Comparison of five glomerular filtration rate estimating equations as predictors of acute kidney injury after cardiovascular surgery

Abstract

We aimed to compare the ability of preoperative estimated glomerular filtration rate (eGFR), calculated using five different equations, to predict adverse renal outcomes after cardiovascular surgery. Cohorts of 4,125 adult patients undergoing elective cardiovascular surgery were evaluated. Preoperative eGFR was calculated using the Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD) II, re-expressed MDRD II, Chronic Kidney Disease Epidemiology Collaboration, and Mayo quadratic (Mayo) equations. The primary outcome was postoperative acute kidney injury (AKI), defined by Kidney Disease: Improving Global Outcomes Definition and Staging criteria based on changes in serum creatinine concentrations within 7 days. The MDRD II and Cockcroft-Gault equations yielded the highest (88.1 ± 26.7 ml/min/1.73 m 2 ) and lowest (79.6 ± 25.5 ml/min/1.73 m 2 ) mean eGFR values, respectively. Multivariable analysis showed that a preoperative decrease in renal function according to all five equations was independently associated with an increased risk of postoperative AKI. The area under the receiver operating characteristics curve for predicting postoperative AKI was highest for the Mayo equation (0.713). Net improvements in reclassification and integrated discrimination were higher for the Mayo equation than for the other equations. The Mayo equation was the most accurate in predicting postoperative AKI in patients undergoing cardiovascular surgery.

Factors associated with acute kidney injury in patients undergoing extracorporeal membrane oxygenation: retrospective cohort

“…On the other hand, the GFR on hospital admission was related to the occurrence of AKI. However, even not being included in the KDIGO criteria for AKI, the GFR values are important to help in detection, understanding the severity, decision about diagnosis, prognosis and treatment of renal dysfunction ( 21 ) . Conditions such as AKI or acute CKD present with reduced baseline GFR, i.e., higher GFR values are related as a protective factor for renal function, which is in agreement with the present study ( 22 ) .…”

The predictive value of creatinine clearance for mortality in patients undergoing revascularization

“…Willems et al showed that the CG and MDRD formulas effectively predicted mortality, whereas the CKD-EPI formula did not [ 20 ]. A recent study by Jo et al showed that the Mayo equation was the most accurate in predicting post-operative acute kidney injury when comparing the five eGFR formulas in 4125 adult patients undergoing elective cardiovascular surgery [ 21 ]. Fu et al showed that among 1050 patients aged > 60 years with CAD, the CKD-EPI and Mayo equations were significantly superior to the MDRD in predicting 1-year mortality, and the Mayo demonstrated mild superiority over the CKD-EPI equation [ 22 ].…”

The Predictive Value of Creatinine Clearance for Mortality in Patients Undergoing Revascularization

“…showed that the Mayo equation was the most accurate in predicting post-operative acute kidney injury when comparing the ve eGFR formulas in 4,125 adult patients undergoing elective cardiovascular surgery (23). Fu et al showed that among 1050 patients aged >60 years with CAD, the CKD-EPI and Mayo equations were signi cantly superior to the MDRD in predicting 1-year mortality, and the Mayo demonstrated mild superiority over the CKD-EPI equation (24).…”