Chronic kidney disease and 1-year survival in elderly patients discharged from acute care hospitals: A comparison of three glomerular filtration rate equations

Andrea Corsonello, Claudio Pedone, Fabrizia Lattanzio, Antonio Cherubini, Graziano Onder, Francesco Corica, Luigi Pranno, Vincenzo Mari, Irma Laino, Sabrina Garasto, Raffaele Antonelli Incalzi

Research output: Contribution to journalArticle

Abstract

Background. Glomerular filtration rate (GFR) is directly associated with survival. However, the prognostic significance of GFR might be different according to the formula used to estimate it. We aimed at comparing the association between GFR estimated using three different formulas and 1-year survival in elderly patients discharged from acute care hospitals.Methods. Our series consisted of 439 patients aged 65 and older admitted to 11 acute care medical wards enrolled in a multicentre prospective observational study. GFR was estimated by body surface area-adjusted CockcroftGault (CG-BSA), Modification of Diet in Renal Disease study (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. The relative risk of mortality in patients with estimated GFR = 3059.9 or <30 mL/min/1.73 m2 compared to people with estimated GFR <60 mL/min/1.73 m2 was calculated using Cox regression analysis.Results. Participants with reduced GFR showed an increased mortality, regardless of the equation used, and the highest one was associated with CG-BSA-estimated GFR <30 mL/min/1.73 m2. After adjusting for potential confounders, CKD-EPI-estimated GFR remained significantly associated with the outcome [3059.9 mL/min/1.73 m2, hazard ratio (HR) = 1.70, 95% confidence interval (95% CI) = 1.022.98; <30 mL/min/1.73 m2, HR = 2.60, 95% CI = 1.205.66], while the strength of the association was clearly reduced for MDRD (3059.9 mL/min/1.73 m2, HR = 1.47, 95% CI = 0.832.38; <30 mL/min/1.73 m2, HR = 2.07, 95% CI = 1.014.30) and CG-BSA (3059.9 mL/min/1.73 m2, HR = 1.79, 95% CI = 0.674.53; <30 mL/min/1.73 m2, HR = 2.68, 95% CI = 0.927.55).Conclusion. GFR adds to the list of prognostic indicators in elderly and frail people, and CKD-EPI-derived GFR, which outperforms to some extent MDRD and CG-BSA-derived GFR in a multivariable predictive model, seems worthy of testing in wider populations.

Original languageEnglish
Pages (from-to)360-364
Number of pages5
JournalNephrology Dialysis Transplantation
Volume26
Issue number1
DOIs
Publication statusPublished - Jan 2011

Keywords

  • elderly
  • glomerular filtration rate
  • survival

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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