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

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-EP...

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Vydáno v:	American journal of kidney diseases Ročník 55; číslo 4; s. 648
Hlavní autoři:	Matsushita, Kunihiro, Selvin, Elizabeth, Bash, Lori D, Astor, Brad C, Coresh, Josef
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.04.2010
Témata:	Cause of Death Chronic Disease Coronary Disease - epidemiology Coronary Disease - etiology Female Glomerular Filtration Rate Humans Kidney Diseases - complications Kidney Diseases - diet therapy Kidney Diseases - epidemiology Kidney Diseases - physiopathology Kidney Failure, Chronic - epidemiology Kidney Failure, Chronic - etiology Male Mathematics Middle Aged Prospective Studies Risk Assessment Stroke - epidemiology Stroke - etiology
ISSN:	1523-6838, 1523-6838
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Abstract	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. Prospective cohort study, the Atherosclerosis Risk in Communities (ARIC) Study. 13,905 middle-aged participants without a history of cardiovascular disease with median follow-up of 16.9 years. eGFR. We compared the association of eGFR in categories (>or=120, 90-119, 60-89, 30-59, and <30 mL/min/1.73 m(2)) using the CKD-EPI and MDRD Study equations with risk of incident end-stage renal disease, all-cause mortality, coronary heart disease, and stroke. The median value for eGFR(CKD-EPI) was higher than that for eGFR(MDRD) (97.6 vs 88.8 mL/min/1.73 m(2); P < 0.001). The CKD-EPI equation reclassified 44.9% (n = 3,079) and 43.5% (n = 151) of participants with eGFR(MDRD) of 60-89 and 30-59 mL/min/1.73 m(2), respectively, upward to a higher eGFR category, but reclassified no one with eGFR(MDRD) of 90-119 or <30 mL/min/1.73 m(2), decreasing the prevalence of CKD stages 3-5 from 2.7% to 1.6%. Participants with eGFR(MDRD) of 30-59 mL/min/1.73 m(2) 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 eGFR(MDRD) of 60-89 mL/min/1.73 m(2). 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 m(2) was positive for all outcomes (P < 0.001). Limited number of cases with eGFR < 60 mL/min/1.73 m(2) and no measurement of albuminuria. 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.
AbstractList	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. Prospective cohort study, the Atherosclerosis Risk in Communities (ARIC) Study. 13,905 middle-aged participants without a history of cardiovascular disease with median follow-up of 16.9 years. eGFR. We compared the association of eGFR in categories (>or=120, 90-119, 60-89, 30-59, and <30 mL/min/1.73 m(2)) using the CKD-EPI and MDRD Study equations with risk of incident end-stage renal disease, all-cause mortality, coronary heart disease, and stroke. The median value for eGFR(CKD-EPI) was higher than that for eGFR(MDRD) (97.6 vs 88.8 mL/min/1.73 m(2); P < 0.001). The CKD-EPI equation reclassified 44.9% (n = 3,079) and 43.5% (n = 151) of participants with eGFR(MDRD) of 60-89 and 30-59 mL/min/1.73 m(2), respectively, upward to a higher eGFR category, but reclassified no one with eGFR(MDRD) of 90-119 or <30 mL/min/1.73 m(2), decreasing the prevalence of CKD stages 3-5 from 2.7% to 1.6%. Participants with eGFR(MDRD) of 30-59 mL/min/1.73 m(2) 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 eGFR(MDRD) of 60-89 mL/min/1.73 m(2). 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 m(2) was positive for all outcomes (P < 0.001). Limited number of cases with eGFR < 60 mL/min/1.73 m(2) and no measurement of albuminuria. 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. 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.BACKGROUNDThe 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.Prospective cohort study, the Atherosclerosis Risk in Communities (ARIC) Study.STUDY DESIGNProspective cohort study, the Atherosclerosis Risk in Communities (ARIC) Study.13,905 middle-aged participants without a history of cardiovascular disease with median follow-up of 16.9 years.SETTING & PARTICIPANTS13,905 middle-aged participants without a history of cardiovascular disease with median follow-up of 16.9 years.eGFR.PREDICTOReGFR.We compared the association of eGFR in categories (>or=120, 90-119, 60-89, 30-59, and <30 mL/min/1.73 m(2)) using the CKD-EPI and MDRD Study equations with risk of incident end-stage renal disease, all-cause mortality, coronary heart disease, and stroke.OUTCOMES & MEASUREMENTSWe compared the association of eGFR in categories (>or=120, 90-119, 60-89, 30-59, and <30 mL/min/1.73 m(2)) using the CKD-EPI and MDRD Study equations with risk of incident end-stage renal disease, all-cause mortality, coronary heart disease, and stroke.The median value for eGFR(CKD-EPI) was higher than that for eGFR(MDRD) (97.6 vs 88.8 mL/min/1.73 m(2); P < 0.001). The CKD-EPI equation reclassified 44.9% (n = 3,079) and 43.5% (n = 151) of participants with eGFR(MDRD) of 60-89 and 30-59 mL/min/1.73 m(2), respectively, upward to a higher eGFR category, but reclassified no one with eGFR(MDRD) of 90-119 or <30 mL/min/1.73 m(2), decreasing the prevalence of CKD stages 3-5 from 2.7% to 1.6%. Participants with eGFR(MDRD) of 30-59 mL/min/1.73 m(2) 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 eGFR(MDRD) of 60-89 mL/min/1.73 m(2). 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 m(2) was positive for all outcomes (P < 0.001).RESULTSThe median value for eGFR(CKD-EPI) was higher than that for eGFR(MDRD) (97.6 vs 88.8 mL/min/1.73 m(2); P < 0.001). The CKD-EPI equation reclassified 44.9% (n = 3,079) and 43.5% (n = 151) of participants with eGFR(MDRD) of 60-89 and 30-59 mL/min/1.73 m(2), respectively, upward to a higher eGFR category, but reclassified no one with eGFR(MDRD) of 90-119 or <30 mL/min/1.73 m(2), decreasing the prevalence of CKD stages 3-5 from 2.7% to 1.6%. Participants with eGFR(MDRD) of 30-59 mL/min/1.73 m(2) 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 eGFR(MDRD) of 60-89 mL/min/1.73 m(2). 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 m(2) was positive for all outcomes (P < 0.001).Limited number of cases with eGFR < 60 mL/min/1.73 m(2) and no measurement of albuminuria.LIMITATIONSLimited number of cases with eGFR < 60 mL/min/1.73 m(2) and no measurement of albuminuria.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.CONCLUSIONSThe 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.
Author	Coresh, Josef Bash, Lori D Astor, Brad C Selvin, Elizabeth Matsushita, Kunihiro
Author_xml	– sequence: 1 givenname: Kunihiro surname: Matsushita fullname: Matsushita, Kunihiro email: kmatsush@jhsph.edu organization: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD 21287, USA. kmatsush@jhsph.edu – sequence: 2 givenname: Elizabeth surname: Selvin fullname: Selvin, Elizabeth – sequence: 3 givenname: Lori D surname: Bash fullname: Bash, Lori D – sequence: 4 givenname: Brad C surname: Astor fullname: Astor, Brad C – sequence: 5 givenname: Josef surname: Coresh fullname: Coresh, Josef
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/20189275$$D View this record in MEDLINE/PubMed
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ContentType	Journal Article
Copyright	Copyright 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Copyright_xml	– notice: Copyright 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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References	20338463 - Am J Kidney Dis. 2010 Apr;55(4):622-7. doi: 10.1053/j.ajkd.2010.02.337.
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Snippet	The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recently published an equation for estimated glomerular filtration rate (eGFR) using the same...
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SubjectTerms	Cause of Death Chronic Disease Coronary Disease - epidemiology Coronary Disease - etiology Female Glomerular Filtration Rate Humans Kidney Diseases - complications Kidney Diseases - diet therapy Kidney Diseases - epidemiology Kidney Diseases - physiopathology Kidney Failure, Chronic - epidemiology Kidney Failure, Chronic - etiology Male Mathematics Middle Aged Prospective Studies Risk Assessment Stroke - epidemiology Stroke - etiology
Title	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
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