Cockcroft-Gault versus modification of diet in renal disease: importance of glomerular filtration rate formula for classification of chronic kidney disease in patients with non-ST-segment elevation acute coronary syndromes.
OBJECTIVE
Our purpose was to compare formulae for estimating glomerular filtration rate (GFR) in non-ST-segment elevation acute coronary syndromes (NSTE ACS) patients.


BACKGROUND
Assessment of GFR is important for antithrombotic dose adjustment in NSTE ACS patients.


METHODS
We assessed estimated glomerular filtration rate (eGFR) with Cockcroft-Gault (C-G) and Modification of Diet in Renal Disease (MDRD) formulae in 46,942 NSTE ACS patients from 408 CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines) hospitals. Formula agreement was shown continuously and by chronic kidney disease (CKD) stages. We determined in-hospital outcomes and the association between antithrombotic dose adjustment and bleeding for moderate CKD as determined by each formula.


RESULTS
The median (interquartile range [IQR]) eGFR was 53.2 ml/min (34.7, 75.1 ml/min) by C-G and 65.8 ml/min (47.6, 83.5 ml/min) by MDRD. The mean eGFR was higher with MDRD (approximately 9.1 ml/min), but this difference was greater in age, weight, and gender subgroups. Chronic kidney disease classification differed in 20% of the population and altered when antithrombotic dose adjustment was required by C-G versus MDRD (eptifibatide: 45.7% vs. 27.3%; enoxaparin: 19.0% vs. 9.6%).


CONCLUSIONS
Important CKD disagreements occur in approximately 20% of acute coronary syndrome patients, affecting dosing adjustments in those already susceptible to bleeding. Dosing based on C-G formula is preferable, particularly in the small, female, or elderly patient.
Melloni
Chiara
C
Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27705, USA.
Peterson
Eric D
ED
Chen
Anita Y
AY
Szczech
Lynda A
LA
Newby
L Kristin
LK
Harrington
Robert A
RA
Gibler
W Brian
WB
Ohman
E Magnus
EM
Spinler
Sarah A
SA
Roe
Matthew T
MT
Alexander
Karen P
KP
D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy*; D000367:Age Factors; D000368:Aged; D003404:Creatinine / Q000097:blood*; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005919:Glomerular Filtration Rate; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007676:Kidney Failure, Chronic / Q000145:classification* / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019370:Observation; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D012737:Sex Factors
D017984:Enoxaparin; D005343:Fibrinolytic Agents; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D003404:Creatinine