Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate.
Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate.
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DOI：
10.1001/jama.2012.3954
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发表时间：
2012-05-09
影响因子：
120.7
通讯作者：
Levey, Andrew S.
中科院分区：
文献类型：
--
作者：
Matsushita, Kunihiro;Mahmoodi, Bakhtawar K.;Woodward, Mark;Emberson, Jonathan R.;Jafar, Tazeen H.;Jee, Sun Ha;Polkinghorne, Kevan R.;Shankar, Anoop;Smith, David H.;Tonelli, Marcello;Warnock, David G.;Wen, Chi-Pang;Coresh, Josef;Gansevoort, Ron T.;Hemmelgarn, Brenda R.;Levey, Andrew S.
CKD-EPI方程比MDRD研究方程使用相同的变量更准确地估计肾小球滤过率（eGFR），特别是在较高的GFR下，但缺乏其在不同环境中的风险影响的确切证据。在具有广泛人口统计学和临床特征的人群中评价eGFRCKD-EPI与eGFRMDRD相比的风险影响。荟萃分析基于来自25个一般人群、7个高风险（血管疾病）和13个慢性肾脏疾病（CKD）队列的1，130，472名成人（年龄≥ 18岁）的数据。2011年3月至2012年3月期间进行了数据传输和分析。在940万人-年的随访期间，全因死亡率（40个队列的84，482例死亡）、心血管死亡率（28个队列的22，176例事件）和终末期肾病（ESRD）（21个队列的7，644例事件）（各队列的平均随访时间中位数为7.4年）。根据两个方程将eGFR分为6类（≥90、60-89、45-59、30-44、15-29和<15 ml/min/1.73m2）。与eGFRMDRD相比，来自一般人群队列的24.4%和0.6%的受试者分别被CKD-EPI方程重新分类为较高和较低的eGFR类别，CKD 3-5期（eGFR <60 ml/min/1.73m2）的患病率从8.7%降至6.3%。34.7%的eGFRMDRD 45-59的受试者被重新分类为eGFRCKD-EPI 60-89，与未重新分类的受试者相比，结局的发生率（每1,000人-年）较低（全因死亡率9.9 vs. 34.5，心血管死亡率2.7 vs. 13.0，ESRD 0.5 vs. 0.8）。全因死亡率、心血管死亡率和终末期肾病的相应校正风险比分别为0.80（95%置信区间，0.74 - 0.86）、0.73（0.65 - 0.82）和0.49（0.27 - 0.88）。在其他eGFRMDRD类别中观察到类似结果。基于eGFR分类的净重新分类改善（NRI）对所有结局均具有显著的正向影响（范围为0.06 - 0.13，均P<0.001）。在按年龄（<和≥65岁）、性别、人种/种族（白色、亚洲人和黑人）以及是否存在糖尿病和高血压定义的大多数亚组中，NRI同样呈阳性。高风险和CKD队列的结果与一般人群队列基本一致。在广泛的人群中，与MDRD研究方程相比，CKD-EPI方程将更少的个体分类为CKD，并且更准确地分类了死亡率和ESRD的风险。
The CKD-EPI equation more accurately estimates glomerular filtration rate (eGFR) than the MDRD Study equation using the same variables, especially at higher GFR, but definitive evidence of its risk implications in diverse settings is lacking. To evaluate risk implications of eGFRCKD-EPI compared to eGFRMDRD in populations with a broad range of demographic and clinical characteristics. Meta-analyses based on data from 1,130,472 adults (aged 18 years or older) from 25 general population, 7 high-risk (of vascular disease), and 13 chronic kidney disease (CKD) cohorts. Data transfer and analyses were conducted between March 2011 and March 2012. All-cause mortality (84,482 deaths from 40 cohorts), cardiovascular mortality (22,176 events from 28 cohorts), and end-stage renal disease (ESRD) (7,644 events from 21 cohorts) during 9.4 million person-years of follow-up (median of mean follow-up time across cohorts was 7.4 years). eGFR was classified into six categories (≥90, 60-89, 45-59, 30-44, 15-29, and <15 ml/min/1.73m2) by both equations. Compared to eGFRMDRD, 24.4% and 0.6% of participants from general population cohorts were reclassified to a higher and lower eGFR category by the CKD-EPI equation, respectively, and the prevalence of CKD stage 3-5 (eGFR <60 ml/min/1.73m2) was reduced from 8.7% to 6.3%. 34.7% of participants with eGFRMDRD 45-59 were reclassified to eGFRCKD-EPI 60-89 and had lower incidence rates (per 1,000 person-years) of outcomes compared to those not reclassified (9.9 vs. 34.5 for all-cause mortality, 2.7 vs. 13.0 for cardiovascular mortality, and 0.5 vs. 0.8 for ESRD). The corresponding adjusted hazard ratios were 0.80 (95% confidence interval, 0.74 to 0.86) for all-cause mortality, 0.73 (0.65 to 0.82) for cardiovascular mortality, and 0.49 (0.27 to 0.88) for ESRD. Similar findings were observed in other eGFRMDRD categories. Net reclassification improvement (NRI) based on eGFR categories was significantly positive for all outcomes (range from 0.06 to 0.13, all P<0.001). NRI was similarly positive in most subgroups defined by age (< and ≥65 years), sex, race/ethnicity (white, Asian, and black), and presence or absence of diabetes and hypertension. The results in high-risk and CKD cohorts were largely consistent with the general population cohorts. The CKD-EPI equation classified fewer individuals as CKD and more accurately categorized the risk for mortality and ESRD than did the MDRD Study equation across a broad range of populations.
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影响因子：
37.8
作者：
Cook, Nancy R.
通讯作者：
Cook, Nancy R.
影响因子：
13.6
作者：
Hallan, Stein I.;Coresh, Josef;Holmen, Jostein
通讯作者：
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影响因子：
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作者：
Jorsal, Anders;Tarnow, Lise;Rossing, Peter
通讯作者：
Rossing, Peter
DOI：
10.1093/ndt/gfp042
发表时间：
2009-07
期刊：
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
影响因子：
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作者：
Jafar TH;Qadri Z;Hashmi S
通讯作者：
Hashmi S
影响因子：
13.3
作者：
Carter, J. L.;Stevens, P. E.;Lamb, E. J.
通讯作者：
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