Comparing the association of GFR estimated by the CKD-EPI and MDRD study equations and mortality: the third national health and nutrition examination survey (NHANES III)

BMC Nephrology

Josef Coresh⁴  Lesley A Inker¹  Brad C Astor⁵  Yingying Sang³  Elizabeth Selvin³  Kunihiro Matsushita³  Tariq Shafi² 

[1] Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA, USA;Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA;Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Department of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

关键词: Outcomes;    Epidemiology;    Chronic kidney disease;    Glomerular filtration rate;   

Others  :  1083171
DOI  :  10.1186/1471-2369-13-42

 received in 2011-10-02, accepted in 2012-05-14,  发布年份 2012

【 摘 要 】

Background

The Chronic Kidney Disease Epidemiology Collaboration equation for estimation of glomerular filtration rate (eGFR_CKD-EPI) improves GFR estimation compared with the Modification of Diet in Renal Disease Study equation (eGFR_MDRD) but its association with mortality in a nationally representative population sample in the US has not been studied.

Methods

We examined the association between eGFR and mortality among 16,010 participants of the Third National Health and Nutrition Examination Survey (NHANES III). Primary predictors were eGFR_CKD-EPI and eGFR_MDRD. Outcomes of interest were all-cause and cardiovascular disease (CVD) mortality. Improvement in risk categorization with eGFR_CKD-EPI was evaluated using adjusted relative hazard (HR) and Net Reclassification Improvement (NRI).

Results

Overall, 26.9% of the population was reclassified to higher eGFR categories and 2.2% to lower eGFR categories by eGFR_CKD-EPI, reducing the proportion of prevalent CKD classified as stage 3–5 from 45.6% to 28.8%_. There were 3,620 deaths (1,540 from CVD) during 215,082 person-years of follow-up (median, 14.3 years). Among those with eGFR_MDRD 30–59 ml/min/1.73 m², 19.4% were reclassified to eGFR_CKD-EPI 60–89 ml/min/1.73 m² and these individuals had a lower risk of all-cause mortality (adjusted HR, 0.53; 95% CI, 0.34-0.84) and CVD mortality (adjusted HR, 0.51; 95% CI, 0.27-0.96) compared with those not reclassified. Among those with eGFR_MDRD >60 ml/min/1.73 m², 0.5% were reclassified to lower eGFR_CKD-EPI and these individuals had a higher risk of all-cause (adjusted HR, 1.31; 95% CI, 1.01-1.69) and CVD (adjusted HR, 1.42; 95% CI, 1.01-1.99) mortality compared with those not reclassified. Risk prediction improved with eGFR_CKD-EPI; NRI was 0.21 for all-cause mortality (p < 0.001) and 0.22 for CVD mortality (p < 0.001).

Conclusions

eGFR_CKD-EPI categories improve mortality risk stratification of individuals in the US population. If eGFR_CKD-EPI replaces eGFR_MDRD in the US, it will likely improve risk stratification.

【 授权许可】

   
2012 Shafi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1 .

Figure 2 .

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