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Predicting survival of older community‐dwelling individuals according to five estimated glomerular filtration rate equations: The InChianti study
Author(s) -
Corsonello Andrea,
Pedone Claudio,
Bandinelli Stefania,
Ferrucci Luigi,
Antonelli Incalzi Raffaele
Publication year - 2018
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1111/ggi.13225
Subject(s) - medicine , cystatin c , renal function , creatinine , kidney disease , receiver operating characteristic , area under the curve , urology
Aims There is uncertainty about which estimated glomerular filtration rate eGFR equation to use in older people with respect to the prediction of prognosis. Our aim was: (i) to compare the discriminative capacity of eGFR estimated by different equations with respect to all‐cause mortality; and (ii) to identify the eGFR threshold at which the risk of mortality starts to increase for each equation. Methods We used data from 828 community‐dwelling older adults aged >65 years enrolled in the InCHIANTI study. The outcome measure was all‐cause mortality at 9 years. GFR was estimated by five different equations: Chronic Kidney Disease Epidemiological Collaboration (creatinine equation [CKD‐EPI cre ], and creatinine and cystatin C equation [CKD‐EPI cre‐cys ]), Berlin Initiative Study (BIS cre and BIS cre‐cys ) and full age spectrum. Sensitivity, specificity, areas under receiver operating curve (AUC) and C‐statistics were used to compare their predictive capacity. Results The best mix of sensitivity, specificity, AUC and C‐statistic value in predicting mortality was observed with BIS equations. BIS cre (AUC 0.65, 95% CI 0.61–0.69) outperformed both CKD‐EPI cre (AUC 0.60, 95% CI 0.56–0.64; P = 0.005) and full age spectrum (AUC 0.63, 95% CI 0.59–0.67; P = 0.002) in terms of predictivity. Similarly, BIS cre‐cys (AUC 0.67, 95% CI 0.63–0.71) outperformed CKD‐EPI cre‐cys (AUC 0.63, 95% CI 0.59–0.67; P = 0.01). AUC obtained with equations also including cystatin C were not significantly different compared with their creatinine‐based counterparts. The risk of long‐term mortality began to increase at under 65.6 mL/min/1.73 m 2 for CKD‐EPI cre‐cys , 60.5 for CKD‐EPI cre , 60 for BIS cre‐cys , 56.3 for BIS cre and 55.2 for full age spectrum. Conclusions The BIS equation discriminates the risk of all‐cause mortality better than other equations in older community‐dwelling individuals. The eGFR threshold under which mortality starts to increase could change as a function of the equation used. Geriatr Gerontol Int 2018; 18: 607–614 .