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Clinical risk implications of the CKD Epidemiology Collaboration (CKD-EPI) equation compared with the Modification of Diet in Renal Disease (MDRD) Study equation for estimated GFR.
Am J Kidney Dis. 2012 Aug; 60(2):241-9.AJ

Abstract

BACKGROUND

The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine-based equation for estimated glomerular filtration rate (eGFR) is more accurate than the MDRD (Modification of Diet in Renal Disease) Study equation. However, it has not been determined whether the improvement in risk categorization applies to all segments of the population.

STUDY DESIGN

Population-based cohort study.

SETTING & PARTICIPANTS

Adults (aged ≥18 years) who did not have kidney failure at baseline and had at least one serum creatinine measurement and dipstick proteinuria evaluation in a province-wide laboratory registry from Alberta, Canada, in 2002-2007 (N = 1,010,988).

PREDICTOR

eGFR categories of ≥90, 60-89, 45-59, 30-44, and 15-29 mL/min/1.73 m(2).

OUTCOMES

All-cause mortality, acute myocardial infarction, end-stage renal disease, and doubling of serum creatinine level.

MEASUREMENTS

GFR was estimated by the CKD-EPI and MDRD Study equations.

RESULTS

The CKD-EPI equation reclassified 22.6% and 1.2% of participants to a higher and lower eGFR category, respectively, and decreased the prevalence of CKD stages 3 and 4 from 9.2% to 7.3%. Of 70,071 participants with eGFR(MDRD) of 45-59 mL/min/1.73 m(2), 30.8% were reclassified to eGFR(CKD-EPI) of 60-89 mL/min/1.73 m(2), and after adjusting for potential confounders, participants reclassified had a lower risk of all-cause mortality (incidence rate ratio [IRR], 0.77; 95% CI, 0.69-0.86), acute myocardial infarction (IRR, 0.73; 95% CI, 0.60-0.88), end-stage renal disease (IRR, 0.55; 95% CI, 0.32-0.94), and doubling of creatinine level (IRR, 0.78; 95% CI, 0.59-1.04) compared with those not reclassified. Similar findings were observed for those reclassified to a higher eGFR category from other eGFR(MDRD) categories. Net reclassification improvements based on eGFR categories were positive for all outcomes (range, 0.146-0.256; all P < 0.001).

LIMITATIONS

Relatively short follow-up (median, 2.8 years), lack of data for some potential confounders (eg, smoking), and mainly white participants.

CONCLUSIONS

These results suggest that the CKD-EPI equation more accurately categorizes individuals regarding clinical risk than the MDRD Study equation.

Authors+Show Affiliations

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. kmatsush@jhsph.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22560843

Citation

Matsushita, Kunihiro, et al. "Clinical Risk Implications of the CKD Epidemiology Collaboration (CKD-EPI) Equation Compared With the Modification of Diet in Renal Disease (MDRD) Study Equation for Estimated GFR." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 60, no. 2, 2012, pp. 241-9.
Matsushita K, Tonelli M, Lloyd A, et al. Clinical risk implications of the CKD Epidemiology Collaboration (CKD-EPI) equation compared with the Modification of Diet in Renal Disease (MDRD) Study equation for estimated GFR. Am J Kidney Dis. 2012;60(2):241-9.
Matsushita, K., Tonelli, M., Lloyd, A., Levey, A. S., Coresh, J., & Hemmelgarn, B. R. (2012). Clinical risk implications of the CKD Epidemiology Collaboration (CKD-EPI) equation compared with the Modification of Diet in Renal Disease (MDRD) Study equation for estimated GFR. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 60(2), 241-9. https://doi.org/10.1053/j.ajkd.2012.03.016
Matsushita K, et al. Clinical Risk Implications of the CKD Epidemiology Collaboration (CKD-EPI) Equation Compared With the Modification of Diet in Renal Disease (MDRD) Study Equation for Estimated GFR. Am J Kidney Dis. 2012;60(2):241-9. PubMed PMID: 22560843.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical risk implications of the CKD Epidemiology Collaboration (CKD-EPI) equation compared with the Modification of Diet in Renal Disease (MDRD) Study equation for estimated GFR. AU - Matsushita,Kunihiro, AU - Tonelli,Marcello, AU - Lloyd,Anita, AU - Levey,Andrew S, AU - Coresh,Josef, AU - Hemmelgarn,Brenda R, AU - ,, Y1 - 2012/05/04/ PY - 2011/11/23/received PY - 2012/03/16/accepted PY - 2012/5/8/entrez PY - 2012/5/9/pubmed PY - 2012/9/29/medline SP - 241 EP - 9 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 60 IS - 2 N2 - BACKGROUND: The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine-based equation for estimated glomerular filtration rate (eGFR) is more accurate than the MDRD (Modification of Diet in Renal Disease) Study equation. However, it has not been determined whether the improvement in risk categorization applies to all segments of the population. STUDY DESIGN: Population-based cohort study. SETTING & PARTICIPANTS: Adults (aged ≥18 years) who did not have kidney failure at baseline and had at least one serum creatinine measurement and dipstick proteinuria evaluation in a province-wide laboratory registry from Alberta, Canada, in 2002-2007 (N = 1,010,988). PREDICTOR: eGFR categories of ≥90, 60-89, 45-59, 30-44, and 15-29 mL/min/1.73 m(2). OUTCOMES: All-cause mortality, acute myocardial infarction, end-stage renal disease, and doubling of serum creatinine level. MEASUREMENTS: GFR was estimated by the CKD-EPI and MDRD Study equations. RESULTS: The CKD-EPI equation reclassified 22.6% and 1.2% of participants to a higher and lower eGFR category, respectively, and decreased the prevalence of CKD stages 3 and 4 from 9.2% to 7.3%. Of 70,071 participants with eGFR(MDRD) of 45-59 mL/min/1.73 m(2), 30.8% were reclassified to eGFR(CKD-EPI) of 60-89 mL/min/1.73 m(2), and after adjusting for potential confounders, participants reclassified had a lower risk of all-cause mortality (incidence rate ratio [IRR], 0.77; 95% CI, 0.69-0.86), acute myocardial infarction (IRR, 0.73; 95% CI, 0.60-0.88), end-stage renal disease (IRR, 0.55; 95% CI, 0.32-0.94), and doubling of creatinine level (IRR, 0.78; 95% CI, 0.59-1.04) compared with those not reclassified. Similar findings were observed for those reclassified to a higher eGFR category from other eGFR(MDRD) categories. Net reclassification improvements based on eGFR categories were positive for all outcomes (range, 0.146-0.256; all P < 0.001). LIMITATIONS: Relatively short follow-up (median, 2.8 years), lack of data for some potential confounders (eg, smoking), and mainly white participants. CONCLUSIONS: These results suggest that the CKD-EPI equation more accurately categorizes individuals regarding clinical risk than the MDRD Study equation. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/22560843/Clinical_risk_implications_of_the_CKD_Epidemiology_Collaboration__CKD_EPI__equation_compared_with_the_Modification_of_Diet_in_Renal_Disease__MDRD__Study_equation_for_estimated_GFR_ DB - PRIME DP - Unbound Medicine ER -