Comparison of predictive value for first cardiovascular event between Japanese GFR equation and coefficient-modified CKD-EPI equation

Hiroyuki Terawaki, Masaaki Nakayama, Koichi Asahi, Takeyasu Kakamu, Takehito Hayakawa, Kunitoshi Iseki, Kenjiro Kimura, Toshiki Moriyama, Kunihiro Yamagata, Ichiei Narita, Shouichi Fujimoto, Kazuhiko Tsuruya, Tsuneo Konta, Masahide Kondo, Issei Kurahashi, Yasuo Ohashi, Tetsuhito Fukushima, Tsuyoshi Watanabe

Research output: Contribution to journalArticle

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Abstract

Background: The most superior GFR-estimating equation from the viewpoint of cardiovascular disease (CVD) prediction remains unclear. Thus, we performed cross-sectional comparison between two GFR-estimating equations (Japanese GFR equation and coefficient-modified CKD-EPI equation) and CVD incidence using Japanese nationwide “specific health checkup” data. Methods: We recruited Japanese residents (241,159 individuals; mean 63 years; male, 38.6 %) who had not experienced CVD event (cardiac disease or stroke, or both). We calculated estimated GFR using two equations, and compared their predictive value for first symptomatic CVD event within 1 year. Results: Of all subjects, the mean GFR estimated by the Japanese GFR equation (JPN-eGFR) modified for Japanese was 75.83 ± 16.18 mL/min/1.73 m2, and that by the coefficient-modified CKD-EPI equation (mCKDEPI-eGFR) was 76.39 ± 9.61 mL/min/1.73 m2. Area under the receiver operating characteristics curves (95 % confidence intervals) for predicting CVD event by mCKDEPI-eGFR vs. JPN-eGFR were 0.596 (0.589–0.603) vs. 0.562 (0.554–0.569). Using mCKDEPI-eGFR, the crude odds ratio (OR) for CVD incident in the 4th quartile group was far more than double (OR 2.46, 95 % CI 2.29–2.66) that in the 1st quartile group. Using JPN-eGFR, the crude OR in the 4th quartile group was less than double (OR 1.61, 95 % CI 1.51–1.73) that in the 1st quartile group. However, such superior predictive value of mCKDEPI-eGFR disappeared after adjustment for confounding factors (age, gender, BMI, presence of proteinuria, hypertension, diabetes, dyslipidemia and current smoking). Conclusion: GFR estimated by the coefficient-modified CKD-EPI equation was more closely related to CVD incidence than that estimated by the Japanese GFR equation. However, it is possible that low mCKDEPI-eGFR also reflects some cardiovascular risk(s) other than kidney dysfunction.

Original languageEnglish
Pages (from-to)387-394
Number of pages8
JournalClinical and Experimental Nephrology
Volume19
Issue number3
DOIs
Publication statusPublished - Jun 17 2015

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Cardiovascular Diseases
Odds Ratio
Age Factors
Incidence
Dyslipidemias
Proteinuria
ROC Curve
Heart Diseases
Smoking
Stroke
Confidence Intervals
Hypertension
Kidney
Health

All Science Journal Classification (ASJC) codes

  • Physiology
  • Nephrology
  • Physiology (medical)

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Comparison of predictive value for first cardiovascular event between Japanese GFR equation and coefficient-modified CKD-EPI equation. / Terawaki, Hiroyuki; Nakayama, Masaaki; Asahi, Koichi; Kakamu, Takeyasu; Hayakawa, Takehito; Iseki, Kunitoshi; Kimura, Kenjiro; Moriyama, Toshiki; Yamagata, Kunihiro; Narita, Ichiei; Fujimoto, Shouichi; Tsuruya, Kazuhiko; Konta, Tsuneo; Kondo, Masahide; Kurahashi, Issei; Ohashi, Yasuo; Fukushima, Tetsuhito; Watanabe, Tsuyoshi.

In: Clinical and Experimental Nephrology, Vol. 19, No. 3, 17.06.2015, p. 387-394.

Research output: Contribution to journalArticle

Terawaki, H, Nakayama, M, Asahi, K, Kakamu, T, Hayakawa, T, Iseki, K, Kimura, K, Moriyama, T, Yamagata, K, Narita, I, Fujimoto, S, Tsuruya, K, Konta, T, Kondo, M, Kurahashi, I, Ohashi, Y, Fukushima, T & Watanabe, T 2015, 'Comparison of predictive value for first cardiovascular event between Japanese GFR equation and coefficient-modified CKD-EPI equation', Clinical and Experimental Nephrology, vol. 19, no. 3, pp. 387-394. https://doi.org/10.1007/s10157-014-0997-7
Terawaki, Hiroyuki ; Nakayama, Masaaki ; Asahi, Koichi ; Kakamu, Takeyasu ; Hayakawa, Takehito ; Iseki, Kunitoshi ; Kimura, Kenjiro ; Moriyama, Toshiki ; Yamagata, Kunihiro ; Narita, Ichiei ; Fujimoto, Shouichi ; Tsuruya, Kazuhiko ; Konta, Tsuneo ; Kondo, Masahide ; Kurahashi, Issei ; Ohashi, Yasuo ; Fukushima, Tetsuhito ; Watanabe, Tsuyoshi. / Comparison of predictive value for first cardiovascular event between Japanese GFR equation and coefficient-modified CKD-EPI equation. In: Clinical and Experimental Nephrology. 2015 ; Vol. 19, No. 3. pp. 387-394.
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T1 - Comparison of predictive value for first cardiovascular event between Japanese GFR equation and coefficient-modified CKD-EPI equation

AU - Terawaki, Hiroyuki

AU - Nakayama, Masaaki

AU - Asahi, Koichi

AU - Kakamu, Takeyasu

AU - Hayakawa, Takehito

AU - Iseki, Kunitoshi

AU - Kimura, Kenjiro

AU - Moriyama, Toshiki

AU - Yamagata, Kunihiro

AU - Narita, Ichiei

AU - Fujimoto, Shouichi

AU - Tsuruya, Kazuhiko

AU - Konta, Tsuneo

AU - Kondo, Masahide

AU - Kurahashi, Issei

AU - Ohashi, Yasuo

AU - Fukushima, Tetsuhito

AU - Watanabe, Tsuyoshi

PY - 2015/6/17

Y1 - 2015/6/17

N2 - Background: The most superior GFR-estimating equation from the viewpoint of cardiovascular disease (CVD) prediction remains unclear. Thus, we performed cross-sectional comparison between two GFR-estimating equations (Japanese GFR equation and coefficient-modified CKD-EPI equation) and CVD incidence using Japanese nationwide “specific health checkup” data. Methods: We recruited Japanese residents (241,159 individuals; mean 63 years; male, 38.6 %) who had not experienced CVD event (cardiac disease or stroke, or both). We calculated estimated GFR using two equations, and compared their predictive value for first symptomatic CVD event within 1 year. Results: Of all subjects, the mean GFR estimated by the Japanese GFR equation (JPN-eGFR) modified for Japanese was 75.83 ± 16.18 mL/min/1.73 m2, and that by the coefficient-modified CKD-EPI equation (mCKDEPI-eGFR) was 76.39 ± 9.61 mL/min/1.73 m2. Area under the receiver operating characteristics curves (95 % confidence intervals) for predicting CVD event by mCKDEPI-eGFR vs. JPN-eGFR were 0.596 (0.589–0.603) vs. 0.562 (0.554–0.569). Using mCKDEPI-eGFR, the crude odds ratio (OR) for CVD incident in the 4th quartile group was far more than double (OR 2.46, 95 % CI 2.29–2.66) that in the 1st quartile group. Using JPN-eGFR, the crude OR in the 4th quartile group was less than double (OR 1.61, 95 % CI 1.51–1.73) that in the 1st quartile group. However, such superior predictive value of mCKDEPI-eGFR disappeared after adjustment for confounding factors (age, gender, BMI, presence of proteinuria, hypertension, diabetes, dyslipidemia and current smoking). Conclusion: GFR estimated by the coefficient-modified CKD-EPI equation was more closely related to CVD incidence than that estimated by the Japanese GFR equation. However, it is possible that low mCKDEPI-eGFR also reflects some cardiovascular risk(s) other than kidney dysfunction.

AB - Background: The most superior GFR-estimating equation from the viewpoint of cardiovascular disease (CVD) prediction remains unclear. Thus, we performed cross-sectional comparison between two GFR-estimating equations (Japanese GFR equation and coefficient-modified CKD-EPI equation) and CVD incidence using Japanese nationwide “specific health checkup” data. Methods: We recruited Japanese residents (241,159 individuals; mean 63 years; male, 38.6 %) who had not experienced CVD event (cardiac disease or stroke, or both). We calculated estimated GFR using two equations, and compared their predictive value for first symptomatic CVD event within 1 year. Results: Of all subjects, the mean GFR estimated by the Japanese GFR equation (JPN-eGFR) modified for Japanese was 75.83 ± 16.18 mL/min/1.73 m2, and that by the coefficient-modified CKD-EPI equation (mCKDEPI-eGFR) was 76.39 ± 9.61 mL/min/1.73 m2. Area under the receiver operating characteristics curves (95 % confidence intervals) for predicting CVD event by mCKDEPI-eGFR vs. JPN-eGFR were 0.596 (0.589–0.603) vs. 0.562 (0.554–0.569). Using mCKDEPI-eGFR, the crude odds ratio (OR) for CVD incident in the 4th quartile group was far more than double (OR 2.46, 95 % CI 2.29–2.66) that in the 1st quartile group. Using JPN-eGFR, the crude OR in the 4th quartile group was less than double (OR 1.61, 95 % CI 1.51–1.73) that in the 1st quartile group. However, such superior predictive value of mCKDEPI-eGFR disappeared after adjustment for confounding factors (age, gender, BMI, presence of proteinuria, hypertension, diabetes, dyslipidemia and current smoking). Conclusion: GFR estimated by the coefficient-modified CKD-EPI equation was more closely related to CVD incidence than that estimated by the Japanese GFR equation. However, it is possible that low mCKDEPI-eGFR also reflects some cardiovascular risk(s) other than kidney dysfunction.

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