Abstract
We aimed to compare the ability of preoperative estimated glomerular filtration rate (eGFR), calculated using five different equations, to predict adverse renal outcomes after cardiovascular surgery. Cohorts of 4,125 adult patients undergoing elective cardiovascular surgery were evaluated. Preoperative eGFR was calculated using the Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD) II, re-expressed MDRD II, Chronic Kidney Disease Epidemiology Collaboration, and Mayo quadratic (Mayo) equations. The primary outcome was postoperative acute kidney injury (AKI), defined by Kidney Disease: Improving Global Outcomes Definition and Staging criteria based on changes in serum creatinine concentrations within 7 days. The MDRD II and Cockcroft-Gault equations yielded the highest (88.1 ± 26.7 ml/min/1.73 m2) and lowest (79.6 ± 25.5 ml/min/1.73 m2) mean eGFR values, respectively. Multivariable analysis showed that a preoperative decrease in renal function according to all five equations was independently associated with an increased risk of postoperative AKI. The area under the receiver operating characteristics curve for predicting postoperative AKI was highest for the Mayo equation (0.713). Net improvements in reclassification and integrated discrimination were higher for the Mayo equation than for the other equations. The Mayo equation was the most accurate in predicting postoperative AKI in patients undergoing cardiovascular surgery.
Highlights
Preoperative renal dysfunction is prevalent in patients undergoing cardiovascular surgery, and is an independent risk factor for morbidity and mortality after surgery[1,2,3]
When the patients were classified into five categories or two categories, the best agreement was shown between the Modification of Diet in Renal Disease (MDRD) II and CKD-EPI equation and the worst between the CG and Mayo equation
Despite the relatively good correlation and agreement between estimated glomerular filtration rate (GFR) (eGFR) calculated using all five equations, the proportion of patients classified into different renal function groups varied considerably
Summary
Preoperative renal dysfunction is prevalent in patients undergoing cardiovascular surgery, and is an independent risk factor for morbidity and mortality after surgery[1,2,3]. Other equations used to calculate eGFR include the re-expressed MDRD II equation, developed for use with standardized sCr assays[7]; the Mayo Quadratic (Mayo) equation, developed to better estimate GFR in healthy patients with preserved renal function[8]; and the recently developed Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation[9]. Of these five equations, CKD-EPI equation is known to have the highest accuracy in estimating GFR and is currently recommended for use to estimate GFR by the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines[10]. The aim of this study was to evaluate the agreement between eGFRs calculated using five different equations based on a single preoperative sCr value, as well as to confirm which equation can best predict postoperative renal dysfunction in patients undergoing cardiovascular surgery
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