Novel eGFR equations and cardiovascular outcomes in a multiethnic Asian cohort

Abstract Background Novel creatinine-based glomerular filtration rate (GFR) estimating equations were proposed for chronic kidney disease (CKD) evaluation but their comparative ability to predict mortality and cardiovascular events is less established. We compared four Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations and three European Kidney Function Consortium (EKFC) equations, in predicting risk for all-cause mortality and cardiovascular events in multi-ethnic Asians. Methods We performed analysis of Singapore Epidemiology of Eye Diseases population-based cohort that recruited Chinese and Indian aged 40-80 years between 2007-2011. The outcomes of death and incident cardiovascular events were ascertained by data linkage with National Registry of Diseases Office until 31 March 2021. Using Cox proportional hazards model, we conducted multivariable regression analyses to evaluate the association of CKD and outcomes. C-statistic was performed to compare prediction performance of these equations. Results During mean follow-up of 11.3 ± 2.2 years, all-cause mortality rate was 12.9% (743 of 5738 participants). When using Creat-ASR 2009, Creat-AS 2021, Cys 2012, Creat-cys 2021, EKFCcreat, EKFCcys and EKFCcreat-cys, mortality rates among those with CKD (eGFR 60 ml/min/1.73 m2) were 41.3%, 45.3%, 39.7%, 47.9%, 41.4%, 43.1% and 45.8%, respectively. After excluding those with existing cardiovascular disease (CVD), incident cardiovascular event rate was 9.9% (508 of 5120 participants). For all-cause mortality, Creat-cys 2021 (c-index 0.809) had better predictive ability than Creat-ASR 2009 (0.806, p = 0.001), Creat-AS 2021 (0.807, p = 0.016) and EKFCcreat (0.806,p = 0.001). For incident CVD, there was no difference in CVD prediction between Creat-cys 2021 (c-index 0.794) and EKFCcreat (0.792,p = 0.263) or Creat-AS 2021 (0.790,p = 0.050). Conclusion Creat-cys 2021 outperformed creatinine-based GFR equations and demonstrated comparable performance to Cys 2012, EKFCcys and EKFCcreat-cys in predicting all-cause mortality. For incident CVD, Creat-AS 2021 and EKFCcreat demonstrated performance comparable to that of Cys 2012, Creat-cys 2021, EKFCcys, and EKFCcreat-cys, providing cost-effective and equally reliable alternatives in this multi-ethnic Asian population.