Prediction of cardiovascular outcome by estimated glomerular filtration rate and estimated creatinine clearance in the high-risk hypertension population of the VALUE trial - PubMed (original) (raw)
Randomized Controlled Trial
Prediction of cardiovascular outcome by estimated glomerular filtration rate and estimated creatinine clearance in the high-risk hypertension population of the VALUE trial
Luis M Ruilope et al. J Hypertens. 2007 Jul.
Abstract
Background: Reduced renal function is predictive of poor cardiovascular outcomes but the predictive value of different measures of renal function is uncertain.
Methods: We compared the value of estimated creatinine clearance, using the Cockcroft-Gault formula, with that of estimated glomerular filtration rate (GFR), using the Modification of Diet in Renal Disease (MDRD) formula, as predictors of cardiovascular outcome in 15 245 high-risk hypertensive participants in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial. For the primary end-point, the three secondary end-points and for all-cause death, outcomes were compared for individuals with baseline estimated creatinine clearance and estimated GFR < 60 ml/min and > or = 60 ml/min using hazard ratios and 95% confidence intervals. Coronary heart disease, left ventricular hypertrophy, age, sex and treatment effects were included as covariates in the model.
Results: For each end-point considered, the risk in individuals with poor renal function at baseline was greater than in those with better renal function. Estimated creatinine clearance (Cockcroft-Gault) was significantly predictive only of all-cause death [hazard ratio = 1.223, 95% confidence interval (CI) = 1.076-1.390; P = 0.0021] whereas estimated GFR was predictive of all outcomes except stroke. Hazard ratios (95% CIs) for estimated GFR were: primary cardiac end-point, 1.497 (1.332-1.682), P < 0.0001; myocardial infarction, 1.501 (1.254-1.796), P < 0.0001; congestive heart failure, 1.699 (1.435-2.013), P < 0.0001; stroke, 1.152 (0.952-1.394) P = 0.1452; and all-cause death, 1.231 (1.098-1.380), P = 0.0004.
Conclusion: These results indicate that estimated glomerular filtration rate calculated with the MDRD formula is more informative than estimated creatinine clearance (Cockcroft-Gault) in the prediction of cardiovascular outcomes.
Comment in
- Prediction of cardiovascular outcome by the estimated glomerular filtration rate and estimated creatinine clearance in the high-risk hypertension population of the VALUE trial.
Maaravi Y, Bursztyn M, Stessman J. Maaravi Y, et al. J Hypertens. 2008 Jan;26(1):154; author reply 154. doi: 10.1097/HJH.0b013e3282f0ca09. J Hypertens. 2008. PMID: 18090555 No abstract available.
Similar articles
- Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction.
Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, White HD, Nordlander R, Maggioni A, Dickstein K, Zelenkofske S, Leimberger JD, Califf RM, Pfeffer MA. Anavekar NS, et al. N Engl J Med. 2004 Sep 23;351(13):1285-95. doi: 10.1056/NEJMoa041365. N Engl J Med. 2004. PMID: 15385655 Clinical Trial. - Drawbacks and prognostic value of formulas estimating renal function in patients with chronic heart failure and systolic dysfunction.
Smilde TD, van Veldhuisen DJ, Navis G, Voors AA, Hillege HL. Smilde TD, et al. Circulation. 2006 Oct 10;114(15):1572-80. doi: 10.1161/CIRCULATIONAHA.105.610642. Epub 2006 Oct 2. Circulation. 2006. PMID: 17015793 - Comparison of the Modification of Diet in Renal Disease and Cockcroft-Gault equations for dosing antimicrobials.
Hermsen ED, Maiefski M, Florescu MC, Qiu F, Rupp ME. Hermsen ED, et al. Pharmacotherapy. 2009 Jun;29(6):649-55. doi: 10.1592/phco.29.6.649. Pharmacotherapy. 2009. PMID: 19476418 - Evaluation of glomerular filtration rate and of albuminuria/proteinuria.
Cirillo M. Cirillo M. J Nephrol. 2010 Mar-Apr;23(2):125-32. J Nephrol. 2010. PMID: 20213606 Review. - Chronic kidney disease and global cardiovascular risk in essential hypertension.
Segura J, Campo C, Ruilope LM. Segura J, et al. Minerva Med. 2004 Oct;95(5):375-83. Minerva Med. 2004. PMID: 15467513 Review.
Cited by
- Prediction of cardiovascular outcome by estimated glomerular filtration rate among high-risk patients: a Thai nationwide cohort study.
Aiumtrakul N, Kittithaworn A, Supasyndh O, Krittayaphong R, Phrommintikul A, Satirapoj B. Aiumtrakul N, et al. Clin Exp Nephrol. 2022 Dec;26(12):1180-1193. doi: 10.1007/s10157-022-02262-5. Epub 2022 Aug 23. Clin Exp Nephrol. 2022. PMID: 35999302 - Proteinuria as an independent predictor of stroke: Systematic review and meta-analysis.
Kelly DM, Rothwell PM. Kelly DM, et al. Int J Stroke. 2020 Jan;15(1):29-38. doi: 10.1177/1747493019895206. Epub 2020 Jan 14. Int J Stroke. 2020. PMID: 31935154 Free PMC article. - Intermittent claudication and severe renal artery stenosis are independently associated in hypertensive patients referred for renal arteriography.
Macedo TA, Drager LF, Pedrosa RP, Muela HCS, Costa-Hong V, Kajita LJ, Bortolotto LA. Macedo TA, et al. Clinics (Sao Paulo). 2017 Jul;72(7):411-414. doi: 10.6061/clinics/2017(07)04. Clinics (Sao Paulo). 2017. PMID: 28793000 Free PMC article. - Two-Year Changes in Proteinuria and the Risk of Stroke in the Chinese Population: A Prospective Cohort Study.
Wang A, Liu X, Su Z, Chen S, Zhang N, Wu S, Wang Y, Wang Y. Wang A, et al. J Am Heart Assoc. 2017 Jun 30;6(7):e006271. doi: 10.1161/JAHA.117.006271. J Am Heart Assoc. 2017. PMID: 28666989 Free PMC article. - Proteinuria Is an Independent Risk Factor for First Incident Stroke in Adults Under Treatment for Hypertension in China.
Zhang C, Wang X, He M, Qin X, Tang G, Xu X, Wang Y, Huo Y, Cai Y, Fu J, Zhao G, Dong Q, Xu X, Wang B, Hou FF. Zhang C, et al. J Am Heart Assoc. 2015 Dec 18;4(12):e002639. doi: 10.1161/JAHA.115.002639. J Am Heart Assoc. 2015. PMID: 26683219 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical