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J Am Coll Cardiol. 2015 Jun 30;65(25):2714-23. doi: 10.1016/j.jacc.2015.04.037.

Choice of Estimated Glomerular Filtration Rate Equation Impacts Drug-Dosing Recommendations and Risk Stratification in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Interventions.

Author information

1
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
2
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
3
Michigan Heart and Vascular Institute, St. Joseph Mercy Hospital, Ann Arbor, Michigan.
4
Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Michigan.
5
Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan.
6
The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York.
7
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; VA Ann Arbor Healthcare System, Ann Arbor, Michigan. Electronic address: hgurm@med.umich.edu.

Abstract

BACKGROUND:

Multiple equations exist to estimate glomerular filtration rate (GFR); however, there is no consensus on which is superior for risk classification in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI).

OBJECTIVES:

The goals of this study were to identify which equation to estimate GFR is superior for predicting adverse outcomes after PCI and to examine how equation selection would impact drug-dosing recommendations.

METHODS:

Estimated GFR (eGFR) was calculated with the Cockcroft-Gault, Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations for 128,805 patients undergoing PCI in the state of Michigan. Agreement between patient pre-PCI eGFR estimates and resultant CKD stage classifications, their ability to discriminate post-procedural in-hospital clinical outcomes, and the impact of equation choice on dosing recommendations for commonly used antiplatelet and antithrombotic medications were investigated.

RESULTS:

CKD-EPI best discriminated post-PCI mortality by receiver operator characteristic analysis. There was wide variability in eGFR, which persisted after grouping by CKD stages. Reclassification by CKD-EPI resulted in net reclassification index improvement for acute kidney injury and new requirement for dialysis. Equation choice affected drug-dosing recommendations, with the formulas agreeing for only 50.3%, 40.0%, and 34.3% of potentially impacted patients for eGFR cutoffs of <60, <50, and <30 ml/min/1.73 m(2), respectively.

CONCLUSIONS:

Different eGFR equations result in CKD stage reclassification that has major clinical implications for predicting adverse outcomes after PCI and drug-dosing recommendations. Our results support the use of CKD-EPI for risk stratification among patients undergoing PCI.

KEYWORDS:

catheterization; chronic; coronary disease; creatinine; renal insufficiency; risk assessment

PMID:
26112195
DOI:
10.1016/j.jacc.2015.04.037
[Indexed for MEDLINE]
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