TY - JOUR
T1 - Comparing the association of GFR estimated by the CKD-EPI and MDRD study equations and mortality
T2 - The third national health and nutrition examination survey (NHANES III)
AU - Shafi, Tariq
AU - Matsushita, Kunihiro
AU - Selvin, Elizabeth
AU - Sang, Yingying
AU - Astor, Brad C.
AU - Inker, Lesley A.
AU - Coresh, Josef
PY - 2012
Y1 - 2012
N2 - Background: The Chronic Kidney Disease Epidemiology Collaboration equation for estimation of glomerular filtration rate (eGFRCKD-EPI) improves GFR estimation compared with the Modification of Diet in Renal Disease Study equation (eGFRMDRD) 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 eGFRCKD-EPI and eGFR MDRD. Outcomes of interest were all-cause and cardiovascular disease (CVD) mortality. Improvement in risk categorization with eGFRCKD-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 35 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 3059 ml/min/1.73 m2, 19.4% were reclassified to eGFRCKD-EPI 6089 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 eGFRMDRD >60 ml/ min/1.73 m 2, 0.5% were reclassified to lower eGFRCKD-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: eGFRCKD-EPI categories improve mortality risk stratification of individuals in the US population. If eGFRCKD-EPI replaces eGFRMDRD in the US, it will likely improve risk stratification.
AB - Background: The Chronic Kidney Disease Epidemiology Collaboration equation for estimation of glomerular filtration rate (eGFRCKD-EPI) improves GFR estimation compared with the Modification of Diet in Renal Disease Study equation (eGFRMDRD) 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 eGFRCKD-EPI and eGFR MDRD. Outcomes of interest were all-cause and cardiovascular disease (CVD) mortality. Improvement in risk categorization with eGFRCKD-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 35 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 3059 ml/min/1.73 m2, 19.4% were reclassified to eGFRCKD-EPI 6089 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 eGFRMDRD >60 ml/ min/1.73 m 2, 0.5% were reclassified to lower eGFRCKD-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: eGFRCKD-EPI categories improve mortality risk stratification of individuals in the US population. If eGFRCKD-EPI replaces eGFRMDRD in the US, it will likely improve risk stratification.
KW - Chronic kidney disease
KW - Epidemiology
KW - Glomerular filtration rate
KW - Outcomes
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U2 - 10.1186/1471-2369-13-42
DO - 10.1186/1471-2369-13-42
M3 - Article
C2 - 22702805
AN - SCOPUS:84862233020
VL - 13
JO - BMC Nephrology
JF - BMC Nephrology
SN - 1471-2369
IS - 1
M1 - 42
ER -