Renal function estimation and Cockroft-Gault formulas for predicting cardiovascular mortality in population-based, cardiovascular risk, heart failure and post-myocardial infarction cohorts: The Heart 'OMics' in AGEing (HOMAGE) and the high-risk myocardial infarction database initiatives

João Pedro Ferreira, Nicolas Girerd, Pierpaolo Pellicori, Kevin Duarte, Sophie Girerd, Marc A. Pfeffer, John J V McMurray, Bertram Pitt, Kenneth Dickstein, Lotte Jacobs, Jan A. Staessen, Javed Butler, Roberto Latini, Serge Masson, Alexandre Mebazaa, Hans Peter Brunner La Rocca, Christian Delles, Stephane Heymans, Naveed Sattar, J. Wouter JukemaJohn G. Cleland, Faiez Zannad, Patrick Rossignol, for the Heart 'OMics' in AGEing (HOMAGE) initiative and the High-Risk Myocardial Infarction database initiative

Research output: Contribution to journalArticle

Abstract

Background: Renal impairment is a major risk factor for mortality in various populations. Three formulas are frequently used to assess both glomerular filtration rate (eGFR) or creatinine clearance (CrCl) and mortality prediction: body surface area adjusted-Cockcroft-Gault (CG-BSA), Modification of Diet in Renal Disease Study (MDRD4), and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. The CKD-EPI is the most accurate eGFR estimator as compared to a "gold-standard"; however, which of the latter is the best formula to assess prognosis remains to be clarified. This study aimed to compare the prognostic value of these formulas in predicting the risk of cardiovascular mortality (CVM) in population-based, cardiovascular risk, heart failure (HF) and post-myocardial infarction (MI) cohorts. Methods: Two previously published cohorts of pooled patient data derived from the partners involved in the HOMAGE-consortium and from four clinical trials - CAPRICORN, EPHESUS, OPTIMAAL and VALIANT - the high risk MI initiative, were used. A total of 54,111 patients were included in the present analysis: 2644 from population-based cohorts; 20,895 from cardiovascular risk cohorts; 1801 from heart failure cohorts; and 28,771 from post-myocardial infarction cohorts. Participants were patients enrolled in the respective cohorts and trials. The primary outcome was CVM. Results: All formulas were strongly and independently associated with CVM. Lower eGFR/CrCl was associated with increasing CVM rates for values below 60 mL/min/m2. Categorical renal function stages diverged in a more pronounced manner with the CG-BSA formula in all populations (higher χ2 values), with lower stages showing stronger associations. The discriminative improvement driven by the CG-BSA formula was superior to that of MDRD4 and CKD-EPI, but remained low overall (increase in C-index ranging from 0.5 to 2 %) while not statistically significant in population-based cohorts. The integrated discrimination improvement and net reclassification improvement were higher (P < 0.05) for the CG-BSA formula compared to MDRD4 and CKD-EPI in CV risk, HF and post-MI cohorts, but not in population-based cohorts. The CKD-EPI formula was superior overall to MDRD4. Conclusions: The CG-BSA formula was slightly more accurate in predicting CVM in CV risk, HF, and post-MI cohorts (but not in population-based cohorts). However, the CG-BSA discriminative improvement was globally low compared to MDRD4 and especially CKD-EPI, the latter offering the best compromise between renal function estimation and CVM prediction.

Original languageEnglish
Article number181
JournalBMC Medicine
Volume14
Issue number1
DOIs
Publication statusPublished - Nov 10 2016

Keywords

  • Cardiovascular mortality prediction
  • Cardiovascular risk
  • Glomerular filtration rate formulas
  • Heart failure and post-myocardial infarction cohorts
  • Population based
  • Renal function

ASJC Scopus subject areas

  • Medicine(all)

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    Ferreira, J. P., Girerd, N., Pellicori, P., Duarte, K., Girerd, S., Pfeffer, M. A., McMurray, J. J. V., Pitt, B., Dickstein, K., Jacobs, L., Staessen, J. A., Butler, J., Latini, R., Masson, S., Mebazaa, A., Rocca, H. P. B. L., Delles, C., Heymans, S., Sattar, N., ... for the Heart 'OMics' in AGEing (HOMAGE) initiative and the High-Risk Myocardial Infarction database initiative (2016). Renal function estimation and Cockroft-Gault formulas for predicting cardiovascular mortality in population-based, cardiovascular risk, heart failure and post-myocardial infarction cohorts: The Heart 'OMics' in AGEing (HOMAGE) and the high-risk myocardial infarction database initiatives. BMC Medicine, 14(1), [181]. https://doi.org/10.1186/s12916-016-0731-2