Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Renal Disease
Comparison of Predictability of Future Cardiovascular Events Between Chronic Kidney Disease (CKD) Stage Based on CKD Epidemiology Collaboration Equation and That Based on Modification of Diet in Renal Disease Equation in the Japanese General Population
– Iwate KENCO Study –
Masaki OhsawaKozo TannoKazuyoshi ItaiTanvir Chowdhury TurinTomonori OkamuraAkira OgawaKuniaki OgasawaraTomoaki FujiokaToshiyuki OnodaYuki YoshidaShin-ichi OmamaYasuhiro IshibashiMotoyuki NakamuraShinji MakitaFumitaka TanakaToru KuribayashiTomiko KoyamaKiyomi SakataAkira Okayama
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2013 Volume 77 Issue 5 Pages 1315-1325

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Abstract

Background: Whether estimated glomerular filtration rate (eGFR) calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Study equation (eGFRCKDEPI) improves risk prediction compared to that calculated using the Modification of Diet in Renal Disease (MDRD) study equation (eGFRMDRD) has not been examined in a prospective study in Japanese people. Methods and Results: Participants (n=24,560) were divided into 4 stages (1, ≥90; 2, 60–89 (reference); 3a, 45–59; 3b+ <45ml·min–1·1.73m–2) according to eGFRCKDEPI or eGFRMDRD. Endpoints were all-cause death, myocardial infarction (MI) and stroke. Area under the receiver operating characteristic curves (95% confidence intervals) for predicting all-cause death, MI and stroke by eGFRCKDEPI vs. eGFRMDRD were 0.680 (0.662–0.697) vs. 0.582 (0.562–0.602); 0.718 (0.665–0.771) vs. 0.642 (0.581–0.703); and 0.656 (0.636–0.676) vs. 0.576 (0.553–0.599), respectively. Multivariate-adjusted Cox regression and Poisson regression analysis results were similar for adjusted incidence rates and adjusted hazard ratios in each corresponding stage between the 2 models and no differences were found in model assessment parameters. Net reclassification improvement (NRI) for predicting all-cause death, MI and stroke were estimated to be 6.7% (P<0.001), –1.89% (P=0.029) and –0.20% (P=0.421), respectively. Conclusions: Better discrimination was achieved using eGFRCKDEPI than eGFRMDRD on univariate analysis. NRI analysis indicated that the use of eGFRCKDEPI instead of eGFRMDRD offered a significant improvement in reclassification of death risk.  (Circ J 2013; 77: 1315–1325)

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© 2013 THE JAPANESE CIRCULATION SOCIETY
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