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Comparing the association of GFR estimated by the CKD-EPI and MDRD study equations and mortality: the third national health and nutrition examination survey (NHANES III).
BMC Nephrol. 2012 Jun 15; 13:42.BN

Abstract

BACKGROUND

The Chronic Kidney Disease Epidemiology Collaboration equation for estimation of glomerular filtration rate (eGFR(CKD-EPI)) improves GFR estimation compared with the Modification of Diet in Renal Disease Study equation (eGFR(MDRD)) but its association with mortality in a nationally representative population sample in the US has not been studied.

METHODS

We examined the association between eGFR and mortality among 16,010 participants of the Third National Health and Nutrition Examination Survey (NHANES III). Primary predictors were eGFR(CKD-EPI) and eGFR(MDRD). Outcomes of interest were all-cause and cardiovascular disease (CVD) mortality. Improvement in risk categorization with eGFR(CKD-EPI) was evaluated using adjusted relative hazard (HR) and Net Reclassification Improvement (NRI).

RESULTS

Overall, 26.9% of the population was reclassified to higher eGFR categories and 2.2% to lower eGFR categories by eGFR(CKD-EPI), reducing the proportion of prevalent CKD classified as stage 3-5 from 45.6% to 28.8%. There were 3,620 deaths (1,540 from CVD) during 215,082 person-years of follow-up (median, 14.3 years). Among those with eGFR(MDRD) 30-59 ml/min/1.73 m(2), 19.4% were reclassified to eGFR(CKD-EPI) 60-89 ml/min/1.73 m(2) and these individuals had a lower risk of all-cause mortality (adjusted HR, 0.53; 95% CI, 0.34-0.84) and CVD mortality (adjusted HR, 0.51; 95% CI, 0.27-0.96) compared with those not reclassified. Among those with eGFR(MDRD) >60 ml/min/1.73 m(2), 0.5% were reclassified to lower eGFR(CKD-EPI) and these individuals had a higher risk of all-cause (adjusted HR, 1.31; 95% CI, 1.01-1.69) and CVD (adjusted HR, 1.42; 95% CI, 1.01-1.99) mortality compared with those not reclassified. Risk prediction improved with eGFR(CKD-EPI); NRI was 0.21 for all-cause mortality (p < 0.001) and 0.22 for CVD mortality (p < 0.001).

CONCLUSIONS

eGFR(CKD-EPI) categories improve mortality risk stratification of individuals in the US population. If eGFR(CKD-EPI) replaces eGFR(MDRD) in the US, it will likely improve risk stratification.

Authors+Show Affiliations

Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. tshafi@jhmi.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, N.I.H., Extramural

Language

eng

PubMed ID

22702805

Citation

Shafi, Tariq, et al. "Comparing the Association of GFR Estimated By the CKD-EPI and MDRD Study Equations and Mortality: the Third National Health and Nutrition Examination Survey (NHANES III)." BMC Nephrology, vol. 13, 2012, p. 42.
Shafi T, Matsushita K, Selvin E, et al. Comparing the association of GFR estimated by the CKD-EPI and MDRD study equations and mortality: the third national health and nutrition examination survey (NHANES III). BMC Nephrol. 2012;13:42.
Shafi, T., Matsushita, K., Selvin, E., Sang, Y., Astor, B. C., Inker, L. A., & Coresh, J. (2012). Comparing the association of GFR estimated by the CKD-EPI and MDRD study equations and mortality: the third national health and nutrition examination survey (NHANES III). BMC Nephrology, 13, 42.
Shafi T, et al. Comparing the Association of GFR Estimated By the CKD-EPI and MDRD Study Equations and Mortality: the Third National Health and Nutrition Examination Survey (NHANES III). BMC Nephrol. 2012 Jun 15;13:42. PubMed PMID: 22702805.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparing the association of GFR estimated by the CKD-EPI and MDRD study equations and mortality: the third national health and nutrition examination survey (NHANES III). AU - Shafi,Tariq, AU - Matsushita,Kunihiro, AU - Selvin,Elizabeth, AU - Sang,Yingying, AU - Astor,Brad C, AU - Inker,Lesley A, AU - Coresh,Josef, Y1 - 2012/06/15/ PY - 2011/10/02/received PY - 2012/05/14/accepted PY - 2012/6/19/entrez PY - 2012/6/19/pubmed PY - 2013/5/28/medline SP - 42 EP - 42 JF - BMC nephrology JO - BMC Nephrol VL - 13 N2 - BACKGROUND: The Chronic Kidney Disease Epidemiology Collaboration equation for estimation of glomerular filtration rate (eGFR(CKD-EPI)) improves GFR estimation compared with the Modification of Diet in Renal Disease Study equation (eGFR(MDRD)) but its association with mortality in a nationally representative population sample in the US has not been studied. METHODS: We examined the association between eGFR and mortality among 16,010 participants of the Third National Health and Nutrition Examination Survey (NHANES III). Primary predictors were eGFR(CKD-EPI) and eGFR(MDRD). Outcomes of interest were all-cause and cardiovascular disease (CVD) mortality. Improvement in risk categorization with eGFR(CKD-EPI) was evaluated using adjusted relative hazard (HR) and Net Reclassification Improvement (NRI). RESULTS: Overall, 26.9% of the population was reclassified to higher eGFR categories and 2.2% to lower eGFR categories by eGFR(CKD-EPI), reducing the proportion of prevalent CKD classified as stage 3-5 from 45.6% to 28.8%. There were 3,620 deaths (1,540 from CVD) during 215,082 person-years of follow-up (median, 14.3 years). Among those with eGFR(MDRD) 30-59 ml/min/1.73 m(2), 19.4% were reclassified to eGFR(CKD-EPI) 60-89 ml/min/1.73 m(2) and these individuals had a lower risk of all-cause mortality (adjusted HR, 0.53; 95% CI, 0.34-0.84) and CVD mortality (adjusted HR, 0.51; 95% CI, 0.27-0.96) compared with those not reclassified. Among those with eGFR(MDRD) >60 ml/min/1.73 m(2), 0.5% were reclassified to lower eGFR(CKD-EPI) and these individuals had a higher risk of all-cause (adjusted HR, 1.31; 95% CI, 1.01-1.69) and CVD (adjusted HR, 1.42; 95% CI, 1.01-1.99) mortality compared with those not reclassified. Risk prediction improved with eGFR(CKD-EPI); NRI was 0.21 for all-cause mortality (p < 0.001) and 0.22 for CVD mortality (p < 0.001). CONCLUSIONS: eGFR(CKD-EPI) categories improve mortality risk stratification of individuals in the US population. If eGFR(CKD-EPI) replaces eGFR(MDRD) in the US, it will likely improve risk stratification. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/22702805/Comparing_the_association_of_GFR_estimated_by_the_CKD_EPI_and_MDRD_study_equations_and_mortality:_the_third_national_health_and_nutrition_examination_survey__NHANES_III__ DB - PRIME DP - Unbound Medicine ER -