Comparison of the heart failure risk stratification performance of the CKD-EPI equation and the MDRD equation for estimated glomerular filtration rate in patients with Type 2 diabetes.Diabet Med. 2016 May; 33(5):609-20.DM
To investigate the risk prediction and the risk stratification performances of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the Modification of Diet in Renal Disease (MDRD) equation for estimated glomerular filtration rate (eGFRCKD - EPI vs. eGFRMDRD) on heart failure in patients with Type 2 diabetes.
The study cohort included 12 258 White and 16 886 African American low-income patients with Type 2 diabetes who were 30-90 years old at baseline. Heart failure risk according to different eGFRCKD - EPI and eGFRMDRD categories was prospectively assessed.
During a mean follow-up of 6.5 years, 5043 incident heart failure cases were identified. Multivariable-adjusted hazard ratios (HRs) of heart failure associated with the eGFRCKD - EPI categories [≥ 90 (reference group), 75-89, 60-74, 30-59 and < 30 ml/min/1.73 m(2) ] were 1.00, 1.11, 1.31, 1.75 and 2.93 (Ptrend < 0.001) for African American patients, and 1.00, 1.11, 1.08, 1.59 and 2.92 (Ptrend < 0.001) for White patients, respectively. The model with eGFRCKD - EPI and the other risk factors had significantly higher Harrell's C than the model with eGFRMDRD and other risk factors. Patients reclassified downward from eGFRMDRD 60-74 to eGFRCKD - EPI 30-59 and from eGFRMDRD 30-59 to eGFRCKD - EPI < 30 ml/min/1.73 m(2) showed higher heart failure risk than those who were not reclassified.
Impaired kidney function (i.e. GFR < 60 ml/min/1.73 m(2)), and even mildly decreased GFR (60-74 ml/min/1.73 m(2)) estimated by both equations is associated with an increased risk of heart failure. Compared with GFR estimated using the MDRD equation, GFR estimated using the CKD-EPI equation added more predictive power to the model with the other risk factors. Also, eGFRCKD - EPI provided more accurate heart failure risk stratification than eGFRMDRD .