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Estimated GFR and incident cardiovascular disease events in American Indians: the Strong Heart Study.
Am J Kidney Dis. 2012 Nov; 60(5):795-803.AJ

Abstract

BACKGROUND

In populations with high prevalences of diabetes and obesity, estimating glomerular filtration rate (GFR) by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation may predict cardiovascular disease (CVD) risk better than by using the Modification of Diet in Renal Disease (MDRD) Study equation.

STUDY DESIGN

Longitudinal cohort study comparing the association of GFR estimated using either the CKD-EPI or MDRD Study equation with incident CVD outcomes.

SETTING & PARTICIPANTS

American Indians participating in the Strong Heart Study, a longitudinal population-based cohort with high prevalences of diabetes, CVD, and CKD.

PREDICTOR

Estimated GFR (eGFR) predicted using the CKD-EPI and MDRD Study equations.

OUTCOMES

Fatal and nonfatal cardiovascular events, consisting of coronary heart disease, stroke, and heart failure.

MEASUREMENTS

The association between eGFR and outcomes was explored in Cox proportional hazards models adjusted for traditional risk factors and albuminuria; the net reclassification index and integrated discrimination improvement were determined for the CKD-EPI versus MDRD Study equations.

RESULTS

In 4,549 participants, diabetes was present in 45%; CVD, in 7%; and stages 3-5 CKD, in 10%. During a median of 15 years, there were 1,280 cases of incident CVD, 929 cases of incident coronary heart disease, 305 cases of incident stroke, and 381 cases of incident heart failure. Reduced eGFR (<90 mL/min/1.73 m2) was associated with adverse events in most models. Compared with the MDRD Study equation, the CKD-EPI equation correctly reclassified 17.0% of 2,151 participants without incident CVD to a lower risk (higher eGFR) category and 1.3% (n=28) were reclassified incorrectly to a higher risk (lower eGFR) category.

LIMITATIONS

Single measurements of eGFR and albuminuria at study visits.

CONCLUSIONS

Although eGFR based on either equation had similar associations with incident CVD, coronary heart disease, stroke, and heart failure events, in those not having events, reclassification of participants to eGFR categories was superior using the CKD-EPI equation compared with the MDRD Study equation.

Authors+Show Affiliations

MedStar Health Research Institute, Hyattsville, MD 20782, USA. nawar.shara@medstar.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

22841159

Citation

Shara, Nawar M., et al. "Estimated GFR and Incident Cardiovascular Disease Events in American Indians: the Strong Heart Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 60, no. 5, 2012, pp. 795-803.
Shara NM, Wang H, Mete M, et al. Estimated GFR and incident cardiovascular disease events in American Indians: the Strong Heart Study. Am J Kidney Dis. 2012;60(5):795-803.
Shara, N. M., Wang, H., Mete, M., Al-Balha, Y. R., Azalddin, N., Lee, E. T., Franceschini, N., Jolly, S. E., Howard, B. V., & Umans, J. G. (2012). Estimated GFR and incident cardiovascular disease events in American Indians: the Strong Heart Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 60(5), 795-803. https://doi.org/10.1053/j.ajkd.2012.06.015
Shara NM, et al. Estimated GFR and Incident Cardiovascular Disease Events in American Indians: the Strong Heart Study. Am J Kidney Dis. 2012;60(5):795-803. PubMed PMID: 22841159.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Estimated GFR and incident cardiovascular disease events in American Indians: the Strong Heart Study. AU - Shara,Nawar M, AU - Wang,Hong, AU - Mete,Mihriye, AU - Al-Balha,Yaman Rai, AU - Azalddin,Nameer, AU - Lee,Elisa T, AU - Franceschini,Nora, AU - Jolly,Stacey E, AU - Howard,Barbara V, AU - Umans,Jason G, Y1 - 2012/07/25/ PY - 2012/01/11/received PY - 2012/06/12/accepted PY - 2012/7/31/entrez PY - 2012/7/31/pubmed PY - 2013/1/1/medline SP - 795 EP - 803 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 60 IS - 5 N2 - BACKGROUND: In populations with high prevalences of diabetes and obesity, estimating glomerular filtration rate (GFR) by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation may predict cardiovascular disease (CVD) risk better than by using the Modification of Diet in Renal Disease (MDRD) Study equation. STUDY DESIGN: Longitudinal cohort study comparing the association of GFR estimated using either the CKD-EPI or MDRD Study equation with incident CVD outcomes. SETTING & PARTICIPANTS: American Indians participating in the Strong Heart Study, a longitudinal population-based cohort with high prevalences of diabetes, CVD, and CKD. PREDICTOR: Estimated GFR (eGFR) predicted using the CKD-EPI and MDRD Study equations. OUTCOMES: Fatal and nonfatal cardiovascular events, consisting of coronary heart disease, stroke, and heart failure. MEASUREMENTS: The association between eGFR and outcomes was explored in Cox proportional hazards models adjusted for traditional risk factors and albuminuria; the net reclassification index and integrated discrimination improvement were determined for the CKD-EPI versus MDRD Study equations. RESULTS: In 4,549 participants, diabetes was present in 45%; CVD, in 7%; and stages 3-5 CKD, in 10%. During a median of 15 years, there were 1,280 cases of incident CVD, 929 cases of incident coronary heart disease, 305 cases of incident stroke, and 381 cases of incident heart failure. Reduced eGFR (<90 mL/min/1.73 m2) was associated with adverse events in most models. Compared with the MDRD Study equation, the CKD-EPI equation correctly reclassified 17.0% of 2,151 participants without incident CVD to a lower risk (higher eGFR) category and 1.3% (n=28) were reclassified incorrectly to a higher risk (lower eGFR) category. LIMITATIONS: Single measurements of eGFR and albuminuria at study visits. CONCLUSIONS: Although eGFR based on either equation had similar associations with incident CVD, coronary heart disease, stroke, and heart failure events, in those not having events, reclassification of participants to eGFR categories was superior using the CKD-EPI equation compared with the MDRD Study equation. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/22841159/Estimated_GFR_and_incident_cardiovascular_disease_events_in_American_Indians:_the_Strong_Heart_Study_ DB - PRIME DP - Unbound Medicine ER -