Dataset Information

Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality stratification in acute heart failure: A STROBE-compliant prospective observational study.

ABSTRACT: An increasing number of studies outline renal function as an important risk marker for mortality in acute heart failure (AHF). However, routine estimation of glomerular filtration rate (eGFR) based on serum creatinine is imprecise.This study aims to compare the prognostic impact of CKD-EPI creatinine based equation (eGFRcr), cystatin C based equation (eGFRcyst), and creatinine-cystatin C equation (eGFRcrcyst) for the mortality stratification in AHF.A total of 354 Patients with AHF were prospectively included between January 2012 and June 2016. Creatinine and cystatin C were measured using the same blood sample tube on admission. We quantified eGFR by the eGFRcr, eGFRcyst, and eGFRcrcyst equations. The continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) were calculated to compare the discriminative prognostic value of different CKD-EPI formula.After a median follow-up of 35 months, 161 patients (45.5%) died. Reduced eGFRcyst and eGFRcrcyst remained significant association with death after adjustment. eGFRcyst showed the best area under the curve value (0.706) for the prediction of all-cause mortality. Considering mortality reclassification, both eGFRcyst (IDI?=?7.3%, P?

SUBMITTER: Cheang I

PROVIDER: S-EPMC7598854 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality stratification in acute heart failure: A STROBE-compliant prospective observational study.

Cheang Iokfai I Liao Shengen S Yao Wenming W Lu Xinyi X Gao Rongrong R Zhou Yanli Y Zhang Haifeng H Li Xinli X

Medicine 20201001 44

An increasing number of studies outline renal function as an important risk marker for mortality in acute heart failure (AHF). However, routine estimation of glomerular filtration rate (eGFR) based on serum creatinine is imprecise.This study aims to compare the prognostic impact of CKD-EPI creatinine based equation (eGFRcr), cystatin C based equation (eGFRcyst), and creatinine-cystatin C equation (eGFRcrcyst) for the mortality stratification in AHF.A total of 354 Patients with AHF were prospecti ...[more]

PMID: 33126378

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Project description:Use of race adjustment in estimating glomerular filtration rate (eGFR) has been challenged given concerns that it may negatively impact the clinical care of Black patients, as it results in Black patients being systematically assigned higher eGFR values than non-Black patients. We conducted a systematic review to assess how well eGFR, with and without race adjustment, estimates measured GFR (mGFR) in Black adults globally. A search across multiple databases for articles published from 1999 to May 2021 that compared eGFR to mGFR and reported outcomes by Black race was performed. We included studies that assessed eGFR using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICr) creatinine equations. Risk of study bias and applicability were assessed with the QUality Assessment of Diagnostic Accuracy Studies-2. Of 13,167 citations identified, 12 met the data synthesis criteria (unique patient cohorts in which eGFR was compared to mGFR with and without race adjustment). The studies included patients with and without kidney disease from Africa (n = 6), the United States (n = 3), Europe (n = 2), and Brazil (n = 1). Of 11 CKD-EPI equation studies, all assessed bias, 8 assessed accuracy, 6 assessed precision, and 5 assessed correlation/concordance. Of 7 MDRD equation studies, all assessed bias, 6 assessed accuracy, 5 assessed precision, and 3 assessed correlation/concordance. The majority of studies found that removal of race adjustment improved bias, accuracy, and precision of eGFR equations for Black adults. Risk of study bias was often unclear, but applicability concerns were low. Our systematic review supports the need for future studies to be conducted in diverse populations to assess the possibility of alternative approaches for estimating GFR. This study additionally provides systematic-level evidence for the American Society of Nephrology-National Kidney Foundation Task Force efforts to pursue other options for GFR estimation.

Project description:BACKGROUND:The Kidney Disease Improving Global Outcomes (KDIGO) guideline recommends use of a cystatin C-based estimated glomerular filtration rate (eGFR) to confirm creatinine-based eGFR between 45 and 59 mL · min(-1) · (1.73 m(2))(-1). Prior studies have demonstrated that comorbidities such as solid-organ transplant strongly influence the relationship between measured GFR, creatinine, and cystatin C. Our objective was to evaluate the performance of cystatin C-based eGFR equations compared with creatinine-based eGFR and measured GFR across different clinical presentations. METHODS:We compared the performance of the CKD-EPI 2009 creatinine-based estimated GFR equation (eGFRCr) and the newer CKD-EPI 2012 cystatin C-based equations (eGFRCys and eGFRCr-Cys) with measured GFR (iothalamate renal clearance) across defined patient populations. Patients (n = 1652) were categorized as transplant recipients (n = 568 kidney; n = 319 other organ), known chronic kidney disease (CKD) patients (n = 618), or potential kidney donors (n = 147). RESULTS:eGFRCr-Cys showed the most consistent performance across different clinical populations. Among potential kidney donors without CKD [stage 2 or higher; eGFR >60 mL · min(-1) · (1.73 m(2))(-1)], eGFRCys and eGFRCr-Cys demonstrated significantly less bias than eGFRCr; however, all 3 equations substantially underestimated GFR when eGFR was <60 mL · min(-1) · (1.73 m(2))(-1). Among transplant recipients with CKD stage 3B or greater [eGFR <45 mL · min(-1) · (1.73 m(2))(-1)], eGFRCys was significantly more biased than eGFRCr. No clear differences in eGFR bias between equations were observed among known CKD patients regardless of eGFR range or in any patient group with a GFR between 45 and 59 mL · min(-1) · (1.73 m(2))(-1). CONCLUSIONS:The performance of eGFR equations depends on patient characteristics that are readily apparent on presentation. Among the 3 CKD-EPI equations, eGFRCr-Cys performed most consistently across the studied patient populations.

Project description:ContextThe Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation more accurately estimates glomerular filtration rate (GFR) than the Modification of Diet in Renal Disease (MDRD) Study equation using the same variables, especially at higher GFR, but definitive evidence of its risk implications in diverse settings is lacking.ObjectiveTo evaluate risk implications of estimated GFR using the CKD-EPI equation compared with the MDRD Study equation in populations with a broad range of demographic and clinical characteristics.Design, setting, and participantsA meta-analysis of data from 1.1 million adults (aged ≥ 18 years) from 25 general population cohorts, 7 high-risk cohorts (of vascular disease), and 13 CKD cohorts. Data transfer and analyses were conducted between March 2011 and March 2012.Main outcome measuresAll-cause mortality (84,482 deaths from 40 cohorts), cardiovascular mortality (22,176 events from 28 cohorts), and end-stage renal disease (ESRD) (7644 events from 21 cohorts) during 9.4 million person-years of follow-up; the median of mean follow-up time across cohorts was 7.4 years (interquartile range, 4.2-10.5 years).ResultsEstimated GFR was classified into 6 categories (≥90, 60-89, 45-59, 30-44, 15-29, and <15 mL/min/1.73 m(2)) by both equations. Compared with the MDRD Study equation, 24.4% and 0.6% of participants from general population cohorts were reclassified to a higher and lower estimated GFR category, respectively, by the CKD-EPI equation, and the prevalence of CKD stages 3 to 5 (estimated GFR <60 mL/min/1.73 m(2)) was reduced from 8.7% to 6.3%. In estimated GFR of 45 to 59 mL/min/1.73 m(2) by the MDRD Study equation, 34.7% of participants were reclassified to estimated GFR of 60 to 89 mL/min/1.73 m(2) by the CKD-EPI equation and had lower incidence rates (per 1000 person-years) for the outcomes of interest (9.9 vs 34.5 for all-cause mortality, 2.7 vs 13.0 for cardiovascular mortality, and 0.5 vs 0.8 for ESRD) compared with those not reclassified. The corresponding adjusted hazard ratios were 0.80 (95% CI, 0.74-0.86) for all-cause mortality, 0.73 (95% CI, 0.65-0.82) for cardiovascular mortality, and 0.49 (95% CI, 0.27-0.88) for ESRD. Similar findings were observed in other estimated GFR categories by the MDRD Study equation. Net reclassification improvement based on estimated GFR categories was significantly positive for all outcomes (range, 0.06-0.13; all P < .001). Net reclassification improvement was similarly positive in most subgroups defined by age (<65 years and ≥65 years), sex, race/ethnicity (white, Asian, and black), and presence or absence of diabetes and hypertension. The results in the high-risk and CKD cohorts were largely consistent with the general population cohorts.ConclusionThe CKD-EPI equation classified fewer individuals as having CKD and more accurately categorized the risk for mortality and ESRD than did the MDRD Study equation across a broad range of populations.

Dataset Information

Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality stratification in acute heart failure: A STROBE-compliant prospective observational study.

Publications

Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality stratification in acute heart failure: A STROBE-compliant prospective observational study.

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