Choice of Estimated Glomerular Filtration Rate Equation Impacts Drug-Dosing Recommendations and Risk Stratification in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Interventions

J Am Coll Cardiol. 2015 Jun 30;65(25):2714-23. doi: 10.1016/j.jacc.2015.04.037.

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).

Objectives: 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.

Keywords: catheterization; chronic; coronary disease; creatinine; renal insufficiency; risk assessment.

MeSH terms

  • Aged
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Glomerular Filtration Rate*
  • Humans
  • Male
  • Mathematics
  • Percutaneous Coronary Intervention* / adverse effects
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Renal Insufficiency, Chronic / physiopathology*
  • Risk Assessment / methods*

Substances

  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors