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Comparison of the C...
Comparison of the Chronic Kidney Disease Epidemiology Collaboration, the Modification of Diet in Renal Disease study and the Cockcroft-Gault equation in patients with heart failure
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Szummer, Karolina (författare)
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Evans, Marie (författare)
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Carrero, Juan Jesus (författare)
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Alehagen, Urban 1951- (författare)
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Dahlström, Ulf 1946- (författare)
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Benson, Lina (författare)
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Lund, Lars H (författare)
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- Gateshead, United Kingdom Open House International Association 2017
- 2017
- Engelska.
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Ingår i: Open heart. - 0168-2601. ; 4:2
Abstract
Ämnesord
Stäng
- BACKGROUND: It is unknown how the creatinine-based renal function estimations differ for dose adjustment cut-offs and risk prediction in patients with heart failure. METHOD AND RESULTS: The renal function was similar with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) (median 59 mL/min/1.73 m2, IQR 42 to 77) and Modification of Diet in Renal Disease Study (MDRD) (59 mL/min/1.73 m2, IQR 43 to 75) and slightly lower with the Cockcroft-Gault (CG) equation (57 mL/min, IQR 39 to 82). Across the commonly used renal function stages, the CKD-EPI and the MDRD classified patients into the same stage in 87.2% (kappa coefficient 0.83, p<0.001); the CKD-EPI and the CG equation agreed in 52.3% (kappa coefficient 0.39, p<0.001). Hence, a differing number of patients will receive dose adjustment depending on which formula is used as cut-off. The CG equation predicted worse prognosis better (c-statistics 0.740, 95% CI 0.734 to 0.746) than CKD-EPI (0.697, 95% CI 0.690 to 0.703, p<0.001) and MDRD (0.680, 95% CI 0.734 to 0.746). Using net reclassification improvement (NRI), the CG identified 12.8% more patients at higher risk of death as compared with the CKD-EPI equation. Patients registered in the Swedish Heart Failure Registry (n= 40 736) with standardised creatinine values between 2000 and 2012 had their renal function estimated with the CKD-EPI, the MDRD and the CG. Agreement between the formulas was compared for categories. Prediction of death was assessed with c-statistics and with NRI. CONCLUSION: The choice of renal function estimation formula has clinical implications and differing results at various cut-off levels. For prognosis, the CG predicts mortality better than the CKD-EPI and MDRD.
Ämnesord
- Medical and Health Sciences (hsv)
- Clinical Medicine (hsv)
- Cardiac and Cardiovascular Systems (hsv)
- Medicin och hälsovetenskap (hsv)
- Klinisk medicin (hsv)
- Kardiologi (hsv)
Nyckelord
- application
- creatinine
- heart failure
- prognosis
- register
- renal function estimation
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