title: Estimated GFR and incident cardiovascular disease events in American Indians: the Strong Heart Study.
abstract: BACKGROUND
  In populations with high prevalences of diabetes and obesity, estimating glomerular filtration rate (GFR) by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation may predict cardiovascular disease (CVD) risk better than by using the Modification of Diet in Renal Disease (MDRD) Study equation.
  
  
  METHODS
  Longitudinal cohort study comparing the association of GFR estimated using either the CKD-EPI or MDRD Study equation with incident CVD outcomes.
  
  
  METHODS
  American Indians participating in the Strong Heart Study, a longitudinal population-based cohort with high prevalences of diabetes, CVD, and CKD.
  
  
  METHODS
  Estimated GFR (eGFR) predicted using the CKD-EPI and MDRD Study equations.
  
  
  RESULTS
  Fatal and nonfatal cardiovascular events, consisting of coronary heart disease, stroke, and heart failure.
  
  
  METHODS
  The association between eGFR and outcomes was explored in Cox proportional hazards models adjusted for traditional risk factors and albuminuria; the net reclassification index and integrated discrimination improvement were determined for the CKD-EPI versus MDRD Study equations.
  
  
  RESULTS
  In 4,549 participants, diabetes was present in 45%; CVD, in 7%; and stages 3-5 CKD, in 10%. During a median of 15 years, there were 1,280 cases of incident CVD, 929 cases of incident coronary heart disease, 305 cases of incident stroke, and 381 cases of incident heart failure. Reduced eGFR (<90 mL/min/1.73 m2) was associated with adverse events in most models. Compared with the MDRD Study equation, the CKD-EPI equation correctly reclassified 17.0% of 2,151 participants without incident CVD to a lower risk (higher eGFR) category and 1.3% (n=28) were reclassified incorrectly to a higher risk (lower eGFR) category.
  
  
  CONCLUSIONS
  Single measurements of eGFR and albuminuria at study visits.
  
  
  CONCLUSIONS
  Although eGFR based on either equation had similar associations with incident CVD, coronary heart disease, stroke, and heart failure events, in those not having events, reclassification of participants to eGFR categories was superior using the CKD-EPI equation compared with the MDRD Study equation.
authors: MedStar Health Research Institute, Hyattsville, MD 20782, USA. nawar.shara@medstar.net
authors: Nawar M
authors: NM
authors: Shara
authors: Hong
authors: H
authors: Wang
authors: Mihriye
authors: M
authors: Mete
authors: Yaman Rai
authors: YR
authors: Al-Balha
authors: Nameer
authors: N
authors: Azalddin
authors: Elisa T
authors: ET
authors: Lee
authors: Nora
authors: N
authors: Franceschini
authors: Stacey E
authors: SE
authors: Jolly
authors: Barbara V
authors: BV
authors: Howard
authors: Jason G
authors: JG
authors: Umans
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007198:Indians, North American; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment