Key result
Cockcroft-Gault outperforms MDRD and CKD-EPI for predicting major adverse events in AF on DOACs.
Why the study?
The Cockcroft-Gault formula is the gold standard for assessing renal function in patients with AF receiving DOACs, though various other estimation formulas exist. This study evaluated the concordance and predictive performance of different renal function formulas regarding clinical outcomes in these patients.
Does renal function assessment using alternative formulas (such as MDRD and CKD-EPI) improve the prediction of composite clinical outcomes (thromboembolism, all-cause mortality, and major bleeding) compared to the Cockcroft-Gault formula in patients with non-valvular atrial fibrillation receiving direct oral anticoagulants?
Observational (n=21,318)
Does renal function assessment using alternative formulas (such as MDRD and CKD-EPI) improve the prediction of composite clinical outcomes (thromboembolism, all-cause mortality, and major bleeding) compared to the Cockcroft-Gault formula in patients with non-valvular atrial fibrillation receiving direct oral anticoagulants?
The Cockcroft-Gault formula remains superior to other renal function equations like MDRD and CKD-EPI for predicting adverse clinical outcomes (thromboembolism, mortality, and major bleeding) in patients with atrial fibrillation treated with DOACs.
Cockcroft-Gault may support better event prediction than MDRD or CKD-EPI in DOAC-treated AF; leaves open impact on dosing decisions.
Background The Cockcroft-Gault (CG) formula remains the gold standard for renal function assessment in patients with atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs), though various other estimation formulas exist. We compared the concordance and predictive performance of different renal function formulas regarding clinical outcomes in patients with AF receiving DOAC therapy. Methods A total of 21,318 patients with non-valvular AF receiving DOACs was studied. Renal function was estimated using eight formulas, including CG, MDRD, and CKD-EPI. Concordance was assessed utilizing weighted Cohen’s Kappa. The accuracies of different renal function equations in predicting composite clinical outcomes (thromboembolism, all-cause mortality, and major bleeding) were assessed using receiver operating characteristic (ROC) curves. Results Most patients were classified as having chronic kidney disease (CKD) stage 2 across the eight renal function formulas, with proportions ranging from 29.2% using the CG formula to 48.2% using the CKD-EPI formula. The concordance between the CG and MDRD (K=0.498; 95%CI, 0.481-0.515) or CKD-EPI (K=0.485; 95%CI, 0.468-0.502) formula is only moderate (Figure 1). Both the MDRD (AUC: 0.641; 95% CI: 0.633–0.649) and CKD-EPI (AUC: 0.664; 95% CI: 0.656–0.672) formulas, along with other renal function equations, demonstrated inferior discriminatory performance for predicting major adverse events compared with the Cockcroft–Gault formula (AUC: 0.707; 95% CI: 0.690–0.704), regardless of whether eGFR was analyzed as a continuous variable (Figure 2A) or categorized into six CKD stages (Figure 2B). Conclusions The CG formula plays a crucial role in the management of patients with AF in the DOAC era, as it is essential for both dose guidance and the prediction of adverse clinical events.figure--1--correlation.jpgfigure--2--renal--equation--figure.jpg
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Chao et al. (2026) conducted an observational in Non-valvular atrial fibrillation (n=21,318). Cockcroft-Gault (CG) renal function formula vs. MDRD, CKD-EPI, and five other renal function formulas was evaluated on Composite clinical outcomes (thromboembolism, all-cause mortality, and major bleeding) (AUC 0.707, 95% CI 0.690-0.704). The Cockcroft-Gault formula (AUC 0.707) had superior discrimination for predicting major adverse events in AF patients on DOACs vs MDRD (AUC 0.641) and CKD-EPI (AUC 0.664).
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