in Communities (ARIC) Study. Setting & Participants 13,905 middle-aged participants without a history of cardiovascular disease with median follow-up of 16.9 years. Predictor eGFR. Outcomes & Measurements We compared the association of eGFR in categories (≥120, 90-119, 60-89, 30-59, and <30 mL/min/1.73 m2 ) using the CKD-EPI and MDRD Study equations with risk of incident end-stage renal disease, all-cause mortality, coronary heart disease, and stroke. Results The median value for eGFRCKD-EPI was higher than that for eGFRMDRD (97.6 vs 88.8 mL/min/1.73 m2 ; P < 0.001). The CKD-EPI equation reclassified 44.9% (n = 3,079) and 43.5% (n = 151) of participants with eGFRMDRD of 60-89 and 30-59 mL/min/1.73 m2 , respectively, upward to a higher eGFR category, but reclassified no one with eGFRMDRD of 90-119 or <30 mL/min/1.73 m2 , decreasing the prevalence of CKD stages 3-5 from 2.7% to 1.6%. Participants with eGFRMDRD of 30-59 mL/min/1.73 m2 who were reclassified upward had lower risk compared with those who were not reclassified (end-stage renal disease incidence rate ratio, 0.10 [95% CI, 0.03-0.33]; all-cause mortality, 0.30 [95% CI, 0.19-0.48]; coronary heart disease, 0.36 [95% CI, 0.21-0.61]; and stroke, 0.50 [95% CI, 0.24-1.02]). Similar results were observed for participants with eGFRMDRD of 60-89 mL/min/1.73 m2 . More frequent reclassification of younger, female, and white participants explained some of these trends. Net reclassification improvement in participants with eGFR < 120 mL/min/1.73 m2 was positive for all outcomes ( P < 0.001). Limitations Limited number of cases with eGFR < 60 mL/min/1.73 m2 and no measurement of albuminuria. Conclusions The CKD-EPI equation more appropriately categorized individuals with respect to long-term clinical risk compared with the MDRD Study equation, suggesting improved clinical usefulness in this middle-aged population.