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The predictive value of creatinine clearance for mortality in patients undergoing revascularization
Eilon Ram1,2, Pazit Beckerman3,4, Amit Segev3,5
1Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel. eilon.ram@sheba.health.gov.il.
Insights
The Mayo formula may better predict mortality in multi-vessel coronary artery disease (CAD) patients than the MDRD formula. This study compared five formulas for estimating glomerular filtration rate (eGFR) in 1112 CAD patients.
Area of Science:
- Cardiology
- Nephrology
- Medical Statistics
Background:
- Renal function is crucial for prognosis in multi-vessel coronary artery disease (CAD) patients undergoing revascularization.
- Current risk stratification methods using estimated glomerular filtration rate (eGFR) and creatinine clearance lack precision.
Purpose of the Study:
- To compare the performance of five different formulas for estimating glomerular filtration rate (eGFR).
- To assess the predictive value of these eGFR formulas for 3-year mortality in patients with multi-vessel CAD.
Main Methods:
- Prospective study with 3-year follow-up of 1112 consecutive patients with multi-vessel CAD.
- Comparison of five eGFR formulas: Cockcroft-Gault, Mayo, CKD-EPI, MDRD, and inulin clearance-based.
- Multivariable analysis to determine the independent predictive value of renal function for mortality.
Main Results:
- The Mayo formula yielded the highest mean eGFR, while CKD-EPI yielded the lowest.
- All five formulas showed strong correlations with each other.
- Decreased renal function, estimated by all formulas, independently predicted 3-year mortality, with risk increasing by 15-25% per 10-unit eGFR decrease.
- The Mayo formula demonstrated the highest predictive ability for mortality, superior to the MDRD formula.
Conclusions:
- The Mayo formula, despite not being guideline-recommended, may serve as a valuable tool for predicting mortality in multi-vessel CAD patients.
- It offers a potential alternative to the widely used MDRD formula for risk stratification in this population.
Background:
Renal function plays a significant role in the prognosis and management of patients with multi-vessel coronary artery disease (CAD) referred for revascularization. Current data lack precise risk stratification using estimated glomerular filtration rate (eGFR) and creatinine clearance.
Methods:
This prospective study includes a three-year follow-up of 1112 consecutive patients with multi-vessel CAD enrolled in the 22 hospitals in Israel that perform coronary angiography.
Results:
The Mayo formula yielded the highest mean eGFR (90 ± 26 mL/min per 1.73m2) and chronic kidney disease-epidemiology collaboration (CKD-EPI) the lowest (76 ± 24 mL/min per 1.73m2). Consequently, the Mayo formula classified more patients (56%) as having normal renal function. There was a significant and strong correlation between the values obtained from all five formulas using Cockcroft-Gault as the reference formula: Mayo: r = 0.80, p < 0.001; CKD-EPI: r = 0.87, p < 0.001; modification of diet in renal disease (MDRD): r = 0.84, p < 0.001; inulin clearance-based: r = 0.99, p < 0.001). Multivariable analysis demonstrated that decreased renal function is an independent predictor of 3-year mortality in all five formulas, with risk increasing by 15-25% for each 10-unit decrease in eGFR. Despite the similarities between the formulas, the ability to predict mortality was highest in the Mayo formula and lowest in MDRD.
Conclusions:
Our data suggest that while the Mayo formula is not currently recommended by any nephrology guidelines, it may be an alternative formula to predict mortality among patients with multivessel CAD, including to the widely used MDRD formula.
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