Emrich Insa E, Pickering John W, Götzinger Felix, Kramann Rafael, Kunz Michael, Lauder Lucas, Papademetriou Vasilios, Böhm Michael, Heine Gunnar H, Mahfoud Felix
Saarland University Medical Center, Department of Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, Homburg, Germany.
Saarland University, Faculty of Medicine, Homburg/Saarbrücken, Germany.
Clin Kidney J. 2024 Jan 19;17(2):sfae011. doi: 10.1093/ckj/sfae011. eCollection 2024 Feb.
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.
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.
During a mean follow-up of 3.1 ± 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 or >60 ml/min/1.73 m with an ACR ≥30 mg/g) was 37% vs. 35.3% (= 0.02) vs. 46.4% (< 0.001), respectively. The corresponding mean eGFR was 72.5 ± 20.1 ml/min/1.73 m vs. 73.2 ± 19.4 ml/min/1.73 m (< 0.001) vs. 64.6 ± 17.4 ml/min/1.73 m (< 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%)).
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.
最近提出了基于肌酐的新方程，但与已确立的2009年慢性肾脏病流行病学合作组（CKD-EPI）方程相比，它们对心血管高风险参与者心血管结局的预测性能尚不清楚。
在纳入随机对照收缩压干预试验（SPRINT）的9361名美国参与者中，我们使用2009年CKD-EPI、2021年CKD-EPI和EKFC方程计算基线估计肾小球滤过率（eGFR），并比较它们对心血管事件的预测价值。使用的统计指标是净重新分类改善（NRI），分别针对有事件和无事件的人群呈现。
在平均3.1±0.9年的随访期间，559名参与者（6.0%）发生了主要终点事件。使用2009年CKD-EPI、2021年CKD-EPI和EKFC方程时，慢性肾脏病（eGFR<60 ml/min/1.73 m²或eGFR>60 ml/min/1.73 m²且尿白蛋白肌酐比值（ACR）≥30 mg/g）的患病率分别为37%、35.3%（=0.02）和46.4%（<0.001）。相应的平均eGFR分别为72.5±20.1 ml/min/1.73 m²、73.2±19.4 ml/min/1.73 m²（<0.001）和64.6±17.4 ml/min/1.73 m²（<0.001）。与2009年CKD-EPI方程相比，根据2021年CKD-EPI方程进行的重新分类[2021年CKD-EPI与2009年CKD-EPI相比：有事件者的NRI：-9.5%（95%置信区间（CI）-13.0%至-5.9%）；无事件者的NRI：4.8%（95%CI 3.9%至5.7%）]，以及根据EKFC方程进行的重新分类，均不能更好地预测心血管事件（EKFC与2009年CKD-EPI相比：有事件者的NRI：31.2%（95%CI 27.5%至35.0%）；无事件者的NRI：-31.1%（95%CI -32.1%至-30.1%））。
在无糖尿病的心血管高风险参与者中，用2021年CKD-EPI或EKFC方程替代2009年CKD-EPI方程来计算eGFR，改变了慢性肾脏病的患病率，但对于有事件和无事件的人群，均未改善心血管事件的风险预测。
