Predicting survival of older community-dwelling individuals according to five estimated glomerular filtration rate equations: The InChianti study

Andrea Corsonello, Claudio Pedone, Stefania Bandinelli, Luigi Ferrucci, Raffaele Antonelli Incalzi

Research output: Contribution to journalArticle

Abstract

Aims: There is uncertainty about which estimated glomerular filtration rate eGFR equation to use in older people with respect to the prediction of prognosis. Our aim was: (i) to compare the discriminative capacity of eGFR estimated by different equations with respect to all-cause mortality; and (ii) to identify the eGFR threshold at which the risk of mortality starts to increase for each equation. Methods: We used data from 828 community-dwelling older adults aged >65 years enrolled in the InCHIANTI study. The outcome measure was all-cause mortality at 9 years. GFR was estimated by five different equations: Chronic Kidney Disease Epidemiological Collaboration (creatinine equation [CKD-EPIcre], and creatinine and cystatin C equation [CKD-EPIcre-cys]), Berlin Initiative Study (BIScre and BIScre-cys) and full age spectrum. Sensitivity, specificity, areas under receiver operating curve (AUC) and C-statistics were used to compare their predictive capacity. Results: The best mix of sensitivity, specificity, AUC and C-statistic value in predicting mortality was observed with BIS equations. BIScre (AUC 0.65, 95% CI 0.61–0.69) outperformed both CKD-EPIcre (AUC 0.60, 95% CI 0.56–0.64; P = 0.005) and full age spectrum (AUC 0.63, 95% CI 0.59–0.67; P = 0.002) in terms of predictivity. Similarly, BIScre-cys (AUC 0.67, 95% CI 0.63–0.71) outperformed CKD-EPIcre-cys (AUC 0.63, 95% CI 0.59–0.67; P = 0.01). AUC obtained with equations also including cystatin C were not significantly different compared with their creatinine-based counterparts. The risk of long-term mortality began to increase at under 65.6 mL/min/1.73 m2 for CKD-EPIcre-cys, 60.5 for CKD-EPIcre, 60 for BIScre-cys, 56.3 for BIScre and 55.2 for full age spectrum. Conclusions: The BIS equation discriminates the risk of all-cause mortality better than other equations in older community-dwelling individuals. The eGFR threshold under which mortality starts to increase could change as a function of the equation used. Geriatr Gerontol Int 2018; 18: 607–614.

Original languageEnglish
Pages (from-to)607-614
Number of pages8
JournalGeriatrics and Gerontology International
Volume18
Issue number4
DOIs
Publication statusPublished - Apr 1 2018

Keywords

  • Berlin Initiative Study
  • Chronic Kidney Disease Epidemiological Collaboration
  • estimated glomerular filtration rate
  • full age spectrum
  • mortality

ASJC Scopus subject areas

  • Health(social science)
  • Gerontology
  • Geriatrics and Gerontology

Fingerprint Dive into the research topics of 'Predicting survival of older community-dwelling individuals according to five estimated glomerular filtration rate equations: The InChianti study'. Together they form a unique fingerprint.

  • Cite this