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Eur J Prev Cardiol. 2016 Sep;23(14):1504-13. doi: 10.1177/2047487316638454. Epub 2016 Mar 17.

Chronic kidney disease and prognosis in elderly patients with cardiovascular disease: Comparison between CKD-EPI and Berlin Initiative Study-1 formulas.

Author information

UOC Cardiologia, Azienda ULSS Numero 1, Belluno, Italy.
Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada.
Cardiovascular Center, ASS 1 Trieste, Trieste, Italy.
Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.
Department of Cardiology, Villa Bianca Hospital, Trento, Italy
Department of Cardiology, Spedali Civili, Brescia, Italy.
Department of Cardiology, S. Camillo Hospital, Rome, Italy.



Chronic kidney disease (CKD) is frequent in patients with cardiovascular (CV) disease and impacts prognosis in these subjects. While current guidelines recommend the CKD-EPI equation for the estimated glomerular filtration rate (eGFR) and recognizing CKD, a new creatinine-based equation - the Berlin Initiative Study-1 (BIS-1) - was generated for elders with a high prevalence of CV disease. We assessed whether BIS-1 provided more accurate risk stratification than the CKD-EPI equation in unselected aged patients with CV disease.


Patients aged ≥70 years who were seen consecutively at the Cardiovascular Centre of Trieste (Italy) between November 2009 and October 2013 were recruited into this study. The correlation and agreement between the BIS-1 and CKD-EPI formulas were evaluated and intra-class correlation coefficients (ICCs) were computed in order to estimate the correlation between the two formulas. Patients were followed for all-cause death, composite outcomes of all-cause death/all-cause hospitalization and all-cause death/CV hospitalization.


A total of 7845 subjects met the inclusion criteria for this study. GFR as estimated with the BIS-1 and the CKD-EPI equation was highly correlated (ICC: 0.81; 95% confidence interval [CI]: 0.79-0.82; p < 0.0001). When allocating patients in Kidney Disease Improving Global Outcomes classes of eGFR, compared to CKD-EPI, the BIS-1 formula reclassified 2720 (34.7%) patients: 53 (1.9%) were placed in a better class and 2667 (98.1%) were placed in a worse class. Multivariable Cox models showed that BIS-1 compared to CKD-EPI had a significantly better accuracy for predicting death (NRI: 0.12; 95% CI: 0.03-0.19; p = 0.001), death/CV hospitalization (net reclassification improvement [NRI]: 0.34; 95% CI: 0.27-0.38; p < 0.001) and death/all-cause hospitalization (NRI: 0.14; 95% CI: 0.06-0.21; p = 0.001).


The BIS-1 formula is better than the CKD-EPI formula for risk stratification of CKD in elderly people with CV disease.


BIS-1 formula; CKD-EPI formula; Cardiovascular disease; chronic kidney disease; glomerular filtration rate; prognosis

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