Key result
The eGFR CKD-EPI equation provided significantly better prediction of mortality after coronary artery bypass grafting (AUC 0.77) compared to the MDRD (AUC 0.55) and Cockcroft-Gault (AUC 0.52) equations.
Why the study?
The study was undertaken to compare the accuracy of the CKD-EPI, MDRD, and Cockcroft-Gault equations in predicting mortality after coronary artery bypass grafting.
Does the CKD-EPI equation better predict post-CABG mortality compared to MDRD and Cockcroft-Gault equations in patients undergoing isolated CABG?
Cohort (n=4,408)
No
Does the CKD-EPI equation better predict post-CABG mortality compared to MDRD and Cockcroft-Gault equations in patients undergoing isolated CABG?
Effect estimate: AUC 0.77 (95% CI 0.73-0.81)
Absolute Event Rate: 0.77% vs 0.55%
p-value: p=<0.01
The CKD-EPI equation is superior to MDRD and Cockcroft-Gault for predicting mortality after CABG, though its accuracy decreases in patients with severe kidney disease.
Background This study was undertaken to compare the accuracy of chronic kidney disease-epidemiology collaboration (eGFR CKD-EPI ) to modification of diet in renal disease (eGFR MDRD ) and the Cockcroft-Gault formulas of Creatinine clearance (C CG ) equations in predicting post coronary artery bypass grafting (CABG) mortality. Methods Data from 4408 patients who underwent isolated CABG over a 11-year period were retrieved from one institutional database. Discriminatory power was assessed using the c-index and comparison between the scores’ performance was performed with DeLong, bootstrap, and Venkatraman methods. Calibration was evaluated with calibration curves and associated statistics. Results The discriminatory power was higher in eGFR CKD-EPI than eGFR MDRD and C CG (Area under Curve [AUC]:0.77, 0.55 and 0.52, respectively). Furthermore, eGFR CKD-EPI performed worse in patients with an eGFR ≤29 ml/min/1.73m 2 (AUC: 0.53) while it was not influenced by higher eGFRs, age, and body size. In contrast, the MDRD equation was accurate only in women (calibration statistics p = 0.72), elderly patients ( p = 0.53) and subjects with severe impairment of renal function ( p = 0.06) whereas C CG was not significantly biased only in patients between 40 and 59 years ( p = 0.6) and with eGFR 45–59 ml/min/1.73m 2 ( p = 0.32) or ≥ 60 ml/min/1.73m 2 ( p = 0.48). Conclusions In general, CKD-EPI gives the best prediction of death after CABG with unsatisfactory accuracy and calibration only in patients with severe kidney disease. In contrast, the CG and MDRD equations were inaccurate in a clinically significant proportion of patients.
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Gelsomino et al. (2019) conducted a cohort in Coronary artery disease requiring isolated CABG (n=4,408). eGFR CKD-EPI equation vs. eGFR MDRD and Cockcroft-Gault equations was evaluated on Discriminatory power (AUC) for all-cause mortality within 30 days or index hospitalization (AUC 0.77, 95% CI 0.73-0.81, p=<0.01). The eGFR CKD-EPI equation provided significantly better prediction of mortality after coronary artery bypass grafting (AUC 0.77) compared to the MDRD (AUC 0.55) and Cockcroft-Gault (AUC 0.52) equations.
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