title: Comparison of the heart failure risk stratification performance of the CKD-EPI equation and the MDRD equation for estimated glomerular filtration rate in patients with Type 2 diabetes.
abstract: OBJECTIVE
  To investigate the risk prediction and the risk stratification performances of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the Modification of Diet in Renal Disease (MDRD) equation for estimated glomerular filtration rate (eGFRCKD - EPI vs. eGFRMDRD ) on heart failure in patients with Type 2 diabetes.
  
  
  METHODS
  The study cohort included 12 258 White and 16 886 African American low-income patients with Type 2 diabetes who were 30-90 years old at baseline. Heart failure risk according to different eGFRCKD - EPI and eGFRMDRD categories was prospectively assessed.
  
  
  RESULTS
  During a mean follow-up of 6.5 years, 5043 incident heart failure cases were identified. Multivariable-adjusted hazard ratios (HRs) of heart failure associated with the eGFRCKD - EPI categories [≥ 90 (reference group), 75-89, 60-74, 30-59 and < 30 ml/min/1.73 m(2) ] were 1.00, 1.11, 1.31, 1.75 and 2.93 (Ptrend < 0.001) for African American patients, and 1.00, 1.11, 1.08, 1.59 and 2.92 (Ptrend < 0.001) for White patients, respectively. The model with eGFRCKD - EPI and the other risk factors had significantly higher Harrell's C than the model with eGFRMDRD and other risk factors. Patients reclassified downward from eGFRMDRD 60-74 to eGFRCKD - EPI 30-59 and from eGFRMDRD 30-59 to eGFRCKD - EPI < 30 ml/min/1.73 m(2) showed higher heart failure risk than those who were not reclassified.
  
  
  CONCLUSIONS
  Impaired kidney function (i.e. GFR < 60 ml/min/1.73 m(2) ), and even mildly decreased GFR (60-74 ml/min/1.73 m(2) ) estimated by both equations is associated with an increased risk of heart failure. Compared with GFR estimated using the MDRD equation, GFR estimated using the CKD-EPI equation added more predictive power to the model with the other risk factors. Also, eGFRCKD - EPI provided more accurate heart failure risk stratification than eGFRMDRD .
authors.affiliation: Pennington Biomedical Research Center, Baton Rouge, LA, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Pennington Biomedical Research Center, Baton Rouge, LA, USA.
authors.forename: P T
authors.initials: PT
authors.lastname: Katzmarzyk
authors.affiliation: Pennington Biomedical Research Center, Baton Rouge, LA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Horswell
authors.affiliation: Pennington Biomedical Research Center, Baton Rouge, LA, USA.
authors.forename: W
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Health Care Service Division, Louisiana State University Health Science Center, Baton Rouge, LA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Pennington Biomedical Research Center, Baton Rouge, LA, USA.
authors.forename: G
authors.initials: G
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D058065:Diabetic Cardiomyopathies / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D008137:Longitudinal Studies; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051437:Renal Insufficiency / Q000150:complications* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index