title: Comparison of risk prediction with the CKD-EPI and MDRD equations in acute decompensated heart failure.
abstract: BACKGROUND
  Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations estimate glomerular filtration rate (eGFR) more accurately than the Modification of Diet in Renal Disease (MDRD) equation. The aim of this study was to evaluate whether CKD-EPI equations based on serum creatinine and/or cystatin C (CysC) predict risk for adverse outcomes more accurately than the MDRD equation in a hospitalized cohort of patients with acute decompensated heart failure (ADHF).
  
  
  RESULTS
  A total of 526 subjects with ADHF were studied. Blood was collected within 48 hours from admission. eGFR was calculated with the use of MDRD and CKD-EPI equations. The occurrences of mortality and heart failure (HF) hospitalization were recorded. Over the study period (median 365 days [interquartile range 238-370]), 305 patients (58%) died or were rehospitalized for HF. Areas under the receiver operator characteristic curves for CKD-EPI CysC and CKD-EPI creatinine-CysC equations were significantly higher than that for the MDRD equation, especially in patients with >60 mL min(-1) 1.73 m(-2). After multivariate adjustment, all eGFR equations were independent predictors of adverse outcomes (P < .001). However, only CKD-EPI CysC and CKD-EPI creatinine-CysC equations were associated with significant improvement in reclassification analyses (net reclassification improvements 10.8% and 12.5%, respectively).
  
  
  CONCLUSIONS
  In patients with ADHF, CysC-based CKD-EPI equations were superior to the MDRD equation for predicting mortality and/or HF hospitalization especially in patients with >60 mL min(-1) 1.73 m(-2), and both CKD-EPI equations improved clinical risk stratification.
authors.affiliation: Division of Cardiology, University Hospital Virgen de la Arrixaca, School of Medicine, University of Murcia, Murcia, Spain. sergiosmf13@hotmail.com
authors.forename: Sergio
authors.initials: S
authors.lastname: Manzano-Fernández
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Flores-Blanco
authors.forename: Juan I
authors.initials: JI
authors.lastname: Pérez-Calvo
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Ruiz-Ruiz
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Carrasco-Sánchez
authors.forename: José L
authors.initials: JL
authors.lastname: Morales-Rull
authors.forename: Luis
authors.initials: L
authors.lastname: Galisteo-Almeda
authors.forename: Domingo
authors.initials: D
authors.lastname: Pascual-Figal
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdes
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005247:Feeding Behavior / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors
keywords: Acute heart failure; CKD-EPI; MDRD; prognosis