eGFR and ACR Provide Better Cardiovascular Risk Prediction in CKD

This article originally appeared here.
The combination of eGFR and ACR outperformed most single traditional parameters for cardiovascular risk discrimination in patients with chronic kidney disease.
The combination of eGFR and ACR outperformed most single traditional parameters for cardiovascular risk discrimination in patients with chronic kidney disease.

(HealthDay News) -- Estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) improve prediction of cardiovascular risk above traditional risk factors, according to a meta-analysis published online in The Lancet Diabetes & Endocrinology. The research was published to coincide with the European Renal Association-European Dialysis and Transplant Association Congress in London.

Kunihiro Matsushita, M.D., from the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues used a meta-analysis approach to examine the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk. Data were included for 637,315 individuals without a history of cardiovascular disease from 24 cohorts.

The researchers found that in general populations, the addition of eGFR and ACR significantly improved the discrimination of cardiovascular outcomes beyond traditional risk factors; the improvement was greater for ACR versus eGFR, and was more evident for cardiovascular mortality and heart failure than for coronary disease and stroke. 

In individuals with diabetes or hypertension, the discrimination improvement with eGFR or ACR was especially pronounced; for patients without either of these disorders, the improvement with ACR remained significant for cardiovascular mortality and heart failure. The combination of eGFR and ACR outperformed most single traditional parameters for risk discrimination in individuals with chronic kidney disease; after omission of eGFR and ACR, the C-statistic for cardiovascular mortality decreased by 0.0227 versus less than 0.007 for any single modifiable traditional predictor.

"Our results lend some support to also incorporating eGFR and ACR into assessments of cardiovascular risk in the general population," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

Sources

  1. Matsushita, K, et al. The Lancet; doi: 10.1016/S2213-8587(15)00040-6.
  2. Alberto Ortiz. The Lancet; doi: 10.1016/S2213-8587(15)00092-3.
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