Comparison between three different equations for the estimation of glomerular filtration rate in predicting mortality after coronary artery bypass

Gelsomino, Sandro; Bonacchi, Massimo; Lucà, Fabiana; Barili, Fabio; Del Pace, Stefano; Parise, Orlando; Johnson, Daniel M. and Gulizia, Michele Massimo (2019). Comparison between three different equations for the estimation of glomerular filtration rate in predicting mortality after coronary artery bypass. BMC Nephrology, 20, article no. 371.

DOI: https://doi.org/10.1186/s12882-019-1564-y

Abstract

Background
This study was undertaken to compare the accuracy of chronic kidney disease-epidemiology collaboration (eGFR_CKD-EPI) to modification of diet in renal disease (eGFR_MDRD) and the Cockcroft-Gault formulas of Creatinine clearance (C_CG) equations in predicting post coronary artery bypass grafting (CABG) mortality.

Methods
Data from 4408 patients who underwent isolated CABG over a 11-year period were retrieved from one institutional database. Discriminatory power was assessed using the c-index and comparison between the scores’ performance was performed with DeLong, bootstrap, and Venkatraman methods. Calibration was evaluated with calibration curves and associated statistics.

Results
The discriminatory power was higher in eGFR_CKD-EPI than eGFR_MDRD and C_CG (Area under Curve [AUC]:0.77, 0.55 and 0.52, respectively). Furthermore, eGFR_CKD-EPI performed worse in patients with an eGFR ≤29 ml/min/1.73m² (AUC: 0.53) while it was not influenced by higher eGFRs, age, and body size. In contrast, the MDRD equation was accurate only in women (calibration statistics p = 0.72), elderly patients (p = 0.53) and subjects with severe impairment of renal function (p = 0.06) whereas C_CG was not significantly biased only in patients between 40 and 59 years (p = 0.6) and with eGFR 45–59 ml/min/1.73m² (p = 0.32) or ≥ 60 ml/min/1.73m² (p = 0.48).

Conclusions
In general, CKD-EPI gives the best prediction of death after CABG with unsatisfactory accuracy and calibration only in patients with severe kidney disease. In contrast, the CG and MDRD equations were inaccurate in a clinically significant proportion of patients.

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About

• Item ORO ID
• 68826
• Item Type
• Journal Item
• ISSN
• 1471-2369
• Keywords
• Coronary artery bypass; Renal function; Glomerular filtration; Risk score
• Academic Unit or School
• Faculty of Science, Technology, Engineering and Mathematics (STEM) > Life, Health and Chemical Sciences
  Faculty of Science, Technology, Engineering and Mathematics (STEM)
• Research Group
• Cardiovascular Research Cluster
• Copyright Holders
• © 2019 The Author(s)
• Depositing User
• Daniel Johnson