Estimated GFR and incident cardiovascular disease events in American Indians: the Strong Heart Study.Citation: American Journal of Kidney Diseases. 60(5):795-803, 2012 Nov.PMID: 22841159Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, N.I.H., ExtramuralSubject headings: *Cardiovascular Diseases/ep [Epidemiology] | *Cardiovascular Diseases/pp [Physiopathology] | *Glomerular Filtration Rate | *Indians, North American | Female | Humans | Longitudinal Studies | Male | Middle Aged | Risk AssessmentYear: 2012Local holdings: Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006ISSN:
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|Journal Article||MedStar Authors Catalog||Article||22841159||Available||22841159|
Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006
BACKGROUND: In populations with high prevalences of diabetes and obesity, estimating glomerular filtration rate (GFR) by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation may predict cardiovascular disease (CVD) risk better than by using the Modification of Diet in Renal Disease (MDRD) Study equation.
CONCLUSIONS: Although eGFR based on either equation had similar associations with incident CVD, coronary heart disease, stroke, and heart failure events, in those not having events, reclassification of participants to eGFR categories was superior using the CKD-EPI equation compared with the MDRD Study equation. Copyright 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
LIMITATIONS: Single measurements of eGFR and albuminuria at study visits.
MEASUREMENTS: The association between eGFR and outcomes was explored in Cox proportional hazards models adjusted for traditional risk factors and albuminuria; the net reclassification index and integrated discrimination improvement were determined for the CKD-EPI versus MDRD Study equations.
OUTCOMES: Fatal and nonfatal cardiovascular events, consisting of coronary heart disease, stroke, and heart failure.
PREDICTOR: Estimated GFR (eGFR) predicted using the CKD-EPI and MDRD Study equations.
RESULTS: In 4,549 participants, diabetes was present in 45%; CVD, in 7%; and stages 3-5 CKD, in 10%. During a median of 15 years, there were 1,280 cases of incident CVD, 929 cases of incident coronary heart disease, 305 cases of incident stroke, and 381 cases of incident heart failure. Reduced eGFR (<90 mL/min/1.73 m2) was associated with adverse events in most models. Compared with the MDRD Study equation, the CKD-EPI equation correctly reclassified 17.0% of 2,151 participants without incident CVD to a lower risk (higher eGFR) category and 1.3% (n=28) were reclassified incorrectly to a higher risk (lower eGFR) category.
SETTING & PARTICIPANTS: American Indians participating in the Strong Heart Study, a longitudinal population-based cohort with high prevalences of diabetes, CVD, and CKD.
STUDY DESIGN: Longitudinal cohort study comparing the association of GFR estimated using either the CKD-EPI or MDRD Study equation with incident CVD outcomes.