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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Evaluating the Effect of Estimating Renal Function With the CKD-EPI 2021 Equation on the ABCD-GENE Score for
Maryam Jamal AlSaeed1,2, Cameron D Thomas1, Francesco Franchi3
1Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
Insights
The new CKD-EPI Scr 2021 equation, without race, alters the ABCD-GENE score for predicting clopidogrel response. This impacts risk assessment for patients undergoing percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Nephrology
- Pharmacogenomics
Background:
- The ABCD-GENE score predicts clopidogrel response post-PCI, incorporating age, BMI, CKD, diabetes, and CYP2C19 variants.
- Current guidelines recommend GFR estimation without race using the CKD-EPI Scr 2021 equation.
Purpose of the Study:
- To evaluate the impact of the CKD-EPI Scr 2021 equation versus the 2009 equation on the ABCD-GENE score in patients after PCI.
- To assess how removing the race variable in GFR estimation affects clopidogrel response prediction.
Main Methods:
- Compared GFR estimations using CKD-EPI Scr 2021 and CKD-EPI 2009 equations in 4335 post-PCI patients.
- Recalculated ABCD-GENE scores based on each GFR estimation method.
- Analyzed changes in CKD prevalence and patient risk stratification.
Main Results:
- The CKD-EPI Scr 2021 equation resulted in lower eGFR and higher CKD prevalence in Black patients, but higher eGFR and lower CKD prevalence in non-Black patients.
- This led to reclassification of 1% of Black patients from low to high risk and 1% of non-Black patients from high to low risk for poor clopidogrel response.
- Significant differences in risk prediction were observed between the two GFR estimation equations (P < 0.001).
Conclusions:
- Excluding race from GFR estimation using the CKD-EPI Scr 2021 equation significantly alters the ABCD-GENE score.
- This change impacts the prediction of clopidogrel effectiveness and risk stratification in post-PCI patients.
- Clinical application of the ABCD-GENE score requires consideration of updated GFR estimation methods.
Abstract:
The ABCD-GENE score was developed to predict poor response to clopidogrel and includes Age, Body mass index, Chronic kidney disease (CKD; estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2), Diabetes, and CYP2C19 GENE variants; a score ≥ 10 is predictive of reduced clopidogrel effectiveness after percutaneous coronary intervention (PCI). Estimation of GFR without a race variable via the CKD-EPI Scr 2021 equation is now recommended. We examined the impact of using the CKD-EPI Scr 2021 vs. 2009 equation on the ABCD-GENE score for post-PCI patients. A total of 4335 adult patients (n = 925 Black) who underwent PCI and CYP2C19 genotyping were included, with GFR estimated for each patient via the CKD-EPI Scr 2021 and CKD-EPI 2009 equations. The ABCD-GENE score, calculated based on each GFR estimation, was compared. With the CKD-EPI Scr 2021 vs. 2009 equation, median (IQR) eGFR was lower (74 [55-94] vs. 81 [60-103] mL/min/1.73 m2, P < 0.001), and CKD prevalence was higher (31% vs. 25%, P < 0.001) among Black patients, whereas eGFR was higher (85 [65-99] vs. 80 [61-94] mL/min/1.73m2, P < 0.001), and CKD prevalence was lower (20% vs. 24%, P < 0.001) in non-Black patients. This led to 12 (1%) Black patients being reclassified from low to high risk of poor clopidogrel response and 30 (1%) non-Black patients being recategorized from high to low risk (P < 0.001 for both comparisons). Removal of the race variable from GFR estimation significantly impacted the prediction of clopidogrel effectiveness via the ABCD-GENE score.
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