Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Am Heart J. 2011 Sep;162(3):548-54. doi: 10.1016/j.ahj.2011.06.006. Epub 2011 Aug 9.
Systematic reporting of estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) Study equation is recommended for detection of chronic kidney disease and prediction of cardiovascular (CV) risk. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is a newly developed and validated formula for eGFR that is more accurate at normal or near-normal eGFR. We aimed to assess the incremental prognostic accuracy of eGFR(CKD-EPI) versus eGFR(MDRD) in subjects at increased risk for CV disease.
We performed a post hoc analysis of the VALIANT trial that enrolled 14,527 patients with acute myocardial infarction with signs and symptoms of heart failure and/or left ventricular systolic dysfunction. The eGFR(MDRD) and eGFR(CKD-EPI) were computed using age, gender, race, and baseline creatinine level. Patients were categorized according to their eGFR using each equation. To assess the incremental prognostic value of eGFR(CKD-EPI), the net reclassification improvement was calculated for the composite end point of CV death, recurrent myocardial infarction, heart failure, or stroke.
Twenty-four percent of the subjects were reclassified into a different eGFR category using eGFR(CKD-EPI). The composite end point occurred in 33% of the subjects in this cohort. Based on eGFR(CKD-EPI), subjects reclassified into a higher eGFR experienced fewer events than those reclassified into a lower eGFR (21% vs 43%). In unadjusted analyses, the composite end point risk in subjects with eGFR between 75 and 90 mL/min per 1.73 m(2) was comparable with the referent group (eGFR between 90 and 105) using eGFR(MDRD) (hazard ratio 1.1, 95% CI 0.9-1.2) but was significantly higher using eGFR(CKD-EPI) (hazard ratio 1.2, 95% CI 1.1-1.4). The net reclassification improvement for eGFR(CKD-EPI) over eGFR(MDRD) was 8.7%.
The CKD-EPI equation provides more accurate risk stratification than the MDRD Study equation in patients at high risk for CV disease, including identification of increased risk at mildly decreased eGFR.
推荐使用改良肾脏病饮食研究（MDRD）方程系统报告估算肾小球滤过率（eGFR），以检测慢性肾脏病并预测心血管（CV）风险。慢性肾脏病流行病学协作组（CKD-EPI）方程是一种新开发和验证的 eGFR 公式，在正常或接近正常 eGFR 时更准确。我们旨在评估 eGFR（CKD-EPI）相对于 eGFR（MDRD）在 CV 疾病风险增加的患者中的预后准确性。
我们对 VALIANT 试验进行了事后分析，该试验招募了 14527 名有心力衰竭和/或左心室收缩功能障碍迹象和症状的急性心肌梗死患者。使用年龄、性别、种族和基线肌酐水平计算 eGFR（MDRD）和 eGFR（CKD-EPI）。根据每个方程，患者根据 eGFR 进行分类。为了评估 eGFR（CKD-EPI）的增量预后价值，计算了 CV 死亡、复发性心肌梗死、心力衰竭或中风复合终点的净重新分类改善。
使用 eGFR（CKD-EPI），24%的患者被重新分类到不同的 eGFR 类别。该队列中有 33%的患者发生了复合终点事件。基于 eGFR（CKD-EPI），重新分类到更高 eGFR 的患者比重新分类到更低 eGFR 的患者经历的事件更少（21%比 43%）。在未调整的分析中，使用 eGFR（MDRD）时，eGFR 在 75 至 90 mL/min/1.73 m²之间的患者的复合终点风险与参考组（eGFR 在 90 至 105 之间）相当（危险比 1.1，95%CI 0.9-1.2），但使用 eGFR（CKD-EPI）时明显更高（危险比 1.2，95%CI 1.1-1.4）。eGFR（CKD-EPI）相对于 eGFR（MDRD）的净重新分类改善为 8.7%。
在 CV 疾病风险较高的患者中，CKD-EPI 方程比 MDRD 研究方程提供更准确的风险分层，包括在轻度 eGFR 降低时识别出更高的风险。
