期刊
AMERICAN JOURNAL OF KIDNEY DISEASES
卷 60, 期 2, 页码 241-249出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2012.03.016
关键词
Estimated glomerular filtration rate; mortality; cardiovascular disease; end-stage renal disease; epidemiology
资金
- National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI)
- Alberta Innovates-Health Solutions (AI-HS)
- Canadian Institutes of Health Research
- Alberta Health and Wellness
- Universities of Alberta and Calgary
- AI-HS Interdisciplinary Team
Background: The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine-based equation for estimated glomerular filtration rate (eGFR) is more accurate than the MDRD (Modification of Diet in Renal Disease) Study equation. However, it has not been determined whether the improvement in risk categorization applies to all segments of the population. Study Design: Population-based cohort study. Setting & Participants: Adults (aged >= 18 years) who did not have kidney failure at baseline and had at least one serum creatinine measurement and dipstick proteinuria evaluation in a province-wide laboratory registry from Alberta, Canada, in 2002-2007 (N = 1,010,988). Predictor: eGFR categories of >= 90, 60-89, 45-59, 30-44, and 15-29 mL/min/1.73 m(2). Outcomes: All-cause mortality, acute myocardial infarction, end-stage renal disease, and doubling of serum creatinine level. Measurements: GFR was estimated by the CKD-EPI and MDRD Study equations. Results: The CKD-EPI equation reclassified 22.6% and 1.2% of participants to a higher and lower eGFR category, respectively, and decreased the prevalence of CKD stages 3 and 4 from 9.2% to 7.3%. Of 70,071 participants with eGFR(MDRD) of 45-59 mL/min/1.73 m(2), 30.8% were reclassified to eGFR(CKD-EPI) of 60-89 mL/min/1.73 m(2), and after adjusting for potential confounders, participants reclassified had a lower risk of all-cause mortality (incidence rate ratio [IRR], 0.77; 95% CI, 0.69-0.86), acute myocardial infarction (IRR, 0.73; 95% CI, 0.60-0.88), end-stage renal disease (IRR, 0.55; 95% CI, 0.32-0.94), and doubling of creatinine level (IRR, 0.78; 95% CI, 0.59-1.04) compared with those not reclassified. Similar findings were observed for those reclassified to a higher eGFR category from other eGFR(MDRD) categories. Net reclassification improvements based on eGFR categories were positive for all outcomes (range, 0.146-0.256; all P < 0.001). Limitations: Relatively short follow-up (median, 2.8 years), lack of data for some potential confounders (eg, smoking), and mainly white participants. Conclusions: These results suggest that the CKD-EPI equation more accurately categorizes individuals regarding clinical risk than the MDRD Study equation. Am J Kidney Dis. 60(2):241-249. (C) 2012 by the National Kidney Foundation, Inc.
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