Osadnik Tadeusz, Wasilewski Jarosław, Lekston Andrzej, Strzelczyk Joanna, Kurek Anna, Gutowski Aleksander Rafał, Dyrbuś Krzysztof, Bujak Kamil, Reguła Rafał, Rozentryt Piotr, Szyguła-Jurkiewicz Bożena, Poloński Lech
IIIrd Department of Cardiology, Medical University of Silesia in Katowice, Medical Faculty in Zabrze, Silesian Centre for Heart Diseases, Ul. Marii Skłodowskiej Curie 9, 41-800, Zabrze, Poland,
Clin Res Cardiol. 2014 Jul;103(7):569-76. doi: 10.1007/s00392-014-0687-1. Epub 2014 Mar 9.
The aim was to assess the predictive value of estimated glomerular filtration rate (eGFR) using two formulas: modification of diet in renal disease (MDRD) and chronic kidney disease epidemiology collaboration (CKD-EPI), in a population with stable coronary artery disease (SCAD) undergoing percutaneous coronary revascularization (PCI).
The analyzed cohort included 3,141 consecutive patients with SCAD who underwent PCI, between January 2006 and December 2011. Follow-up data were available for 3,123 (99.4 %) patients.
The median follow-up was 1,127 days (interquartile range 566-1,634 days). During the observation period, 330 deaths were reported. In patients with serum creatinine (S-Cr) within normal range, eGFR by CKD-EPI equation predicted long-term outcome more accurately, than eGFR by MDRD formula-continuous Net Reclassification Improvement: 0.296 (95 % CI, 0.08-0.5 p = 0.03). In patients with elevated S-CR, eGFR calculated by both formulae had similar efficacy in assessing death risk. After adjustment for differences in clinical characteristics, both formulae were associated with mortality, but only in patients with elevated S-Cr: eGFR by MDRD (per 10 ml/min/1.73 m(2)) HR: 0.74 [95 % CI, 0.61-0.89, p = 0.002], eGFR by CKD-EPI (per 10 ml/min/1.73 m(2)) HR: 0.75 (95 % CI, 0.63-0.89, p = 0.001). After adjustment for covariates, eGFR by CKD-EPI equation did not offer more appropriate categorization of individuals with respect to long-term mortality.
Our results indicate that in multivariable analysis eGFR calculated by MDRD and CKD-EPI equations has similar predictive value. In a population of patients with SCAD and S-Cr within normal range, eGFR calculated by CKD-EPI equation outperforms eGFR calculated by MDRD equation in assessing death risk.
本研究旨在评估在接受经皮冠状动脉血运重建术（PCI）的稳定型冠状动脉疾病（SCAD）患者群体中，使用两种公式估算肾小球滤过率（eGFR）的预测价值，这两种公式分别为肾脏病饮食改良（MDRD）公式和慢性肾脏病流行病学协作组（CKD-EPI）公式。
分析队列包括2006年1月至2011年12月期间连续3141例接受PCI的SCAD患者。3123例（99.4%）患者有随访数据。
中位随访时间为1127天（四分位间距566 - 1634天）。观察期内报告330例死亡。在血清肌酐（S-Cr）在正常范围内的患者中，CKD-EPI公式计算的eGFR比MDRD公式计算的eGFR更准确地预测长期预后——连续净重新分类改善：0.296（95%CI，0.08 - 0.5，p = 0.03）。在S-CR升高的患者中，两种公式计算的eGFR在评估死亡风险方面具有相似的效能。在调整临床特征差异后，两种公式均与死亡率相关，但仅在S-Cr升高的患者中：MDRD公式计算的eGFR（每10 ml/min/1.73 m²）HR：0.74 [95%CI，0.61 - 0.89，p = 0.002]，CKD-EPI公式计算的eGFR（每10 ml/min/1.73 m²）HR：0.75（95%CI，0.63 - 0.89，p = 0.001）。在调整协变量后，CKD-EPI公式计算的eGFR在长期死亡率方面并未提供更合适的个体分类。
我们的结果表明，在多变量分析中，MDRD和CKD-EPI公式计算的eGFR具有相似的预测价值。在SCAD且S-Cr在正常范围内的患者群体中，CKD-EPI公式计算的eGFR在评估死亡风险方面优于MDRD公式计算的eGFR。
