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Comparison of associations of outcomes after stroke with estimated GFR using Chinese modifications of the MDRD study and CKD-EPI creatinine equations: results from the China National Stroke Registry.
Am J Kidney Dis. 2014 Jan; 63(1):59-67.AJ

Abstract

BACKGROUND

The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation estimates glomerular filtration rate (GFR) more precisely than the MDRD (Modification of Diet in Renal Disease) Study equation. The risk implications of this equation have been compared with the MDRD Study equation in different demographic and clinical characteristics. However, whether a Chinese modification of this equation performs better than a Chinese modification of the MDRD Study equation in risk prediction in Chinese patients with stroke is unknown.

STUDY DESIGN

Prospective cohort study, China National Stroke Registry.

SETTING & PARTICIPANTS

15,791 consecutive patients with stroke enrolled from September 2007 to August 2008; follow-up time, 1 year.

PREDICTOR

Estimated GFR (eGFR) and eGFR categories computed using Chinese modifications of the MDRD Study and CKD-EPI creatinine equations.

OUTCOMES

All-cause mortality, recurrent stroke, stroke disability, combined end point of stroke or death.

MEASUREMENTS

GFR was estimated by Chinese modifications of the MDRD Study (eGFRMDRD(CN)) and CKD-EPI (eGFRCKD-EPI(CN)) equations.

RESULTS

The median value for eGFRCKD-EPI(CN) was higher than that for eGFRMDRD(CN) (87.3 vs 82.5 mL/min/1.73 m(2); P<0.001). 22.8% of patients were reclassified by the CKD-EPI China equation (11.5% [1,818/15,791] to a higher eGFR category, and 11.3% [1,789/15,791], to a lower eGFR category). Of patients with eGFRMDRD(CN) of 60-89 and 30-59 mL/min/1.73 m(2), 18.3% (1,299/7,090) and 18.4% (422/2,296) were reclassified upward to a higher eGFR category, respectively, reducing the CKD prevalence from 16.4% to 14.2%. Net reclassification improvement favored the Chinese modification of the CKD-EPI equation for the prediction of all-cause mortality, stroke recurrence, death, or stroke recurrence and stroke disability (net reclassification improvements of 0.05, 0.03, 0.04, and 0.1, respectively; all P<0.01).

LIMITATIONS

Relatively short follow-up time and no measurement of albuminuria.

CONCLUSIONS

Our findings suggest that a Chinese modification of the CKD-EPI equation may improve risk prediction of all-cause mortality, stroke recurrence, death or stroke recurrence and stroke disability more than a Chinese modification of the MDRD Study equation in Chinese stroke patients.

Authors+Show Affiliations

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: yongjunwang1962@gmail.com.No affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

24100127

Citation

Wang, Xianwei, et al. "Comparison of Associations of Outcomes After Stroke With Estimated GFR Using Chinese Modifications of the MDRD Study and CKD-EPI Creatinine Equations: Results From the China National Stroke Registry." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 63, no. 1, 2014, pp. 59-67.
Wang X, Luo Y, Wang Y, et al. Comparison of associations of outcomes after stroke with estimated GFR using Chinese modifications of the MDRD study and CKD-EPI creatinine equations: results from the China National Stroke Registry. Am J Kidney Dis. 2014;63(1):59-67.
Wang, X., Luo, Y., Wang, Y., Wang, C., Zhao, X., Wang, D., Liu, L., Liu, G., & Wang, Y. (2014). Comparison of associations of outcomes after stroke with estimated GFR using Chinese modifications of the MDRD study and CKD-EPI creatinine equations: results from the China National Stroke Registry. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 63(1), 59-67. https://doi.org/10.1053/j.ajkd.2013.08.008
Wang X, et al. Comparison of Associations of Outcomes After Stroke With Estimated GFR Using Chinese Modifications of the MDRD Study and CKD-EPI Creatinine Equations: Results From the China National Stroke Registry. Am J Kidney Dis. 2014;63(1):59-67. PubMed PMID: 24100127.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of associations of outcomes after stroke with estimated GFR using Chinese modifications of the MDRD study and CKD-EPI creatinine equations: results from the China National Stroke Registry. AU - Wang,Xianwei, AU - Luo,Yang, AU - Wang,Yilong, AU - Wang,Chunxue, AU - Zhao,Xingquan, AU - Wang,David, AU - Liu,Liping, AU - Liu,Gaifen, AU - Wang,Yongjun, AU - ,, Y1 - 2013/10/04/ PY - 2013/02/24/received PY - 2013/08/06/accepted PY - 2013/10/9/entrez PY - 2013/10/9/pubmed PY - 2014/4/8/medline KW - Estimated glomerular filtration rate KW - epidemiology KW - outcome KW - stroke SP - 59 EP - 67 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 63 IS - 1 N2 - BACKGROUND: The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation estimates glomerular filtration rate (GFR) more precisely than the MDRD (Modification of Diet in Renal Disease) Study equation. The risk implications of this equation have been compared with the MDRD Study equation in different demographic and clinical characteristics. However, whether a Chinese modification of this equation performs better than a Chinese modification of the MDRD Study equation in risk prediction in Chinese patients with stroke is unknown. STUDY DESIGN: Prospective cohort study, China National Stroke Registry. SETTING & PARTICIPANTS: 15,791 consecutive patients with stroke enrolled from September 2007 to August 2008; follow-up time, 1 year. PREDICTOR: Estimated GFR (eGFR) and eGFR categories computed using Chinese modifications of the MDRD Study and CKD-EPI creatinine equations. OUTCOMES: All-cause mortality, recurrent stroke, stroke disability, combined end point of stroke or death. MEASUREMENTS: GFR was estimated by Chinese modifications of the MDRD Study (eGFRMDRD(CN)) and CKD-EPI (eGFRCKD-EPI(CN)) equations. RESULTS: The median value for eGFRCKD-EPI(CN) was higher than that for eGFRMDRD(CN) (87.3 vs 82.5 mL/min/1.73 m(2); P<0.001). 22.8% of patients were reclassified by the CKD-EPI China equation (11.5% [1,818/15,791] to a higher eGFR category, and 11.3% [1,789/15,791], to a lower eGFR category). Of patients with eGFRMDRD(CN) of 60-89 and 30-59 mL/min/1.73 m(2), 18.3% (1,299/7,090) and 18.4% (422/2,296) were reclassified upward to a higher eGFR category, respectively, reducing the CKD prevalence from 16.4% to 14.2%. Net reclassification improvement favored the Chinese modification of the CKD-EPI equation for the prediction of all-cause mortality, stroke recurrence, death, or stroke recurrence and stroke disability (net reclassification improvements of 0.05, 0.03, 0.04, and 0.1, respectively; all P<0.01). LIMITATIONS: Relatively short follow-up time and no measurement of albuminuria. CONCLUSIONS: Our findings suggest that a Chinese modification of the CKD-EPI equation may improve risk prediction of all-cause mortality, stroke recurrence, death or stroke recurrence and stroke disability more than a Chinese modification of the MDRD Study equation in Chinese stroke patients. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/24100127/Comparison_of_associations_of_outcomes_after_stroke_with_estimated_GFR_using_Chinese_modifications_of_the_MDRD_study_and_CKD_EPI_creatinine_equations:_results_from_the_China_National_Stroke_Registry_ DB - PRIME DP - Unbound Medicine ER -