title: Choice of Estimated Glomerular Filtration Rate Equation Impacts Drug-Dosing Recommendations and Risk Stratification in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Interventions.
abstract: BACKGROUND
  Multiple equations exist to estimate glomerular filtration rate (GFR); however, there is no consensus on which is superior for risk classification in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI).
  
  
  OBJECTIVE
  The goals of this study were to identify which equation to estimate GFR is superior for predicting adverse outcomes after PCI and to examine how equation selection would impact drug-dosing recommendations.
  
  
  METHODS
  Estimated GFR (eGFR) was calculated with the Cockcroft-Gault, Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations for 128,805 patients undergoing PCI in the state of Michigan. Agreement between patient pre-PCI eGFR estimates and resultant CKD stage classifications, their ability to discriminate post-procedural in-hospital clinical outcomes, and the impact of equation choice on dosing recommendations for commonly used antiplatelet and antithrombotic medications were investigated.
  
  
  RESULTS
  CKD-EPI best discriminated post-PCI mortality by receiver operator characteristic analysis. There was wide variability in eGFR, which persisted after grouping by CKD stages. Reclassification by CKD-EPI resulted in net reclassification index improvement for acute kidney injury and new requirement for dialysis. Equation choice affected drug-dosing recommendations, with the formulas agreeing for only 50.3%, 40.0%, and 34.3% of potentially impacted patients for eGFR cutoffs of <60, <50, and <30 ml/min/1.73 m(2), respectively.
  
  
  CONCLUSIONS
  Different eGFR equations result in CKD stage reclassification that has major clinical implications for predicting adverse outcomes after PCI and drug-dosing recommendations. Our results support the use of CKD-EPI for risk stratification among patients undergoing PCI.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jessica
authors.initials: J
authors.lastname: Parsh
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Milan
authors.initials: M
authors.lastname: Seth
authors.affiliation: Michigan Heart and Vascular Institute, St. Joseph Mercy Hospital, Ann Arbor, Michigan.
authors.forename: Herbert
authors.initials: H
authors.lastname: Aronow
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Michigan.
authors.forename: Simon
authors.initials: S
authors.lastname: Dixon
authors.affiliation: Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Heung
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; VA Ann Arbor Healthcare System, Ann Arbor, Michigan. Electronic address: hgurm@med.umich.edu.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
mesh_terms: D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008433:Mathematics; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D018570:Risk Assessment / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: catheterization; chronic; coronary disease; creatinine; renal insufficiency; risk assessment