Comparison of estimated glomerular filtration rate by the chronic kidney disease epidemiology collaboration (CKD-EPI) equations with and without cystatin C for predicting clinical outcomes in elderly women

Wai Lim, Joshua Lewis, G. Wong, R.M. Turner, E.M. Lim, P.L. Thompson, Richard Prince

    Research output: Contribution to journalArticle

    6 Citations (Scopus)

    Abstract

    Background: Reduced estimated glomerular filtration rate (eGFR) using the cystatin-C derived equations might be a better predictor of cardiovascular disease (CVD) mortality compared with the creatinine-derived equations, but this association remains unclear in elderly individuals.

    Aim: The aims of this study were to compare the predictive values of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-creatinine, CKD-EPI-cystatin C and CKD-EPI-creatinine-cystatin C eGFR equations for all-cause mortality and CVD events (hospitalizations6mortality).

    Methods: Prospective cohort study of 1165 elderly women aged.70 years. Associations between eGFR and outcomes were examined using Cox regression analysis. Test accuracy of eGFR equations for predicting outcomes was examined using Receiver Operating Characteristic (ROC) analysis and net reclassification improvement (NRI).

    Results: Risk of all-cause mortality for every incremental reduction in eGFR determined using CKD-EPI-creatinine, CKD-EPIcystatin C and the CKD-EPI-creatinine-cystatic C equations was similar. Areas under the ROC curves of CKD-EPI-creatinine, CKD-EPI-cystatin C and CKD-EPI-creatinine-cystatin C equations for all-cause mortality were 0.604 (95%CI 0.561–0.647), 0.606 (95%CI 0.563–0.649; p = 0.963) and 0.606 (95%CI 0.563–0.649; p = 0.894) respectively. For all-cause mortality, there was no improvement in the reclassification of eGFR categories using the CKD-EPI-cystatin C (NRI -4.1%; p = 0.401) and CKD-EPIcreatinine- cystatin C (NRI -1.2%; p = 0.748) compared with CKD-EPI-creatinine equation. Similar findings were observed for CVD events.

    Conclusion: eGFR derived from CKD-EPI cystatin C and CKD-EPI creatinine-cystatin C equations did not improve the accuracy or predictive ability for clinical events compared to CKD-EPI-creatinine equation in this cohort of elderly women.

    Original languageEnglish
    Pages (from-to)1-9
    JournalPLoS One
    Volume9
    Issue number9
    DOIs
    Publication statusPublished - 29 Sep 2014

    Fingerprint

    Cystatin C
    cystatins
    Epidemiology
    glomerular filtration rate
    kidney diseases
    Glomerular Filtration Rate
    Chronic Renal Insufficiency
    epidemiology
    creatinine
    Creatinine
    taxonomic revisions
    Mortality
    cardiovascular diseases
    Cardiovascular Diseases
    ROC Curve
    cohort studies

    Cite this

    @article{c60d6021ba1e4c4f9e85f15cea3816c3,
    title = "Comparison of estimated glomerular filtration rate by the chronic kidney disease epidemiology collaboration (CKD-EPI) equations with and without cystatin C for predicting clinical outcomes in elderly women",
    abstract = "Background: Reduced estimated glomerular filtration rate (eGFR) using the cystatin-C derived equations might be a better predictor of cardiovascular disease (CVD) mortality compared with the creatinine-derived equations, but this association remains unclear in elderly individuals. Aim: The aims of this study were to compare the predictive values of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-creatinine, CKD-EPI-cystatin C and CKD-EPI-creatinine-cystatin C eGFR equations for all-cause mortality and CVD events (hospitalizations6mortality). Methods: Prospective cohort study of 1165 elderly women aged.70 years. Associations between eGFR and outcomes were examined using Cox regression analysis. Test accuracy of eGFR equations for predicting outcomes was examined using Receiver Operating Characteristic (ROC) analysis and net reclassification improvement (NRI). Results: Risk of all-cause mortality for every incremental reduction in eGFR determined using CKD-EPI-creatinine, CKD-EPIcystatin C and the CKD-EPI-creatinine-cystatic C equations was similar. Areas under the ROC curves of CKD-EPI-creatinine, CKD-EPI-cystatin C and CKD-EPI-creatinine-cystatin C equations for all-cause mortality were 0.604 (95{\%}CI 0.561–0.647), 0.606 (95{\%}CI 0.563–0.649; p = 0.963) and 0.606 (95{\%}CI 0.563–0.649; p = 0.894) respectively. For all-cause mortality, there was no improvement in the reclassification of eGFR categories using the CKD-EPI-cystatin C (NRI -4.1{\%}; p = 0.401) and CKD-EPIcreatinine- cystatin C (NRI -1.2{\%}; p = 0.748) compared with CKD-EPI-creatinine equation. Similar findings were observed for CVD events. Conclusion: eGFR derived from CKD-EPI cystatin C and CKD-EPI creatinine-cystatin C equations did not improve the accuracy or predictive ability for clinical events compared to CKD-EPI-creatinine equation in this cohort of elderly women.",
    author = "Wai Lim and Joshua Lewis and G. Wong and R.M. Turner and E.M. Lim and P.L. Thompson and Richard Prince",
    year = "2014",
    month = "9",
    day = "29",
    doi = "10.1371/journal.pone.0106734",
    language = "English",
    volume = "9",
    pages = "1--9",
    journal = "P L o S One",
    issn = "1932-6203",
    publisher = "Public Library of Science (PLoS)",
    number = "9",

    }

    TY - JOUR

    T1 - Comparison of estimated glomerular filtration rate by the chronic kidney disease epidemiology collaboration (CKD-EPI) equations with and without cystatin C for predicting clinical outcomes in elderly women

    AU - Lim, Wai

    AU - Lewis, Joshua

    AU - Wong, G.

    AU - Turner, R.M.

    AU - Lim, E.M.

    AU - Thompson, P.L.

    AU - Prince, Richard

    PY - 2014/9/29

    Y1 - 2014/9/29

    N2 - Background: Reduced estimated glomerular filtration rate (eGFR) using the cystatin-C derived equations might be a better predictor of cardiovascular disease (CVD) mortality compared with the creatinine-derived equations, but this association remains unclear in elderly individuals. Aim: The aims of this study were to compare the predictive values of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-creatinine, CKD-EPI-cystatin C and CKD-EPI-creatinine-cystatin C eGFR equations for all-cause mortality and CVD events (hospitalizations6mortality). Methods: Prospective cohort study of 1165 elderly women aged.70 years. Associations between eGFR and outcomes were examined using Cox regression analysis. Test accuracy of eGFR equations for predicting outcomes was examined using Receiver Operating Characteristic (ROC) analysis and net reclassification improvement (NRI). Results: Risk of all-cause mortality for every incremental reduction in eGFR determined using CKD-EPI-creatinine, CKD-EPIcystatin C and the CKD-EPI-creatinine-cystatic C equations was similar. Areas under the ROC curves of CKD-EPI-creatinine, CKD-EPI-cystatin C and CKD-EPI-creatinine-cystatin C equations for all-cause mortality were 0.604 (95%CI 0.561–0.647), 0.606 (95%CI 0.563–0.649; p = 0.963) and 0.606 (95%CI 0.563–0.649; p = 0.894) respectively. For all-cause mortality, there was no improvement in the reclassification of eGFR categories using the CKD-EPI-cystatin C (NRI -4.1%; p = 0.401) and CKD-EPIcreatinine- cystatin C (NRI -1.2%; p = 0.748) compared with CKD-EPI-creatinine equation. Similar findings were observed for CVD events. Conclusion: eGFR derived from CKD-EPI cystatin C and CKD-EPI creatinine-cystatin C equations did not improve the accuracy or predictive ability for clinical events compared to CKD-EPI-creatinine equation in this cohort of elderly women.

    AB - Background: Reduced estimated glomerular filtration rate (eGFR) using the cystatin-C derived equations might be a better predictor of cardiovascular disease (CVD) mortality compared with the creatinine-derived equations, but this association remains unclear in elderly individuals. Aim: The aims of this study were to compare the predictive values of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-creatinine, CKD-EPI-cystatin C and CKD-EPI-creatinine-cystatin C eGFR equations for all-cause mortality and CVD events (hospitalizations6mortality). Methods: Prospective cohort study of 1165 elderly women aged.70 years. Associations between eGFR and outcomes were examined using Cox regression analysis. Test accuracy of eGFR equations for predicting outcomes was examined using Receiver Operating Characteristic (ROC) analysis and net reclassification improvement (NRI). Results: Risk of all-cause mortality for every incremental reduction in eGFR determined using CKD-EPI-creatinine, CKD-EPIcystatin C and the CKD-EPI-creatinine-cystatic C equations was similar. Areas under the ROC curves of CKD-EPI-creatinine, CKD-EPI-cystatin C and CKD-EPI-creatinine-cystatin C equations for all-cause mortality were 0.604 (95%CI 0.561–0.647), 0.606 (95%CI 0.563–0.649; p = 0.963) and 0.606 (95%CI 0.563–0.649; p = 0.894) respectively. For all-cause mortality, there was no improvement in the reclassification of eGFR categories using the CKD-EPI-cystatin C (NRI -4.1%; p = 0.401) and CKD-EPIcreatinine- cystatin C (NRI -1.2%; p = 0.748) compared with CKD-EPI-creatinine equation. Similar findings were observed for CVD events. Conclusion: eGFR derived from CKD-EPI cystatin C and CKD-EPI creatinine-cystatin C equations did not improve the accuracy or predictive ability for clinical events compared to CKD-EPI-creatinine equation in this cohort of elderly women.

    U2 - 10.1371/journal.pone.0106734

    DO - 10.1371/journal.pone.0106734

    M3 - Article

    VL - 9

    SP - 1

    EP - 9

    JO - P L o S One

    JF - P L o S One

    SN - 1932-6203

    IS - 9

    ER -