Clinical implications of the CKD epidemiology collaboration (CKD-EPI) equation compared with the modification of diet in renal disease (MDRD) study equation for the estimation of renal dysfunction in patients with cardiovascular disease

Abstract

The CKD-EPI equation is more accurate than the MDRD equation in the general population. We performed this study to establish whether chronic kidney disease (CKD) is commonly recognized by clinicians and whether the CKD-EPI equation improves prognosis estimation in patients with chronic cardiovascular disease (CVD). We analyzed data on 12394 CVD patients consecutively examined at the Cardiovascular Center of Trieste (Italy) between November 2009 and October 2013. The outcomes were all-cause death and a composite outcome of death/hospitalization for CV events (D+cvH). CKD-EPI formula reclassified 1786 (14.4 %) patients between KDIGO categories compared to the MDRD: 2.3 % (n = 280) placed in a lower risk and 12.1 % (n = 1506) into a higher risk group. CKD, defined as eGFR-CKD-EPI formula <60 ml/min, was present in 3083 patients (24.9 %) but not recognized by clinicians in 1946 (63.1 % of patients with CKD). The lack of recognition of CKD was inversely proportional to the KDIGO class for both equations. There were 986 deaths and 2726 D+cvH during 24 months follow-up. The incidence of death and D+cvH was about twice as high in patients with unrecognized CKD than in those with normal renal function (31 % vs. 17.1 %, aHR: 1.35, 95 % CI: 1.15 to 1.60), even in those patients with eGFR-MDRD >60 but eGFR-CKD-EPI formula <60 (31.1 % vs 17.1 %, p < 0.001). CKD-EPI equation provides more accurate risk stratification than MDRD equation in patients with CVD. CKD was unrecognized in nearly two-thirds of these patients but clinical outcomes were similar in those for patients with recognized CKD.

Although non-stroke outcomes are more common, stroke risk scores can be used for prediction in patients with atrial fibrillation

“…Age and sex were available from the Alberta Health registry. We used estimated glomerular filtration rate (eGFR; calculated using the CKD-EPI equation) [22] to categorize patients by kidney function. The scores for CHADS 2 , CHA 2 DS 2 -VASc, and ATRIA Stroke were calculated at baseline for each patient and were also updated quarterly.…”

Predictive role of estimated glomerular filtration rate prior to surgery in postsurgical acute kidney injury among very elderly patients: a retrospective cohort study

“…Besides, eGFR is not always sufficiently accurate for clinical decision making in very elderly patients because muscle mass and protein intake, which affect eGFR, are often abnormal in this population [23,24]. Indeed, both equations have been shown to provide risk stratification for AKI after surgery [25]. Our results indicate that although serum creatinine is unstable and eGFR may significantly change within days in very elderly patients, current eGFR equations remain useful for AKI risk stratification.…”

Starting dose and dose adjustment of Non-vitamin K antagonist oral anticoagulation agents in a nationwide cohort of patients with atrial fibrillation

“…Surprisingly, prescribers identified only 10% of patients with renal disease as evidenced by the data. This prevalence is probably underestimated, since it was not required by the Registry to specify the individual renal function, but only to classify the patient as having the disease, and thus taking into account the possibility that the impaired renal function could not be recognized or indicated by prescribing physicians in a consistent proportion of patients [19].…”

“…It is possible that also in AIFA Registry the majority of patients inappropriately prescribed a reduced dose of apixaban met only one dose-reduction criteria. The lack of identification of patients with renal impairment in the Registry [19], as far as the proportion of those with body weight ≤60 kg, may justify the choice in a subgroup of the other patients.…”