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Open Access Highly Accessed Research article

Comparing the association of GFR estimated by the CKD-EPI and MDRD study equations and mortality: the third national health and nutrition examination survey (NHANES III)

Tariq Shafi12*, Kunihiro Matsushita23, Elizabeth Selvin23, Yingying Sang23, Brad C Astor4, Lesley A Inker5 and Josef Coresh236

Author Affiliations

1 Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

2 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA

3 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

4 Department of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

5 Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA, USA

6 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

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BMC Nephrology 2012, 13:42  doi:10.1186/1471-2369-13-42

Published: 15 June 2012

Abstract

Background

The Chronic Kidney Disease Epidemiology Collaboration equation for estimation of glomerular filtration rate (eGFRCKD-EPI) improves GFR estimation compared with the Modification of Diet in Renal Disease Study equation (eGFRMDRD) but its association with mortality in a nationally representative population sample in the US has not been studied.

Methods

We examined the association between eGFR and mortality among 16,010 participants of the Third National Health and Nutrition Examination Survey (NHANES III). Primary predictors were eGFRCKD-EPI and eGFRMDRD. Outcomes of interest were all-cause and cardiovascular disease (CVD) mortality. Improvement in risk categorization with eGFRCKD-EPI was evaluated using adjusted relative hazard (HR) and Net Reclassification Improvement (NRI).

Results

Overall, 26.9% of the population was reclassified to higher eGFR categories and 2.2% to lower eGFR categories by eGFRCKD-EPI, reducing the proportion of prevalent CKD classified as stage 3–5 from 45.6% to 28.8%. There were 3,620 deaths (1,540 from CVD) during 215,082 person-years of follow-up (median, 14.3 years). Among those with eGFRMDRD 30–59 ml/min/1.73 m2, 19.4% were reclassified to eGFRCKD-EPI 60–89 ml/min/1.73 m2 and these individuals had a lower risk of all-cause mortality (adjusted HR, 0.53; 95% CI, 0.34-0.84) and CVD mortality (adjusted HR, 0.51; 95% CI, 0.27-0.96) compared with those not reclassified. Among those with eGFRMDRD >60 ml/min/1.73 m2, 0.5% were reclassified to lower eGFRCKD-EPI and these individuals had a higher risk of all-cause (adjusted HR, 1.31; 95% CI, 1.01-1.69) and CVD (adjusted HR, 1.42; 95% CI, 1.01-1.99) mortality compared with those not reclassified. Risk prediction improved with eGFRCKD-EPI; NRI was 0.21 for all-cause mortality (p < 0.001) and 0.22 for CVD mortality (p < 0.001).

Conclusions

eGFRCKD-EPI categories improve mortality risk stratification of individuals in the US population. If eGFRCKD-EPI replaces eGFRMDRD in the US, it will likely improve risk stratification.

Keywords:
Glomerular filtration rate; Chronic kidney disease; Epidemiology; Outcomes