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Published on: October 21, 2018
The predictive value of five glomerular filtration rate formulas for long-term mortality in patients undergoing
Eilon Ram1,2, Yael Peled3, Ehud Karni1
1Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
The Mayo formula may be superior for predicting mortality risk in patients undergoing coronary artery bypass grafting (CABG). This formula better identifies patients at risk compared to other estimated glomerular filtration rate (eGFR) equations.
Area of Science:
- Nephrology
- Cardiology
- Medical Statistics
Background:
- Renal function is crucial for managing patients undergoing coronary artery bypass grafting (CABG).
- Current methods for risk stratification using estimated glomerular filtration rate (eGFR) lack precision.
- Accurate assessment of renal function is vital for optimizing CABG patient outcomes.
Purpose of the Study:
- To compare the performance of five different eGFR formulas in patients undergoing CABG.
- To determine which eGFR formula provides the most accurate risk stratification for mortality.
- To evaluate the prognostic value of different eGFR equations in the context of CABG surgery.
Main Methods:
- Retrospective analysis of 3744 patients who underwent CABG between 2004 and 2020.
- Assessment of five eGFR formulas: Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), CKD-Epidemiology Collaboration (CKD-EPI), Mayo, and Inulin Clearance-based (IB).
- Statistical comparison of eGFR values, correlation analysis, and multivariable analysis for mortality prediction.
Main Results:
- The Mayo formula yielded the highest mean eGFR, classifying more patients with normal renal function.
- CKD-EPI and Mayo formulas showed stronger correlations with the MDRD formula compared to CG and IB.
- Decreased renal function, as predicted by all formulas, independently predicted 10-year mortality, with risk increasing by 13-17% per 10-unit eGFR decrease.
Conclusions:
- The Mayo formula demonstrated superior performance in prognosticating 10-year mortality after CABG.
- Compared to other formulas, the Mayo equation more accurately categorized mortality risk and identified fewer individuals with renal dysfunction.
- The findings suggest the Mayo formula may be the preferred choice for risk stratification in CABG patients.
Background And Aims:
Renal function plays an important role in the management of patients referred for coronary artery bypass grafting (CABG). Current data is insufficient for precise risk stratification using the estimated glomerular filtration rate (eGFR).
Methods:
This retrospective study includes 3744 consecutive patients who underwent CABG between 2004 and 2020. We assessed five different eGFR formulas: Cockcroft-Gault (CG), modification of diet in renal disease (MDRD), chronic kidney disease Epidemiology Collaboration (CKD-EPI), Mayo, and inulin clearance-based (IB).
Results:
The Mayo formula yielded the highest mean eGFR (90 ± 24 ml/min per 1.73 m2 ) and CKD-EPI the lowest (74 ± 21 ml/min per 1.73 m2 ). As a result, more patients were classified as having a normal renal function (57%) with the Mayo formula as compared with the others. Using MDRD as the reference formula, there was a significant and stronger correlation between the values obtained from the CKD-EPI (r = .95, p < .001) and Mayo (Mayo: r = .87, p < .001) compared to the IB (r = .8, p < .001) and CG (r = .79, p < .001) formulas. Multivariable analysis demonstrated that decreased renal function is an independent predictor of 10-year mortality in all five formulas, with risk increasing by 13-17% 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 the CG and IB.
Conclusions:
Our data suggest that the Mayo formula may be superior to the other formulas in prognosticating mortality after CABG. We have shown that the Mayo equation classified fewer individuals as having renal dysfunction and more accurately categorized the risk for mortality than did all other formulas.
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