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.
N1 - Funding Information:
Support: Drs Matsushita and Coresh were supported in part by a National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) grant. Drs Tonelli and Hemmelgarn were supported by awards from Alberta Innovates–Health Solutions (AI-HS). Dr Tonelli is also supported by a Research Chair from the Canadian Institutes of Health Research. Drs Tonelli and Hemmelgarn were supported by a joint initiative between Alberta Health and Wellness and the Universities of Alberta and Calgary. This work was supported by a grant from the AI-HS Interdisciplinary Team Grants Program to Drs Tonelli and Hemmelgarn.
PY - 2012/8
Y1 - 2012/8
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.
AB - 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.
KW - Estimated glomerular filtration rate
KW - cardiovascular disease
KW - end-stage renal disease
KW - epidemiology
KW - mortality
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U2 - 10.1053/j.ajkd.2012.03.016
DO - 10.1053/j.ajkd.2012.03.016
M3 - Article
C2 - 22560843
AN - SCOPUS:84863984918
VL - 60
SP - 241
EP - 249
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 2
ER -