Prediction of cardiovascular outcome by estimated glomerular filtration rate and estimated creatinine clearance in the high-risk hypertension population of the VALUE trial.
BACKGROUND
Reduced renal function is predictive of poor cardiovascular outcomes but the predictive value of different measures of renal function is uncertain.


METHODS
We compared the value of estimated creatinine clearance, using the Cockcroft-Gault formula, with that of estimated glomerular filtration rate (GFR), using the Modification of Diet in Renal Disease (MDRD) formula, as predictors of cardiovascular outcome in 15 245 high-risk hypertensive participants in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial. For the primary end-point, the three secondary end-points and for all-cause death, outcomes were compared for individuals with baseline estimated creatinine clearance and estimated GFR < 60 ml/min and > or = 60 ml/min using hazard ratios and 95% confidence intervals. Coronary heart disease, left ventricular hypertrophy, age, sex and treatment effects were included as covariates in the model.


RESULTS
For each end-point considered, the risk in individuals with poor renal function at baseline was greater than in those with better renal function. Estimated creatinine clearance (Cockcroft-Gault) was significantly predictive only of all-cause death [hazard ratio = 1.223, 95% confidence interval (CI) = 1.076-1.390; P = 0.0021] whereas estimated GFR was predictive of all outcomes except stroke. Hazard ratios (95% CIs) for estimated GFR were: primary cardiac end-point, 1.497 (1.332-1.682), P < 0.0001; myocardial infarction, 1.501 (1.254-1.796), P < 0.0001; congestive heart failure, 1.699 (1.435-2.013), P < 0.0001; stroke, 1.152 (0.952-1.394) P = 0.1452; and all-cause death, 1.231 (1.098-1.380), P = 0.0004.


CONCLUSIONS
These results indicate that estimated glomerular filtration rate calculated with the MDRD formula is more informative than estimated creatinine clearance (Cockcroft-Gault) in the prediction of cardiovascular outcomes.
Ruilope
Luis M
LM
Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain. ruilope@ad-hocbox.com
Zanchetti
Alberto
A
Julius
Stevo
S
McInnes
Gordon T
GT
Segura
Julian
J
Stolt
Pelle
P
Hua
Tsushung A
TA
Weber
Michael A
MA
Jamerson
Ken
K
D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D023381:Endpoint Determination; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000097:blood / Q000150:complications / Q000175:diagnosis; D012307:Risk Factors
D003404:Creatinine