Cockcroft-Gault Research Articles

Correlation between trough plasma dabigatran concentrations and estimates of glomerular filtration rate based on creatinine and cystatin C.

AimsDabigatran is largely cleared by renal excretion. Renal function is thus a major determinant of trough dabigatran concentrations, which correlate with the risk of thromboembolic and haemorrhagic outcomes. Current dabigatran dosing guidelines use the Cockcroft–Gault (CG) equation to gauge renal function, instead of contemporary equations including the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations employing creatinine (CKD-EPI_Cr), cystatin C (CKD-EPI_Cys) and both renal biomarkers (CKD-EPI_CrCys).MethodsA linear regression model including the dabigatran etexilate maintenance dose rate, relevant interacting drugs and genetic polymorphisms (including CES1), was used to analyse the relationship between the values from each renal function equation and trough steady-state plasma dabigatran concentrations.ResultsThe median dose-corrected trough steady-state plasma dabigatran concentration in 52 patients (38–94 years) taking dabigatran etexilate was 60 µg/L (range 9–279). The dose-corrected trough concentration in a patient on phenytoin and phenobarbitone was >3 standard deviations below the cohort mean. The CG, CKD-EPI_Cr, CKD-EPI_Cys and CKD-EPI_CrCys equations explained (R 2, 95 % CI) 32 % (9–55), 37 % (12–60), 41 % (16–64) and 47 % (20–69) of the variability in dabigatran concentrations between patients, respectively. One-way analysis of variance (ANOVA) comparing the R 2 values for each equation was not statistically significant (p = 0.74).DiscussionEstimates of renal function using the four equations accounted for 32–47 % of the variability in dabigatran concentrations between patients. We are the first to provide evidence that co-administration of phenytoin/phenobarbitone with dabigatran etexilate is associated with significantly reduced dabigatran exposure.Electronic supplementary materialThe online version of this article (doi:10.1007/s40268-014-0045-9) contains supplementary material, which is available to authorized users.

Comparative study of three methods of estimation of creatinine clearance in critically ill patients

BackgroundAt the bedside, the reference method for creatinine clearance determination is based on the measurement of creatinine concentrations in urine and serum (mCrCl). Several models are available to calculate the creatinine clearance from the serum creatinine concentration. This observational survey aimed at testing the hypothesis that the proposed equations are unreliable to determine accurate creatinine clearance in patients admitted to intensive care unit (ICU). MethodCreatinine clearance was determined by the use of mCrCl. Then, we compared three equations: Cockcroft-Gault (CG), Simplified Modification of Diet in Renal Disease (MDRDs), and Chronic Kidney Disease Epidemiology (CKD-EPI) in 156 consecutive patients within the first 24hours after ICU admission. We tested the hypothesis that the three equations were equivalent. The agreement between the three equations was evaluated by linear regression and Bland and Altman analysis. ResultsBland and Altman analysis showed similar agreement between the three equations. The biases and precisions were –4.8±51, –1.3±50, and 8.2±44 for CG, MDRDs, and CKD-EPI equations, respectively (P>0.05). The precisions were similar for the three equations (P>0.05). The percentages of outliers at ±30% were 44%, 45%, and 49% for CG, MDRDs, and CKD-EPI, respectively (P>0.05). ConclusionRegarding the high percentage of outliers, the use of these equations cannot be recommended in ICU patients.

Validity of Estimated Glomerular Filtration Rates for Assessment of Renal Function After Renal Artery Stenting in Patients With Atherosclerotic Renal Artery Stenosis

The purpose of this study was to evaluate the validity of estimates of glomerular filtration rate (eGFR) for assessing serial changes in renal function after renal artery stenting. eGFR are unreliable for assessing serial renal function in patients with atherosclerotic renal artery stenosis (RAS). eGFR have not been validated for assessment of serial renal function after renal artery stenting. Serum creatinine (SCr) and (125)I-iothalamate GFR (iGFR) were measured in RAS patients before and after renal artery stenting. eGFR were calculated from Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft-Gault (CG) formulas. Using iGFR as the reference standard, the sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) were determined for MDRD, CKD-EPI, and CG for assessing changes in GFR before and after intervention. Between 1998 and 2007, 84 patients underwent iGFR and eGFR before and after renal artery stenting. All eGFR demonstrated poor sensitivity and reliability for detecting ≥20% changes in iGFR, and poor agreement in the magnitude and direction of change in iGFR, before and after renal stenting. In RAS patients, eGFR demonstrate poor sensitivity and reliability for detecting meaningful changes in iGFR after renal artery stenting. eGFR should be abandoned as primary endpoints in major clinical trials assessing the impact of renal revascularization on renal function.

CKD-EPI and cockcroft-gault equations identify similar candidates for neoadjuvant chemotherapy in muscle-invasive bladder cancer.

Clinical guidelines suggest neoadjuvant cisplatin-based chemotherapy prior to cystectomy in the setting of muscle-invasive bladder cancer (MIBC). A creatinine clearance (CrCl) >60 mL/min is frequently used to characterize cisplatin-eligible patients, and use of the CKD-EPI equation to estimate CrCl has been advocated. From a prospectively maintained institutional database, patients with MIBC who received cystectomy were identified and clinicopathologic information was ascertained. CrCl prior to surgery was computed using three equations: (1) Cockcroft-Gault (CG), (2) CKD-EPI, and (3) MDRD. The primary objective was to determine if the CG and CKD-EPI equations identified a different proportion of patients who were cisplatin-eligible, based on an estimated CrCl of >60 mL/min. Cisplatin-eligibility was also assessed in subsets based on age, CCI score and race. Actuarial rates of neoadjuvant cisplatin-based chemotherapy use were also reported. Of 126 patients, 70% and 71% of patients were found to be cisplatin-eligible by the CKD-EPI and CG equations, respectively (P = 0.9). The MDRD did not result in significantly different characterization of cisplatin-eligibility as compared to the CKD-EPI and CG equations. In the subset of patients age >80, the CKD-EPI equation identified a much smaller proportion of cisplatin-eligible patients (25%) as compared to the CG equation (50%) or the MDRD equation (63%). Only 34 patients (27%) received neoadjuvant cisplatin-based chemotherapy. Of the 92 patients who did not receive neoadjuvant chemotherapy, 64% had a CrCl >60 mL/min by CG. In contrast to previous reports, the CKD-EPI equation does not appear to characterize a broader span of patients as cisplatin-eligible. Older patients (age >80) may less frequently be characterized as cisplatin-eligible by CKD-EPI. The discordance between actual rates of neoadjuvant chemotherapy use and rates of cisplatin eligibility suggest that other factors (e.g., patient and physician preference) may guide clinical decision-making.

Evaluation of renal function in elderly patients

Measurement of the glomerular filtration rate (GFR) is recognized worldwide as the most accurate way of assessing kidney function. The prevalence of impaired renal function increases with advancing age. In this study we compared the clinical formulae Cockcroft-Gault (CG), isotope dilution mass spectrometry-modification of diet in renal disease (IMDS-MDRD) and chronic kidney disease epidemiology collaboration (CKD-EPI) with (99m)Tc-diethylene triamine pentaacetic acid ((99m)Tc-DTPA) in elderly patients over and under the age of 70 years in an attempt to establish which formula produces the best measurement of renal function in this population. Patients were randomly selected from two age groups [<70 years (n = 37) and ≥ 70 years (n = 39)]. Two plasma samples were collected at 60 and 180 min after injection of (99m)Tc-DTPA, and the GFR was calculated applying Charles D. Russell's two-sample method. In patients younger than 70 years, no statistically significant difference was found between GFR evaluated with (99m)Tc-DTPA and GFR obtained using the other methods.In patients aged at least 70 years, no statistically significant difference was found between GFR evaluated with (99m)Tc-DTPA and GFR evaluated using the CG real weight formula. Conversely, statistically significant differences were found between GFR evaluated with (99m)Tc-DTPA and GFR obtained using the CG normalized weight (P = 0.002), IMDS-MDRD (P = 0.024) and CKD-EPI (P = 0.028) formulae. In patients older than 70 years, the use of the two 'classical' formulae (IMDS-MDRD and CKD-EPI) overestimated GFR in stage III CKD (GFR 30-59 ml/min) when compared with the gold standard (99m)Tc-DTPA method. Thus, in patients aged 70 years and above only the CG real weight formula provided unbiased results comparable to (99m)Tc-DTPA. In conclusion, in elderly patients, GFR measured using CKD-EPI and IMDS-MDRD serum creatinine-based formulae may be overestimated compared with that measured using (99m)Tc-DTPA GFR.

ESTIMATING GLOMERULAR FILTRATION RATE IN PALLIATIVE CARE PATIENTS: COMPARISON OF THE COCKROFT- GAULT AND ABBREVIATED MODIFICATION OF DIET IN RENAL DISEASE FORMULAS-IS IT RELEVANT TO CLINICAL PRACTICE?

BackgroundThe National Kidney Foundation, Kidney Disease Outcomes Quality Initiative recommends the Cockcroft Gault (CG) or abbreviated modified diet in renal disease (aMDRD) formulas for estimating Glomerular Filtration Rate (GFR). Clinical...

Use of selected prediction equations (CG, MDRD4, CKD-EPI) in improving glomerular filtration rate assessment in clinical practice in Slovakia.

Our study aimed to establish the best prediction equation for different age ranges in estimating Glomerular Filtration Rate (GFR) in clinical practice in Slovakia. The GFR by 24-hour creatinine clearance (Ccr) and the estimated GFR (eGFR) using the Cockcroft-Gault (CG), the four-variable Modification of Diet in Renal Disease (MDRD4) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations were obtained in adults aged 30-80 (n = 433, 10-years intervals). The correlation between these prediction equations and Ccr was evaluated. Errors in prediction equations were detected by moving average and by comparisons of the formulas for GFR < 1.5 ml/s and > 1.5 ml/s. The best correlations were established between Ccr and MDRD4 for women (r = 0.7790) and men (r = 0.8009), and between Ccr and CKD-EPI for women (r = 0.7780) and men (r = 0.8002) in the 60-69 age range. High correlation was also established between Ccr and CG (r = 0.8655) and MDRD4 (r = 0.8713) for men in the 40-49 age range. With the exception of the 30-40 age range, a low prediction error was observed for each age range in both genders when GFR was < 1.5 ml/s. We recommend utilization of the MDRD4 and CG equations for men (40-49 years) and MDRD4 and CKD-EPI for women and men (60-69 years), as preferred substitutes for Ccr.

Predictive Model for the Optimal Glomerular Filtration Rate in Living Kidney Transplant Recipients

BackgroundRecipient glomerular filtration rate (GFR) after living kidney transplantation (KT) is influenced by many factors. Defining the appropriate level of recipient GFR post-KT is helpful. The aim of this study was to establish a predictive model to estimate the optimal recipient GFR at 1 week post-KT. MethodsWe retrospectively analyzed 211 living KTs without delayed or slow graft function. Estimated GFR was calculated using the Cockcroft-Gault (CG) formula. Donor kidney volume was obtained from routine computed tomographic angiography (CTA) by work station GE (AW 4.20) program. Multivariate analysis was carried out with automated backward selection to establish the predictive model. The bias, precision, and accuracy of our model were also determined by application of the model to another 37 living KTs. ResultsIn multivariate analysis, the significant parameters to predict recipient GFR were donor age (P = .025) and kidney volume (P < .0001) and both were incorporated in the predictive model; predicted CG recipient GFR = 28.325 + (donor kidney volume x 0.282) - (0.297 x donor age). The correlation coefficient (R) is 0.5. Application to another group revealed that our model had high precision (14.45 mL/min), small positive bias (0.24 mL/min), and high percentage (81%) of predicted value, which was within 30% of the observed recipient GFR post-KT. ConclusionOur predictive model included donor age and donor kidney volume and could be used to estimate the optimal recipient GFR post-KT. This could be helpful to identify early graft dysfunction and to make a decision if further invasive investigation such as allograft biopsy is necessary.

PKP-006 Evaluation of the predictive ability of different formulas to estimate renal function when enoxaparin is used

BackgroundExposure to enoxaparin is significantly increased in patients with severe renal impairment (creatinine clearance ClCr <30 mL/min). Thus, a dose adjustment is recommended for both the therapeutic and prophylactic dose...

DI-077 Evaluation of the Modified Diet in Renal Disease equation for the calculation of carboplatin doses

BackgroundThe glomerular filtration rate (GFR) is used to calculate a dose for carboplatin using the Calvert equation. Our software (Asclepios) uses the Cockcroft-Gault (CG) equation to estimate GFR. According to...

Assessment of Glomerular Filtration Rates by Cockcroft-Gault and Modification of Diet in Renal Disease Equations in a Cohort of Omani Patients

Glomerular filtration rate (GFR) is the best index of renal function and is frequently assessed by corrected creatinine clearance (CCLcr). The limitations of CCLcr have inspired researchers to derive easy formulas to estimate GFR, with Cockcroft-Gault (C-G) and the modification of diet in renal disease (MDRD) being the most widely used. This study aimed to evaluate the validity of these equations by finding the relation between CCLcr and estimated GFR (eGFR) by C-G, modified C-G and MDRD equations. From 2007 to 2011, 158 subjects were analysed for serum creatinine and CCLcr at Bowsher Polyclinic, Muscat, Oman. The C-G equation was used to obtain eGFRC-G which was adjusted to body surface area (BSA) to obtain eGFRmC-G, and the MDRD equation was used to obtain eGFRMDRD. The eGFRMDRD, eGFRmC-G and eGFRC-G were then compared to CCLcr. The eGFRMDRD, eGFRmC-G and eGFRC-G significantly correlated with CCLcr, with a slightly stronger correlation with eGFRMDRD (r = 0.701, 0.658 and 0.605, respectively). A receiver operating characteristic curve analysis showed that the diagnostic accuracy of eGFRMDRD for diagnosing chronic kidney disease (CKD) was higher than that of eGFRmC-G, which in turn was higher than that of eGFRC-G (area under the curve was 0.846, 0.831, and 0.791; cut-off limits were 61.9, 58.3 and 59.5, respectively). C-G and MDRD equations can be an alternative to the CCLcr test for assessing GFR, thus avoiding the need for the cumbersome and expensive GFR test. The MDRD formula had greater validity than the C-G equation and the C-G equation validity was improved by an adjustment to BSA.

Cisplatin dose adjustment in patients with renal impairment, which recommendations should we follow?

Nephrotoxicity is the dose-limiting side effect of cisplatin justifying the assessment of renal function for dose adjustment. To determine whether appropriate dose adjustment is made in patients with renal impairment using the Cockcroft-Gault (CG) or the abbreviated Modification of Diet in Renal Disease (aMDRD) formulas to estimate the glomerular filtration rate (GFR). The study was conducted in a 1,000-bed university hospital. Two years of cisplatin prescriptions were retrospectively compared to the 4 and 3 ranges estimated glomerular filtration rate (eGFR)-stratified dosing recommendations (4RR and 3RR respectively). Cisplatin dose in mg/m(2) based on kidney function and according to the dosing recommendations. Among 1,364 cycles of cisplatin, 156 (11.4 %) were prescribed for 70 patients with eGFR < 60 mL/min and a median age of 67.4 years. For 57 (36 %) of these cycles, doses were not reduced. When reduced, prescribed doses were not different than recommended doses according to 4RR using CG (% of protocol, 63 ± 12 vs. 64 ± 17) while it was significantly lower using aMDRD (% of protocol, 66 ± 12 vs. 81 ± 22, p < 0.01) and significantly higher according to 3RR using both CG and aMDRD (% of protocol, 63 ± 12 vs. 50 ± 3 and 66 ± 12 vs. 50.7 ± 4.0 respectively, p < 0.01). Prescription of at least one appropriate dose according to 4RR and using aMDRD was associated with a statistically significant higher median total cumulative dose (% of protocol, 89.9 vs. 75.1 % respectively, p < 0.01) without higher decrease of eGFR over time. Cisplatin dose adjustment in patients with renal impairment must be improved. Estimating GFR with the aMDRD formula and adding an intermediary level of dose reduction for patients with eGFR from 50 to 59.9 mL/min may result in a higher cumulative dose of cisplatin without higher renal toxicity, which may significantly impact on the effectiveness of the chemotherapy. A prospective evaluation remains needed to assess the benefit/risk ratio of this dose adaptation schedule, taking into account the variability of the GFR estimates.

Performance of formulae based estimates of glomerular filtration rate for carboplatin dosing in stage 1 seminoma

BackgroundSingle cycle carboplatin, dosed by glomerular filtration rate (GFR), is standard adjuvant therapy for stage 1 seminoma. Accurate measurement of GFR is essential for correct dosing. Isotopic methods remain the gold standard for the determination of GFR. Formulae to estimate GFR have improved the assessment of renal function in non-oncological settings. We assessed the utility of these formulae for carboplatin dosing. MethodsWe studied consecutive subjects receiving adjuvant carboplatin for stage 1 seminoma at our institution between 2007 and 2012. Subjects underwent 51Cr-ethylene diamine tetra-acetic acid (EDTA) measurement of GFR with carboplatin dose calculated using the Calvert formula. Theoretical carboplatin doses were calculated from estimated GFR using Chronic Kidney Disease-Epidemiology (CKD-EPI), Management of Diet in Renal Disease (MDRD) and Cockcroft–Gault (CG) formulae with additional correction for actual body surface area (BSA). Carboplatin doses calculated by formulae were compared with dose calculated by isotopic GFR; a difference <10% was considered acceptable. Results115 patients were identified. Mean isotopic GFR was 96.9ml/min/1.73m2. CG and CKD-EPI tended to overestimate GFR whereas MDRD tended to underestimate GFR. The CKD-EPI formula had greatest accuracy. The CKD-EPI formula, corrected for actual BSA, performed best; 45.9% of patients received within 10% of correct carboplatin dose. Patients predicted as underdosed (13.5%) by CKD-EPI were more likely to be obese (p=0.013); there were no predictors of the 40.5% receiving an excess dose. ConclusionsOur data support further evaluation of the CKD-EPI formula in this patient population but clinically significant variances in carboplatin dosing occur using non-isotopic methods of GFR estimation. Isotopic determination of GFR should remain the recommended standard for carboplatin dosing when accuracy is essential.

Renal function estimation and one-year mortality in elderly patients with non-ST-segment elevation acute coronary syndromes

Chronic renal dysfunction is relatively common in patients hospitalized for acute coronary syndrome (ACS) and is among the most powerful predictors of adverse in-hospital outcomes [ [1] Al Suwaidi J. Reddan D.N. Williams K. et al. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation. 2002; 106: 974-980 Crossref PubMed Scopus (419) Google Scholar ]. Mathematical estimations of glomerular filtration rate (GFR), based on serum creatinine concentration, have emerged as a clinically useful method to more accurately measure renal function. The Cockcroft–Gault (CG) equation has been the traditional method of estimating GFR for drug dosing [ [2] Cockcroft D.W. Gault M.H. Prediction of creatinine clearance from serum creatinine. Nephron. 1976; 16: 31 Crossref PubMed Scopus (12986) Google Scholar ]. More recently, the Modification of Diet in Renal Disease (MDRD) formula and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation have been developed and shown to perform better than the CG equation in terms of precision and accuracy [ [3] Michels W.M. Grootendorst D.C. Verduijn M. Elliott E.G. Dekker F.W. Krediet R.T. Performance of the Cockcroft–Gault, MDRD, and new CKD-EPI formulas in relation to GFR, age, and body size. Clin J Am Soc Nephrol. 2010; 5: 1003-1009 Crossref PubMed Scopus (354) Google Scholar ]. However, neither >formula was specifically developed or validated in patients with heart diseases, especially the elderly and the very elderly [ [2] Cockcroft D.W. Gault M.H. Prediction of creatinine clearance from serum creatinine. Nephron. 1976; 16: 31 Crossref PubMed Scopus (12986) Google Scholar ]. The Italian Elderly ACS study, the first specifically investigating treatment strategies for elderly patients with non ST-elevation ACS (NSTEACS), represents a unique opportunity to investigate this issue. Details of the study design and population have been published [ [4] Savonitto S. Cavallini C. Petronio A.S. et al. Italian Elderly ACS Trial InvestigatorsEarly aggressive versus initially conservative treatment in elderly patients with non-ST-segment elevation acute coronary syndrome: a randomized controlled trial. JACC Cardiovasc Interv. 2012; 5: 906-916 Abstract Full Text Full Text PDF PubMed Scopus (177) Google Scholar ]. Overall 645 patients aged ≥75 years were enrolled in the trial or included in a parallel registry. Signature of an informed consent form was a prerequisite for enrolment. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution's human research committee. Serum creatinine (Cr) was analyzed according to the method used in each local laboratory. The GFR from the CG equation was estimated as: ([{140 − age in years} × body weight in kg] / {72 × Cr in mg/dl}) × 0.85 (female gender); for the MDRD formula as: [186 × (Cr in mg/dl)−1.154] × (age)−0.203 × (0.742 if female) and for the CKD-EPI equation as: 141 × min [(Cr (in mg/dl) / κ, 1)α] × max (Cr / κ, 1)−1.209 × 0.993age × (1.018 if female), where κ is 0.7 for females and 0.9 for males and α is −0.329 for females and −0.411 for males. For comparison with other equations, the predicted creatinine clearance by CG was normalized per 1.73 m2 of body surface area (BSA). We defined normal renal function as estimated GFR >60 ml·min·1.73 m−2, mild to moderate renal dysfunction as estimated GFR <60 and >30 ml·min·1.73 m−2 and severe renal dysfunction as estimated GFR <30 ml·min·1.73 m−2.

Comparison of seven kinds of calculation methods on glomerular filtration rate in patients with chronic kidney disease

Objective: The objective was to compare the diagnostic value of seven kinds of calculation methods on glomerular filtration rate (GFR) in patients with chronic kidney disease (CKD). Materials and Methods: A total of 120 cases with CKD and 120 normal people were included in this study. They were grouped according to the GFR results estimated by the plasma clearance of 99m technetium-diethylene-triamine-pentaacetate. Serum cystatin C (Cys C) concentrations were detected by enzyme-linked immunosorbent assay. GFR and serum creatinine (SCr) was simultaneously analyzed using Automatic Biochemistry Analyzer. Estimated GFR (eGFR) was detected with seven kinds of calculation methods. Results: Modification of diet in renal disease (MDRD) equations obtained significantly lower GFR in group CKD2, while Cockcroft-Gault (CG) equation obtained significantly lower GFR in group CKD3. There were no statistical differences between four Cys C-based equations (GFR estimated via cystatin [Cys-eGFR] formula) and GFR from CKD1 to CKD5. In the groups CKD2 and CKD3, GFRs detected by four kinds of formula Cys-eGFR were all superior to that by CG and MDRD. For the CKD patients with GFR <60 mL/min/1.73 m 2 , four kinds of receiver operating characteristic (ROC) curve area of Cys-eGFR were more than GFR estimated via creatinine (Cr-eGFR) formula, the differences were statistically significant. For those with GFR <30 mL/min/1.73 m 2 , the comparative results of ROC curve area had no statistical difference. Conclusion: Cys-eGFR is a more accurate equation for estimating GFR than CG and MDRD equation, but not superior to Cr-eGFR, which based on SCr in advanced chronic renal failure patients.

Impact of kidney function calculation formulae on predicting early adverse renal events in cardiac surgery

The Cockcroft-Gault (CG) equation and the four-variable Modification of Diet in Renal Disease (MDRD) formula are the most commonly used methods to provide estimation of kidney function. The newly developed Mayo Clinic quadratic equation (MCQE) is another alternative. The scope of this study is to investigate the prognostic value of the above algorithms as prediction models for development of acute renal injury (AKI) and early renal dialysis (RD) in cardiac surgery patients during the postoperative ICU stay.

The Chinese version of the modification of diet in renal disease (MDRD) equation is a superior screening tool for chronic kidney disease among middle-aged Taiwanese than the original MDRD and Cockcroft-Gault equations.

Three equations have been often used to estimate glomerular filtration rate (GFR), namely, Modification of Diet in Renal Disease (MDRD), MDRD for Chinese (MDRDc), and Cockcroft-Gault (CG), for the purpose of screening individuals with chronic kidney disease (CKD). However, neither of these equations has been tested in a large Asian population. The aim of this study was to determine which equations were suitable for screening CKD in a large Taiwanese population. The applicability of the three equations was analyzed among 32,542 participants of a health examination at Chang Gung Memorial Hospital (CGMH), Taiwan, between 2005 and 2007. Estimated glomerular filtration rate (eGFR)-MDRDc obtained the highest estimate of GFR (mean 101.5 ± 19.2 ml/min/1.73 m 2 ), followed by eGFR-MDRD (mean 83.8 ± 15.8 ml/min/1.73 m 2 ) and eGFR-CG (mean 79.4 ± 29.1 ml/min/1.73 m 2 ). The prevalence of CKD stage 3-5 was 1.9%, 5.1%, and 25.5% according to MDRDc, MDRD and CG equations, respectively. With respect to CKD staging, the agreement between eGFR-MDRDc and eGFR-CG (weighted kappa, k = 0.22) and that between eGFR-MDRD and eGFR-CG (weighted k = 0.30) was poor. Both the original MDRDc and MDRD indicated that subjects with risk factors for CKD had significantly lower eGFR and higher odds ratios for stage 3-5 disease than those without. Paradoxically, the mean eGFR-CG (or odds ratios) was higher (or lower) in subjects with hyperuricemia, hypertension, obesity, or metabolic syndrome than those without these risk factors. The use of the CG equation in the Taiwanese population is inappropriate for screening individuals with CKD, and the MDRDc equation seems to be better for Taiwanese population.

Abstract 18013: Which Measure of Renal Function is the Best Predictor of Outcome in Heart Failure? A Comparison of Cockcroft Gault, Modification of Diet in Renal Disease Study Group and Chronic Kidney Disease Epidemiology Collaboration Formulae

Introduction: Renal function is an important predictor of prognosis in heart failure (HF). Several formulae can be used to estimate glomerular filtration (eGFR) but which of these is best at predicting outcome in HF is uncertain. We compared the performance of the Cockcroft-Gault (CG), Modification of Diet in Renal Disease Study Group (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in predicting all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). Methods: We studied the 5011 patients aged ≥60 years with symptomatic (NYHA class II-IV) HF of ischemic etiology and a LVEF ≤40% (≤35% in NYHA class II) enrolled in the Controlled Rosuvastatin Multinational Trial in Heart Failure trial (CORONA). Mortality rates were calculated for patients in the eGFR categories &lt;45, 45-59 and ≥60 ml/min/1.73m 2 (reference). The performance of the equations was compared using receiver operating characteristic curve (ROC) analysis. Results: The rate and risk of death was highest in those with the lowest eGFR for each formula (Table). The area under the ROC for CG was 0.64, MDRD 0.59 (P&lt;0.001 versus CG) and CKD-EPI 0.61 (P&lt;0.0001 versus CG). Conclusion: Risk prediction with CG was better than with MDRD or CKD-EPI in patients with HfrEF in CORONA. †Rate per 100 patient years *Reference group

Estimation Of GFR With Different EGFR Equations In Multiple Myeloma Patients Receiving Lenalidomide Treatment

IntroductionRenal impairment (RI) in patients with MM is detrimental organ damage. The estimation of glomerular filtration (eGFR) rates is based on using different equations such as CKD-EPI, MDRD or Cockcroft-Gault (CG). Methods: We enrolled 132 consecutive MM patients treated with lenalidomide for the approved indication in our department between 2006 and 2012. The GFR for quantifying RI was estimated by the CKD-EPI, MDRD- and CG-equations at baseline and after 3 months under lenalidomide therapy. We assessed hematological response by the EBMT criteria, and renal response according to recently proposed criteria (Dimopolous et al. Leukemia 2013) and by comparing the CKD-EPI, MDRD- and CG equations. ResultsMedian patient age was 64 years (range 41-90; males 62%) with predominantly advanced stage II/III Durie & Salmon and International Staging System disease (96% vs. 65%, respectively). Fifty-four MM patients had received ≥2 therapy lines and 50% prior stem cell transplantation. The median lenalidomide dose was 25mg (D1-21/28 day cycle) given with dexamethasone (Rd) as published. The median serum creatinine was normal at 1.0mg/dl, whereas the median eGFR showed CKD stage 2, with substantially different median CKD-EPI, MDRD and CG equations of 77, 81 and 74ml/min/1.73m2, respectively (Figure 1A). For each equation, the number of patients with CKD stage 3–5 via CKD-EPI, MDRD and CG equation was 32%, 23% and 30%, respectively (Table 1). In total, 26 (20%) MM patients with eGFR values by the MDRD equation were reclassified to higher CKD-stages according to CKD-EPI equation and 3 (2%) to lower CKD stages (Figure 1B). This demonstrates that the MDRD may substantially overestimate the GFR, especially in elderly patients with normal or less impaired renal function (GFR >60ml/min/1.73m2). Best overall response (ORR=CR+PR) and clinical benefit rate (CR, PR, SD) in this advanced, substantially pretreated cohort was 48% and 93%, respectively. After 3 months, renal response (CR, PR, MR) according to CKD-EPI, MDRD and CG were 17%, 11% and 15%, respectively, and renal response defined as any eGFR improvement was 52%, 51% and 51%, respectively. For each eGFR equation, the number of patients with renal improvement according to CKD stage 1-2 was more pronounced with the CKD-EPI (68% → 76%), less with the MDRD (77% → 83%) and least with the CG equation (70% → 75%; Table 1). [Display omitted] Table 1Estimated CKD stages and prevalence of CKD stages 3-5 by different eGFR equations at baseline and after 3 months lenalidomide therapyBaselineAfter 3 monthsBaselineAfter 3 monthsBaselineAfter 3 monthsVariablesCKD-EPIMDRDCockcroft-Gaultn (%)n (%)n (%)n (%)n (%)n (%)CKD stage (ml/min/1.73m²)1: eGFR ≥9035 (26)68%40 (33)76%46 (35)77%49 (41)83%49 (37)70%47 (39)75%2: eGFR 89-6055 (42)51 (43)56 (42)50 (42)43 (33)43 (36)3: eGFR 59-3033 (25)32%22 (18)24%21 (16)23%14 (12)17%32 (24)30%23 (19)25%4: eGFR 29-157 (5)6 (5)8 (6)7 (5)7 (5)5 (5)5: eGFR <152 (2)1 (1)1 (1)0 (0)1 (1)1 (1) ConclusionsTo the best of our knowledge, we are the first to demonstrate that measuring renal function by the CKD-EPI equation in Rd-treated MM patients is highly valuable. In these substantially pretreated MM patients, renal response under lenalidomide was seen via CKD-EPI in 17% and any eGFR improvements in 52%, indicating that Rd in these patients is effective and RI best defined via CKD-EPI. Our results enlarge the arsenal of available eGFR equations by the CKD-EPI formula. Disclosures:Kleber:Celgene: Educational grant Other. Engelhardt:Celgene: Educational grant Other.

Comparison of Cockcroft-Gault and Modification of Diet in Renal Disease Formulas as Predictors of Cardiovascular Outcomes in Patients With Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

We prospectively assessed the value of estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault (C-G) equations in predicting inhospital adverse outcomes after primary coronary intervention for acute ST-segment elevation myocardial infarction. We classified 647 patients into 3 categories according to eGFR, <60, 60 to 90, and >90 mL/min/1.73 m(2). The eGFRC-G classified 17 patients in the >90 mL/min/1.73 m(2) subgroup and 6 and 11 patients in the 60 to 90 and <60 mL/min/1.73 m(2) subgroups, respectively. In multivariate analysis, patients with eGFRC-G < 60 mL/min/1.73 m(2) had 19.5-fold (95% confidence interval [CI] 1.55-178) higher mortality risk and 5.48-fold (95% CI 1.75-24.21) higher major adverse cardiac events risk compared to patients with eGFRC-G >90 mL/min/1.73 m(2) (P = .01 and P = .01, respectively); the eGFRMDRD was not predictive. Although the MDRD equation more accurately estimates GFR in certain populations, the CG formula may be a better predictor of adverse events.