Background: Chronic kidney disease (CKD) and atrial fibrillation (AF) often coexist, making accurate renal function estimation crucial, typically through equations calculating estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl). Objective: To compare the concordance and predictive performance of different renal function estimation equations in a European cohort of AF patients. Methods: We analyzed data from AF patients enrolled in a prospective observational European registry. Renal function was estimated using eight formulas: BIS-1, CG, CG-BSA, CKD-EPI, EKFC, FAS, LMR and MDRD. Concordance between formulas was assessed using weighted Cohen's Kappa, while Cox regression and receiver operating characteristic (ROC) curves evaluated their association with outcomes (composite of all-cause death, any coronary revascularization and any thromboembolism). Results: We included 8,506 patients. CKD-EPI demonstrated good to excellent concordance with other formulas, with the lowest concordance with CG (K = 0.607; 95% CI, 0.595-0.618) and the highest with MDRD (K = 0.880; 95% CI, 0.873-0.887). The risk of adverse outcomes increased sharply when renal function dropped below 60 ml/min across all formulas. CG-BSA and CG formulas showed the best discriminative ability for predicting composite outcomes (AUC 0.660, 95% CI 0.644-0.677, and 0.661, 95% CI 0.644-0.678, respectively). Based on integrated discrimination improvement (IDI) analysis, compared to the CKD-EPI equation, the CG and CG-BSA formulas showed significant improvements in sensitivity of 0.9% and 1.1%, respectively CONCLUSION: Equations for estimating renal function vary in concordance, with potential implications for drug prescription and predicting adverse events. CG and CG-BSA formulas showed superior performance in identifying patients at risk for adverse outcomes.
Chronic kidney disease classification according to different formulas and impact on adverse outcomes in patients with atrial fibrillation: A report from a prospective observational European registry / Boriani, Giuseppe; Mei, Davide Antonio; Bonini, Niccolò; Vitolo, Marco; Imberti, Jacopo Francesco; Romiti, Giulio Francesco; Corica, Bernadette; Diemberger, Igor; Dan, Gheorghe Andrei; Potpara, Tatjana; Proietti, Marco; Lip, Gregory Y H. - In: EUROPEAN JOURNAL OF INTERNAL MEDICINE. - ISSN 0953-6205. - (2025). [10.1016/j.ejim.2025.04.038]
Chronic kidney disease classification according to different formulas and impact on adverse outcomes in patients with atrial fibrillation: A report from a prospective observational European registry
Romiti, Giulio Francesco;Corica, Bernadette;
2025
Abstract
Background: Chronic kidney disease (CKD) and atrial fibrillation (AF) often coexist, making accurate renal function estimation crucial, typically through equations calculating estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl). Objective: To compare the concordance and predictive performance of different renal function estimation equations in a European cohort of AF patients. Methods: We analyzed data from AF patients enrolled in a prospective observational European registry. Renal function was estimated using eight formulas: BIS-1, CG, CG-BSA, CKD-EPI, EKFC, FAS, LMR and MDRD. Concordance between formulas was assessed using weighted Cohen's Kappa, while Cox regression and receiver operating characteristic (ROC) curves evaluated their association with outcomes (composite of all-cause death, any coronary revascularization and any thromboembolism). Results: We included 8,506 patients. CKD-EPI demonstrated good to excellent concordance with other formulas, with the lowest concordance with CG (K = 0.607; 95% CI, 0.595-0.618) and the highest with MDRD (K = 0.880; 95% CI, 0.873-0.887). The risk of adverse outcomes increased sharply when renal function dropped below 60 ml/min across all formulas. CG-BSA and CG formulas showed the best discriminative ability for predicting composite outcomes (AUC 0.660, 95% CI 0.644-0.677, and 0.661, 95% CI 0.644-0.678, respectively). Based on integrated discrimination improvement (IDI) analysis, compared to the CKD-EPI equation, the CG and CG-BSA formulas showed significant improvements in sensitivity of 0.9% and 1.1%, respectively CONCLUSION: Equations for estimating renal function vary in concordance, with potential implications for drug prescription and predicting adverse events. CG and CG-BSA formulas showed superior performance in identifying patients at risk for adverse outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
