Decreased GFR estimated by MDRD or Cockcroft-Gault equation predicts incident CVD: the strong heart study.
BACKGROUND
Kidney function, expressed as glomerular filtration rate (GFR), is commonly estimated from serum creatinine (Scr) and, when decreased, may serve as a nonclassical risk factor for incident cardiovascular disease (CVD). The ability of estimated GFR (eGFR) to predict CVD events during 5-10 years of follow-up is assessed using data from the Strong Heart Study (SHS), a large cohort with a high prevalence of diabetes.


METHODS
eGFRs were calculated with the abbreviated Modification of Diet in Renal Disease study (MDRD) and the Cockcroft-Gault (CG) equations. These estimates were compared in participants with normal and abnormal Scr. The association between eGFR and incident CVD was assessed.


RESULTS
More subjects were labeled as having low eGFR (<60 ml/min per 1.73 m2) by the MDRD or CG equation, than by Scr alone. When Scr was in the normal range, both equations labeled similar numbers of participants as having low eGFRs, although concordance between the equations was poor. However, when Scr was elevated, the MDRD equation labeled more subjects as having low eGFR. Persons with low eGFR had increased risk of CVD.


CONCLUSIONS
The MDRD and CG equations labeled more participants as having decreased GFR than did Scr alone. Decreased eGFR was predictive of CVD in this American Indian population with a high prevalence of obesity and type 2 diabetes mellitus.
Shara
Nawar M
NM
Department of Biostatistics, Epidemiology, Outcomes, and Data Management, MedStar Research Institute, Hyattsville, Maryland, USA. Nawar.Shara@medstar.net
Resnick
Helaine E
HE
Lu
Li
L
Xu
Jiaqiong
J
Vupputuri
Suma
S
Howard
Barbara V
BV
Umans
Jason G
JG
D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors