Chronic Kidney Disease Classification in Systolic Blood Pressure Intervention Trial: Comparison Using Modification of Diet in Renal Disease and CKD-Epidemiology Collaboration Definitions

Abstract

Background: Interventional trials have used either the Modification of Diet in Renal Disease (MDRD) or chronic kidney disease (CKD)-Epidemiology Collaboration (CKD-EPI) equation for determination of estimated glomerular filtration rate (eGFR) to define whether participants have stages 3-5 CKD. The equation used to calculate eGFR may influence the number and characteristics of participants designated as having CKD.

Methods: We examined the classification of CKD at baseline using both equations in the Systolic Blood Pressure Intervention Trial (SPRINT). eGFR was calculated at baseline using fasting serum creatinine values from a central laboratory.

Results: Among 9,308 participants with baseline CKD classification using the 4-variable MDRD equation specified in the SPRINT protocol, 681 (7.3%) participants were reclassified to a less advanced CKD stage (higher eGFR) and 346 (3.7%) were reclassified to a more advanced CKD stage (lower eGFR) when the CKD-EPI equation was used to calculate eGFR. For eGFRs <90 ml/min/1.73 m2, participants <75 years were more likely to be reclassified to a less advanced CKD stage; this reclassification was more likely to occur in non-blacks rather than blacks. Participants aged ≥75 years were more likely to be reclassified to a more advanced than a less advanced CKD stage, regardless of baseline CKD stage. Reclassification of baseline CKD status (eGFR <60 ml/min/1.73 m2) occurred in 3% of participants.

Conclusions: Use of the MDRD equation led to a higher percentage of participants being classified as having CKD stages 3-4. Younger and non-black participants were more likely to be reclassified as not having CKD using the CKD-EPI equation.

Trial registration: ClinicalTrials.gov NCT01206062.

© 2016 S. Karger AG, Basel.

Figures

FIGURE 1

Reclassification rates for SPRINT participants (N=9,308) across estimated glomerular filtration rate (eGFR) categories by the CKD-EPI and MDRD Study equations. Blue bars indicate reclassification to less advanced CKD stage (higher eGFR); yellow bars, no reclassification; red bars, downward reclassification to more advanced CKD stage (lower eGFR).

FIGURE 2

Reclassification rates for SPRINT participants by age across estimated glomerular filtration rate (eGFR) categories by the CKD-EPI and MDRD Study equations. Blue bars indicate reclassification to less advanced CKD stage (higher eGFR); yellow bars, no reclassification; red bars, downward reclassification to more advanced CKD stage (lower eGFR).

FIGURE 3

Reclassification rates for SPRINT participants by race (black or white only) / Hispanic ethnicity and gender across estimated glomerular filtration rate (eGFR) categories by the CKD-EPI and MDRD Study equations. Blue bars indicate reclassification to less advanced CKD stage (higher eGFR); yellow bars, no reclassification; red bars, downward reclassification to more advanced CKD stage (lower eGFR).