TY - JOUR
T1 - Risk Implications of the New CKD Epidemiology Collaboration (CKD-EPI) Equation Compared With the MDRD Study Equation for Estimated GFR
T2 - The Atherosclerosis Risk in Communities (ARIC) Study
AU - Matsushita, Kunihiro
AU - Selvin, Elizabeth
AU - Bash, Lori D.
AU - Astor, Brad C.
AU - Coresh, Joe
N1 - Funding Information:
Support: The ARIC Study is carried out as a collaborative study supported by National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI) contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022. Dr Matsushita was supported by a grant from the Japan Society for the Promotion of Science . Dr Selvin was supported by the NIH National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant K01DK076595 . Dr Bash was supported by NIH/NHLBI grant T32HL07024 . Drs Astor and Coresh were supported by NIH/NIDDK grant R01DK076770 and a KDOQI research initiative grant of the National Kidney Foundation .
PY - 2010/4
Y1 - 2010/4
N2 - Background: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recently published an equation for estimated glomerular filtration rate (eGFR) using the same variables (serum creatinine level, age, sex, and race) as the Modification of Diet in Renal Disease (MDRD) Study equation. Although the CKD-EPI equation estimates GFR more precisely compared with the MDRD Study equation, whether this equation improves risk prediction is unknown. Study Design: Prospective cohort study, the Atherosclerosis Risk in Communities (ARIC) Study. Setting & Participants: 13,905 middle-aged participants without a history of cardiovascular disease with median follow-up of 16.9 years. Predictor: eGFR. Outcomes & Measurements: We compared the association of eGFR in categories (≥120, 90-119, 60-89, 30-59, and <30 mL/min/1.73 m2) using the CKD-EPI and MDRD Study equations with risk of incident end-stage renal disease, all-cause mortality, coronary heart disease, and stroke. Results: The median value for eGFRCKD-EPI was higher than that for eGFRMDRD (97.6 vs 88.8 mL/min/1.73 m2; P < 0.001). The CKD-EPI equation reclassified 44.9% (n = 3,079) and 43.5% (n = 151) of participants with eGFRMDRD of 60-89 and 30-59 mL/min/1.73 m2, respectively, upward to a higher eGFR category, but reclassified no one with eGFRMDRD of 90-119 or <30 mL/min/1.73 m2, decreasing the prevalence of CKD stages 3-5 from 2.7% to 1.6%. Participants with eGFRMDRD of 30-59 mL/min/1.73 m2 who were reclassified upward had lower risk compared with those who were not reclassified (end-stage renal disease incidence rate ratio, 0.10 [95% CI, 0.03-0.33]; all-cause mortality, 0.30 [95% CI, 0.19-0.48]; coronary heart disease, 0.36 [95% CI, 0.21-0.61]; and stroke, 0.50 [95% CI, 0.24-1.02]). Similar results were observed for participants with eGFRMDRD of 60-89 mL/min/1.73 m2. More frequent reclassification of younger, female, and white participants explained some of these trends. Net reclassification improvement in participants with eGFR < 120 mL/min/1.73 m2 was positive for all outcomes (P < 0.001). Limitations: Limited number of cases with eGFR < 60 mL/min/1.73 m2 and no measurement of albuminuria. Conclusions: The CKD-EPI equation more appropriately categorized individuals with respect to long-term clinical risk compared with the MDRD Study equation, suggesting improved clinical usefulness in this middle-aged population.
AB - Background: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recently published an equation for estimated glomerular filtration rate (eGFR) using the same variables (serum creatinine level, age, sex, and race) as the Modification of Diet in Renal Disease (MDRD) Study equation. Although the CKD-EPI equation estimates GFR more precisely compared with the MDRD Study equation, whether this equation improves risk prediction is unknown. Study Design: Prospective cohort study, the Atherosclerosis Risk in Communities (ARIC) Study. Setting & Participants: 13,905 middle-aged participants without a history of cardiovascular disease with median follow-up of 16.9 years. Predictor: eGFR. Outcomes & Measurements: We compared the association of eGFR in categories (≥120, 90-119, 60-89, 30-59, and <30 mL/min/1.73 m2) using the CKD-EPI and MDRD Study equations with risk of incident end-stage renal disease, all-cause mortality, coronary heart disease, and stroke. Results: The median value for eGFRCKD-EPI was higher than that for eGFRMDRD (97.6 vs 88.8 mL/min/1.73 m2; P < 0.001). The CKD-EPI equation reclassified 44.9% (n = 3,079) and 43.5% (n = 151) of participants with eGFRMDRD of 60-89 and 30-59 mL/min/1.73 m2, respectively, upward to a higher eGFR category, but reclassified no one with eGFRMDRD of 90-119 or <30 mL/min/1.73 m2, decreasing the prevalence of CKD stages 3-5 from 2.7% to 1.6%. Participants with eGFRMDRD of 30-59 mL/min/1.73 m2 who were reclassified upward had lower risk compared with those who were not reclassified (end-stage renal disease incidence rate ratio, 0.10 [95% CI, 0.03-0.33]; all-cause mortality, 0.30 [95% CI, 0.19-0.48]; coronary heart disease, 0.36 [95% CI, 0.21-0.61]; and stroke, 0.50 [95% CI, 0.24-1.02]). Similar results were observed for participants with eGFRMDRD of 60-89 mL/min/1.73 m2. More frequent reclassification of younger, female, and white participants explained some of these trends. Net reclassification improvement in participants with eGFR < 120 mL/min/1.73 m2 was positive for all outcomes (P < 0.001). Limitations: Limited number of cases with eGFR < 60 mL/min/1.73 m2 and no measurement of albuminuria. Conclusions: The CKD-EPI equation more appropriately categorized individuals with respect to long-term clinical risk compared with the MDRD Study equation, suggesting improved clinical usefulness in this middle-aged population.
KW - Estimated glomerular filtration rate
KW - cardiovascular disease
KW - end-stage renal disease
KW - epidemiology
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U2 - 10.1053/j.ajkd.2009.12.016
DO - 10.1053/j.ajkd.2009.12.016
M3 - Article
C2 - 20189275
AN - SCOPUS:77949558525
SN - 0272-6386
VL - 55
SP - 648
EP - 659
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 4
ER -