Kidney Disease Epidemiology Collaboration Research Articles

Safe Limits of Contrast Media for Contrast-Induced Nephropathy: A Multicenter Prospective Cohort Study.

Background: The safe level of contrast media volume (CV) is an important modifiable risk factor for contrast-induced nephropathy (CIN). The safe limit of CV remains unclear and is limited to single-center studies. Our objective was to determine the association between the ratio of contrast volume-to-glomerular filtration (CV/GFR) and CIN in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI).Methods: We assessed the association between CV/GFR and the risk of CIN in 4,254 patients undergoing CAG or PCI from the year 2013 to 2016 and enrolled in the REICIN (REduction of rIsk for Contrast-Induced Nephropathy), a prospective, multicenter, observational cohort study. CV/GFR was calculated at the five primary GFR equation.Results: Sixty-nine (1.7%) patients with a median contrast volume-to-chronic kidney disease epidemiology collaboration (CV/CKD-EPI) ratio of 2.16 (1.30–3.93) have suffered from CIN. The CV/CKD-EPI demonstrated the best performance of model fit, discrimination (area under curve = 0.736), calibration, reclassification, and equation conciseness (1 variable). The CV/CKD-EPI ≥1.78 was the statistical significance associated with CIN [adjusted odds ratio, 4.64 (2.84–7.56); p < 0.001]. Furthermore, similar results were found in the subgroup analyses.Conclusions: The CV/CKD-EPI showed the best performance in patients undergoing CAG or PCI. CV/CKD-EPI ≥1.78 could be a more reliable and convenient predictor of CIN. Intraprocedural preventive measures should include a priori calculation of CV/GFR to limit contrast volume.

Abstract P039: No Beneficial Associations Between Dairy Products And Kidney Function After Myocardial Infarction

Introduction: Population-based studies showed beneficial associations between (low-fat) dairy products and kidney function. Kidney function declines with age, which is accelerated after myocardial infarction (MI). Little is known about dairy consumption and kidney function in MI patients. Hypothesis: Dairy intake may slow down kidney function decline after MI. Methods: We analysed 2,247 Dutch post-MI patients (60-80 years, 81% men) from the Alpha Omega Cohort. Dietary intakes, including types of dairy, were assessed at baseline (2002-2006) using a validated 203-item food frequency questionnaire. Glomerular filtration rate was estimated at baseline and after ~40 months, using the Chronic Kidney Disease (CKD) Epidemiology Collaboration equations for serum cystatin C alone (eGFR cysC , in ml/min per 1.73m 2 ). Associations between dairy intake and annual eGFR cysC change were obtained using multivariable linear regression models, adjusting for age, sex, lifestyle and dietary factors. Betas (β), with 95% confidence intervals (95% CI), represent additional eGFR cysC changes on top of annual decline, per increment in dairy intake. Results: At baseline, 22% was obese, 18% had diabetes and 15% had CKD (eGFR cysC &lt;60). Median dairy intakes were 70 g/day for milk (62% consumed low-fat milk), 41 g/day for yogurt and 17 g/day for hard cheeses. The mean ± SD eGFR cysC at baseline was 82 ± 19, which on average declined by 3.42 ± 11.04, corresponding to an annual decline of 0.99 ± 3.21. Total milk consumption was not associated with annual eGFR cysC change in the multivariable model (β: 0.01 per 100 g/day, 95% CI: -0.08;0.10; Figure 1). Associations for hard cheeses (per 10 g/day) and yogurt (per 25 g/day) with eGFR cysC decline were also weak and non-significant. Sensitivity analyses in non-diabetic (n=1,843) or non-CKD patients (n=1,910) yielded similar results (Figure 1). Conclusions: Milk, hard cheeses and yogurt consumption were not associated with eGFR cysC decline in Dutch post-MI patients.

A novel nomogram to predict the reliability of estimated glomerular filtration rate formulae in oncology patients

BackgroundFormulae of estimated glomerular filtration rate (eGFR) based on serum creatinine (Scr) are routinely used in oncology patients, however, they are inaccurate in some populations. Our aim was to assess the agreement of eGFR formulae and thereby build a nomogram to predict the reliability of estimates.MethodsMeasured GFR (mGFR) using isotope from 445 oncology patients were compared with eGFR from six formulae (Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), modified MDRD formulae for Chinese (C-MDRD), Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration, Wright and full age spectrum (FAS)). Bias, precision and accuracy of eGFR formulae were examined. We also evaluated statistics of agreement: the total deviation index (TDI), the concordance correlation coefficient (CCC) and the coverage probability (CP). Multivariate logistic regression was applied to identify characteristics associated with inaccurate eGFR and construct a predictive nomogram.ResultsAll eGFR formulae tended to overestimate the eGFR. The percentage of patients with eGFR within 30% the mGFR ranged from 38.0 to 62.8%. Cockcroft-Gault and MDRD showed low bias and high precision. The MDRD formula exhibited lowest TDI, meaning that 90% of estimations ranged from − 36 to 36% of mGFR. Multivariate logistic regression showed that inaccuracy of MDRD was found in elderly patients or in patients with eGFR greater than 120 ml/min. A nomogram was constructed to help oncologists to predict the risk of inaccuracy of eGFR. The calibration curve showed good agreement.ConclusionsOur results suggest that the error of eGFR by any formulae was common and wide in Chinese oncology patients. Our nomogram may assist oncologists in decision-making when mGFR is needed.

P0662A NOVEL NOMOGRAM TO PREDICT THE RELIABILITY OF ESTIMATED GLOMERULAR FILTRATION RATE FORMULA IN ONCOLOGY PATIETNS

Abstract Background and Aims Formulae of estimated glomerular filtration rate (eGFR) based on serum creatinine (Scr) are routinely used in oncology patients, however, they are inaccurate in some populations. Our aim was to identify population characteristics where eGFR formulae performed poorly and thereby build a nomogram to predict the reliability of estimates. Method Measured GFR (mGFR) using isotope from 444 oncology patients were compared with eGFR from four formulae (Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration and Wright). Multivariate logistic regression was applied to identify characteristics associated with inaccurate eGFR and construct a predictive nomogram. Results The Cockcroft–Gault formula exhibited estimates with lowest bias and highest precision. Nonetheless, it was still unreliable in a relevant proportion of patients. The percentage of patients within 30%, 20%, and 10% of the accurate percentage error (APE) was seen in only 62.8%, 47.7% and 24.8% of patients respectively. Inaccuracy was found in overweight patients or in patients with BUN/Scr ratio greater than 20 or with eGFR greater than 120 ml/min. A novel nomogram was constructed to help oncologists to predict the risk of inaccuracy of eGFR. The calibration curve showed good agreement. Conclusion Our results suggest that all eGFR formulae tend to overestimate the eGFR in oncology patients. Our nomogram may assist oncologists in decision-making when mGFR is needed.

GW24-e3537 Association between kidney function and Framingham global cardiovascular disease risk score: a Chinese longitudinal study

ObjectivesRenal function is considered a predictor for cardiovascular disease (CVD) risk. Estimated glomerular filtration rate (eGFR) is a feasible clinical measure of kidney function. Framingham global CVD risk score (FRS)...