Prognostic abilities of different calculation formulas for the glomerular filtration rate in elderly Chinese patients with coronary artery disease

Abstract

ObjectiveAs a standard indicator of renal function, the glomerular filtration rate (GFR) is vital for the prognostic analysis of elderly patients with coronary artery disease (CAD). Thus, the search for the calculation equation of GFR with the best prognostic ability is an important task. The most commonly used Modification of Diet in Renal Disease (MDRD) equation and the Chinese version (CMDRD) of the MDRD equation has many shortcomings. The newly developed Mayo Clinic quadratic (Mayo) and Chronic Kidney Disease (CKD) Epidemiology Collaboration (CKD-EPI) equations may overcome these shortcomings. Because the populations involved in these equation-related studies are almost completely devoid of subjects > 70 years of age, there are more debates on the performance of these equations in the elderly. This study was designed to compare the prognostic abilities of different calculation formulas for the GFR in elderly Chinese patients with CAD.MethodsThis study included 1050 patients (≥60 years of age) with CAD. The endpoint was all-cause mortality over a mean follow-up period of 417 days.ResultsThe median age was 86 years (60–104 years). The median values for the MDRD-GFR, CMDRD-GFR, CKD-EPI-GFR, and Mayo-GFR were 66.0, 69.2, 65.6, and 75.8 mL/minute/1.73 m2, respectively. The prevalence of GFR < 60 mL/minute/1.73 m2 based on these measures was 39.3%, 35.4%, 43.0%, and 28.7%, respectively. Their area under the curve values for predicting death were 0.611, 0.610, 0.625, and 0.632, respectively. Their cut-off points for predicting death were 54.1, 53.5, 48.0, and 57.4 mL/minute/1.73 m2, respectively. Compared with the MDRD-GFR, the net reclassification improvement values of the CMDRD-GFR, CKD-EPI-GFR, and Mayo-GFR were 0.02, 0.10, and 0.14, respectively.ConclusionThe prognostic abilities of the CKD-EPI and Mayo equations were significantly superior to the MDRD and CMDRD equations; the Mayo equation had a mild, but not statistically significant superiority compared with the CKD-EPI equation in elderly Chinese patients with CAD.

Is there a relationship between slow coronary flow and normal to mildly impaired renal function?

“…In another study, the reclassification of patients to a better GFR category using the CKD-EPI equation, compared with the MDRD equation, was related to reduction in all-cause mortality. [19] This type of reclassification was also observed in the present study.…”

“…In addition, it was determined that this equation overcame the limitation of the MDRD equation (i.e., the underestimation of GFR at given range). [17][18][19][20] Stevens LA et al [20] showed that bias was substantially decreased with the CKD-EPI equation, compared to measured GFR, particularly among people with eGFR greater than 60 ml/min/1.73 m 2 . The study also found that bias was increased using the MDRD equation, when eGFR was greater than 90 ml/min/1.73 m 2 .…”

“…According to the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guideline, the CKD-EPI equation provides less bias than the MDRD equation, as well as improved risk stratification, [16] and recent studies have confirmed these findings. [17][18][19][20] In the present study, eGFR values in patients with normal coronary flow (NCF) and SCF, who had near-normal or mildly impaired renal function were compared using the CKD-EPI and MDRD equations. The present study was the first to evaluate this relationship with the CKD-EPI equation.…”

Filtração glomerular em idosos coronarianos agudos: cockcroft-gault é o melhor método?

“…9 A boa correlação entre a MDRD e a CKD-EPI havia sido verificada anteriormente em pacientes com SCA. 18,19 Provavelmente a alta correlação das últimas ocorra por utilizarem as mesmas variáveis para o cálculo, além do desenvolvimento a partir do mesmo padrão-ouro. 6,7 Já a CG adota a idade e a massa corporal, diferente das demais fórmulas, e foi derivada de estudo utilizando a urina de 24 horas.…”

“…18 O oposto foi verificado por AlFaleh et al, 25 com as mesmas fórmulas. Fu et al, 19 analisando uma população com média de 86 anos, SCA e segmento de mais de 400 dias, mostrou superioridade da CKD-EPI. Já Barra et al, 26 incluindo uma população com idade média de 66 anos, encontraram melhor ASC para MDRD em relação à CG tanto para mortalidade, quanto para readmissão por insuficiência cardíaca descompensada num segmento de dois anos.…”