Tags

Type your tag names separated by a space and hit enter

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.
Am J Kidney Dis. 2010 Apr; 55(4):648-59.AJ

Abstract

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 (>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.

RESULTS

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).

LIMITATIONS

Limited number of cases with eGFR < 60 mL/min/1.73 m(2) 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.

Authors+Show Affiliations

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD 21287, USA. kmatsush@jhsph.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20189275

Citation

Matsushita, Kunihiro, et al. "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." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 55, no. 4, 2010, pp. 648-59.
Matsushita K, Selvin E, Bash LD, et al. 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. Am J Kidney Dis. 2010;55(4):648-59.
Matsushita, K., Selvin, E., Bash, L. D., Astor, B. C., & Coresh, J. (2010). 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. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 55(4), 648-59. https://doi.org/10.1053/j.ajkd.2009.12.016
Matsushita K, et al. 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. Am J Kidney Dis. 2010;55(4):648-59. PubMed PMID: 20189275.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Matsushita,Kunihiro, AU - Selvin,Elizabeth, AU - Bash,Lori D, AU - Astor,Brad C, AU - Coresh,Josef, Y1 - 2010/02/26/ PY - 2009/09/15/received PY - 2009/12/07/accepted PY - 2010/3/2/entrez PY - 2010/3/2/pubmed PY - 2010/4/29/medline SP - 648 EP - 59 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 55 IS - 4 N2 - 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 (>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. RESULTS: 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). LIMITATIONS: Limited number of cases with eGFR < 60 mL/min/1.73 m(2) 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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/20189275/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(09)01591-1 DB - PRIME DP - Unbound Medicine ER -