title: Risk stratification for in-hospital mortality after heart transplantation using the modification of diet in renal disease and the chronic kidney disease epidemiology collaboration equations for estimated glomerular filtration rate.
abstract: BACKGROUND
  A new equation for estimating glomerular filtration rate (GFR)-the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation-is better at predicting outcomes in the general population than the Modification of Diet in Renal Disease (MDRD) equation. We compared risk stratification of heart transplant (HT) recipients for early post-HT mortality using estimated GFR from the MDRD and the CKD-EPI equations.
  
  
  METHODS
  We identified all patients 18 years or older who underwent their first HT in the United States between January 2007 and October 2010 (n=6,564). We compared risk stratification for posttransplant in-hospital mortality by GFR estimated by the CKD-EPI equation versus that estimated by the MDRD equation.
  
  
  RESULTS
  Posttransplant in-hospital mortality was 4.6%. Lower GFR (mL/min/1.73 m2, MDRD) was associated with higher in-hospital mortality in adjusted analysis (GFR, 60-89; odds ratio [OR], 1.5; 95% confidence interval [CI], 1.0-2.3; GFR, 30-59; OR, 2.2; 95% CI, 1.4-3.3; GFR<30; OR, 3.3; 95% CI, 1.8-6.1; vs. GFR ≥ 90). Glomerular filtration rate estimated using the CKD-EPI equation reclassified 10%, 15%, and 18% of patients, respectively, in GFR categories lower than 30, 30-59, and 60-89 to the next higher GFR category. Using the CKD-EPI equation was not associated with a significant net reclassification improvement for mortality risk in the overall cohort or in GFR subgroups. The risk models of in-hospital mortality developed using the two GFR equations performed similarly for discrimination and calibration.
  
  
  CONCLUSIONS
  Estimated GFR using the CKD-EPI equation is comparable to estimated GFR using the MDRD equation in risk stratification of HT recipients for early posttransplant mortality.
authors.affiliation: 1 Department of Cardiology, Boston Children's Hospital Harvard School of Public Health, Boston, MA. 2 Department of Cardiology, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA. 3 Department of Pediatrics Harvard School of Public Health, Boston, MA. 4 Department of Medicine, Harvard Medical School, Boston, MA. 5 Department of Biostatistics, Harvard School of Public Health, Boston, MA. 6 Address correspondence to: Tajinder P. Singh, M.D., M.Sc., Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115.
authors.forename: Tajinder P
authors.initials: TP
authors.lastname: Singh
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003404:Creatinine / Q000097:blood; D004032:Diet; D005260:Female; D005919:Glomerular Filtration Rate; D016027:Heart Transplantation; D017052:Hospital Mortality; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000178:diet therapy*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
chemical_list: D003404:Creatinine