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Updated: Oct 3, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Kidney Function According to Different Equations in Patients Admitted to a Cardiology Unit and Impact on Outcome
Vincenzo Livio Malavasi1, Anna Chiara Valenti1, Sara Ruggerini1
1Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy.
Insights
The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula shows good agreement with other equations, but concordance decreases with age. The Berlin Initiative Study (BIS-1) and Full Age Spectrum (FAS) equations best predict mortality in older patients.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Evaluating the concordance of estimated glomerular filtration rate (eGFR) equations is crucial for patient management.
- The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula is widely used, but its agreement with other equations and predictive power for mortality requires further investigation.
Purpose of the Study:
- To assess the concordance between the CKD-EPI formula and alternative eGFR equations.
- To evaluate the predictive power of these equations for all-cause mortality in cardiology patients.
Main Methods:
- Retrospective analysis of 806 patients discharged alive from a cardiology ward.
- Classification of patients into Kidney Disease: Improving Global Outcomes (KDIGO) eGFR categories.
- Assessment of CKD-EPI, Cockcroft-Gault (CG), CG-BSA, Modification of Diet in Renal Disease (MDRD), Berlin Initiative Study (BIS-1), and Full Age Spectrum (FAS) equations.
Main Results:
- Good agreement was observed between CKD-EPI and CG-BSA, MDRD, BIS-1, and FAS equations.
- CKD-EPI and MDRD showed highest agreement in younger (<65 years) and older (≥85 years) patients.
- Mortality risk increased with decreasing eGFR, and BIS-1 and FAS equations demonstrated the best discriminant capability for death prediction.
Conclusions:
- Concordance between CKD-EPI and other eGFR equations decreases with age.
- MDRD formula showed the best agreement across different age groups.
- BIS-1 and FAS equations are superior in predicting mortality in elderly patients (≥75 years).
Background:
This paper aims to evaluate the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and alternative equations and to assess their predictive power for all-cause mortality in unselected patients discharged alive from a cardiology ward.
Methods:
We retrospectively included patients admitted to our Cardiology Division independently of their diagnosis. The total population was classified according to Kidney Disease: Improving Global Outcomes (KDIGO) categories, as follows: G1 (estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m2); G2 (eGFR 89-60 mL/min/1.73 m2); G3a (eGFR 59-45 mL/min/1.73 m2); G3b (eGFR 44-30 mL/min/1.73 m2); G4 (eGFR 29-15 mL/min/1.73 m2); G5 (eGFR <15 mL/min/1.73 m2). Cockcroft-Gault (CG), CG adjusted for body surface area (CG-BSA), Modification of Diet in Renal Disease (MDRD), Berlin Initiative Study (BIS-1), and Full Age Spectrum (FAS) equations were also assessed.
Results:
A total of 806 patients were included. Good agreement was found between the CKD-EPI formula and CG-BSA, MDRD, BIS-1, and FAS equations. In subjects younger than 65 years or aged ≥85 years, CKD-EPI and MDRD showed the highest agreement (Cohen's kappa (K) 0.881 and 0.588, respectively) while CG showed the lowest. After a median follow-up of 407 days, overall mortality was 8.2%. The risk of death was higher in lower eGFR classes (G3b HR4.35; 95%CI 1.05-17.80; G4 HR7.13; 95%CI 1.63-31.23; G5 HR25.91; 95%CI 6.63-101.21). The discriminant capability of death prediction tested with ROC curves showed the best results for BIS-1 and FAS equations.
Conclusion:
In our cohort, the concordance between CKD-EPI and other equations decreased with age, with the MDRD formula showing the best agreement in both younger and older patients. Overall, mortality rates increased with the renal function decreasing. In patients aged ≥75 years, the best discriminant capability for death prediction was found for BIS-1 and FAS equations.
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