Comparison of the heart failure risk stratification performance of the CKD – EPI equation and the MDRD equation for estimated glomerular filtration rate in patients with Type 2 diabetes

Aims To investigate the risk prediction and the risk stratification performances of the Chronic Kidney Disease Epidemiology Collaboration ( CKD – EPI ) equation and the Modification of Diet in Renal Disease ( MDRD ) equation for estimated glomerular filtration rate ( eGFR CKD – EPI vs. eGFR MDRD ) on heart failure in patients with Type 2 diabetes. Methods The study cohort included 12 258 White and 16 886 African American low‐income patients with Type 2 diabetes who were 30–90 years old at baseline. Heart failure risk according to different eGFR CKD – EPI and eGFR MDRD categories was prospectively assessed. Results During a mean follow‐up of 6.5 years, 5043 incident heart failure cases were identified. Multivariable‐adjusted hazard ratios ( HR s) of heart failure associated with the eGFR CKD – EPI categories [≥ 90 (reference group), 75–89, 60–74, 30–59 and < 30 ml/min/1.73 m 2 ] were 1.00, 1.11, 1.31, 1.75 and 2.93 ( P trend  < 0.001) for African American patients, and 1.00, 1.11, 1.08, 1.59 and 2.92 ( P trend  < 0.001) for White patients, respectively. The model with eGFR CKD – EPI and the other risk factors had significantly higher Harrell's C than the model with eGFR MDRD and other risk factors. Patients reclassified downward from eGFR MDRD 60–74 to eGFR CKD – EPI 30–59 and from eGFR MDRD 30–59 to eGFR CKD – EPI  < 30 ml/min/1.73 m 2 showed higher heart failure risk than those who were not reclassified. Conclusions Impaired kidney function (i.e. GFR  < 60 ml/min/1.73 m 2 ), and even mildly decreased GFR (60–74 ml/min/1.73 m 2 ) estimated by both equations is associated with an increased risk of heart failure. Compared with GFR estimated using the MDRD equation, GFR estimated using the CKD – EPI equation added more predictive power to the model with the other risk factors. Also, eGFR CKD – EPI provided more accurate heart failure risk stratification than eGFR MDRD .