Comparison of risk prediction using the CKD-EPI equations and the MDRD study equation in patients with acutely decompensated heart failure

Abstract

Purpose: Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations estimate glomerular filtration rate (eGFR) more accurately than the Modification of Diet in Renal Disease (MDRD) equation. The aim of the present study is to evaluate whether CKD-EPI equations based on serum creatinine and/or cystatin C (CysC) predict risk for adverse outcomes more accurately than the MDRD equation in a hospitalized cohort of patients with Acutely Decompensated Heart Failure (ADHF). Methods and results: 526 subjects with ADHF were studied. Blood was collected within 48 hours from admission. eGFR was calculated using the MDRD and CKD-EPI equations. The occurrence of mortality and HF hospitalization was recorded. Over the study period (median 365 days [interquartile range 238 to 370], 305 patients (58%) died or were rehospitalized for HF. Area under the receiver operator characteristic curves for CKD-EPI CysC and CKD-EPI creatinine-CysC equations were significantly higher than that for the MDRD equation, especially in patients with >60 ml/min/1.73m2. After multivariate adjustment, all eGFR equations were independent predictors of adverse outcomes (p<0.001). However, only CKD-EPI CysC and CKD-EPI creatinine-CysC equations were associated with a significant improvement in reclassification analyses (NRI = 10.8% and 12.5%, respectively). Conclusion: In patients with ADHF, CysC-based CKD-EPI equations were superior to MDRD Study equation for predicting mortality and/or HF hospitalization, and both improved clinical risk stratification.