학술논문
Comparison of three creatinine-based equations to predict adverse outcome in a cardiovascular high-risk cohort: an investigation using the SPRINT research materials
ORIGINAL ARTICLE
ORIGINAL ARTICLE
Document Type
Academic Journal
Author
Source
Clinical Kidney Journal. February 2024, Vol. 17 Issue 2, p1, 11 p.
Subject
Language
English
ISSN
2048-8505
Abstract
INTRODUCTION Glomerular filtration rate (GFR) is used to assess exocrine kidney function and to diagnose and classify chronic kidney disease (CKD). Additionally, GFR is an established independent predictor of all-cause [...]
Background. Novel creatinine-based equations have recently been proposed but their predictive performance for cardiovascular outcomes in participants at high cardiovascular risk in comparison to the established CKD-EPI 2009 equation is unknown. Method. In 9361 participants from the United States included in the randomized controlled SPRINT trial, we calculated baseline estimated glomerular filtration rate (eGFR) using the CKD-EPI 2009, CKD-EPI 2021, and EKFC equations and compared their predictive value of cardiovascular events. The statistical metric used is the net reclassification improvement (NRI) presented separately for those with and those without events. Results. During a mean follow-up of 3.1 [+ or -] 0.9 years, the primary endpoint occurred in 559 participants (6.0%). When using the CKD-EPI 2009, the CKD-EPI 2021, and the EKFC equations, the prevalence of CKD (eGFR 60 ml/min/1.73 [m.sup.2] with an ACR [greater than or equal to]30 mg/g) was 37% vs. 35.3% (P = 0.02) vs. 46.4% (P < 0.001), respectively. The corresponding mean eGFR was 72.5 [+ or -] 20.1 ml/min/1.73 [m.sup.2] vs. 73.2 [+ or -] 19.4 ml/min/1.73 [m.sup.2] (P < 0.001) vs. 64.6 [+ or -] 17.4 ml/min/1.73 [m.sup.2] (P < 0.001). Neither reclassification according to the CKD-EPI 2021 equation [CKD-EPI 2021 vs. CKD-EPI 2009: NRIevents:-9.5% (95% confidence interval (CI)-13.0% to-5.9%); NRInonevents: 4.8% (95% CI 3.9% to 5.7%)], nor reclassification according to the EKFC equation allowed better prediction of cardiovascular events compared to the CKD-EPI 2009 equation (EKFC vs. CKD-EPI 2009: NRIevents: 31.2% (95% CI 27.5% to 35.0%); NRInonevents:-31.1% (95% CI-32.1% to-30.1%)). Conclusion. Substituting the CKD-EPI 2009 with the CKD-EPI 2021 or the EKFC equation for calculation of eGFR in participants with high cardiovascular risk without diabetes changed the prevalence of CKD but was not associated with improved risk prediction of cardiovascular events for both those with and without the event. Keywords: cardiovascular risk prediction, CKD-EPI 2009 equation, CKD-EPI 2021 equation, classification, estimated glomerular filtration rate, European Kidney Function Consortium (EKFC) equation
Background. Novel creatinine-based equations have recently been proposed but their predictive performance for cardiovascular outcomes in participants at high cardiovascular risk in comparison to the established CKD-EPI 2009 equation is unknown. Method. In 9361 participants from the United States included in the randomized controlled SPRINT trial, we calculated baseline estimated glomerular filtration rate (eGFR) using the CKD-EPI 2009, CKD-EPI 2021, and EKFC equations and compared their predictive value of cardiovascular events. The statistical metric used is the net reclassification improvement (NRI) presented separately for those with and those without events. Results. During a mean follow-up of 3.1 [+ or -] 0.9 years, the primary endpoint occurred in 559 participants (6.0%). When using the CKD-EPI 2009, the CKD-EPI 2021, and the EKFC equations, the prevalence of CKD (eGFR 60 ml/min/1.73 [m.sup.2] with an ACR [greater than or equal to]30 mg/g) was 37% vs. 35.3% (P = 0.02) vs. 46.4% (P < 0.001), respectively. The corresponding mean eGFR was 72.5 [+ or -] 20.1 ml/min/1.73 [m.sup.2] vs. 73.2 [+ or -] 19.4 ml/min/1.73 [m.sup.2] (P < 0.001) vs. 64.6 [+ or -] 17.4 ml/min/1.73 [m.sup.2] (P < 0.001). Neither reclassification according to the CKD-EPI 2021 equation [CKD-EPI 2021 vs. CKD-EPI 2009: NRIevents:-9.5% (95% confidence interval (CI)-13.0% to-5.9%); NRInonevents: 4.8% (95% CI 3.9% to 5.7%)], nor reclassification according to the EKFC equation allowed better prediction of cardiovascular events compared to the CKD-EPI 2009 equation (EKFC vs. CKD-EPI 2009: NRIevents: 31.2% (95% CI 27.5% to 35.0%); NRInonevents:-31.1% (95% CI-32.1% to-30.1%)). Conclusion. Substituting the CKD-EPI 2009 with the CKD-EPI 2021 or the EKFC equation for calculation of eGFR in participants with high cardiovascular risk without diabetes changed the prevalence of CKD but was not associated with improved risk prediction of cardiovascular events for both those with and without the event. Keywords: cardiovascular risk prediction, CKD-EPI 2009 equation, CKD-EPI 2021 equation, classification, estimated glomerular filtration rate, European Kidney Function Consortium (EKFC) equation