Estudio transversal comparativo de las fórmulas CKD-EPI y MDRD-4 a partir de la historia clínica informatizada de Atención Primaria de Barcelona / A comparative, cross-sectional study of the CKD-EPI and MDRD-4 equations from the Primary Care computerized clinical history of Barcelona

Antecedentes: La prevalencia de enfermedad renal crónica (ERC) en España supera el 7%. Su diagnóstico precoz puede ayudar a frenar la evolución. En Atención Primaria (AP) se calcula el filtrado glomerular estimado (FGe) mediante fórmulas basadas en la creatinina plasmática(CrP).Objetivos: Comparar los FG e según las fórmulas MDRD-4 y CKD-EPI a partir de la historia clínica informatizada (HCI) y la clasificación de ERC en una población de AP. Material y métodos: Estudio transversal. Se incluyó a pacientes de 20-99 años, asignados a centros de AP de Barcelona, con CrP entre julio de 2008 y junio de 2010. Se obtuvieron losdatos de la HCI. Se calculó el FGe mediante CKD-EPI y MDRD-4.Resultados: Se estudió a un total de 447.140 personas: 58,7% mujeres, 56,6 (DE 18,8) años. El 32,5% con diagnóstico de hipertensión arterial, 11% con diabetes mellitus y 9,3% con enfermedad cardiovascular asociada. La CrP media fue 0,89 (0,28) mg/dL, FGe por MDRD-4 de 80,59(21,04) mL/min/1,73 m2y por CKD-EPI de 85,03 (21,13) mL/min/1,73 m2. La CKD-EPI, respecto a MDRD-4, clasificó el 2,3% de los pacientes en estadios menos avanzados de ERC, el 96,8% en el mismo y el 0,9% en más avanzados. El índice kappa fue de 0,87. En números absolutos clasificó en estadios 3b-4-5 (posible derivación a nefrología) a 958 pacientes más, con 691 personas >69 años en estadio 3b.Conclusiones: Utilizar una u otra fórmula puede variar el FGe. La CKD-EPI tiende a clasificar enestadios más avanzados en > 69 años. El uso de cada fórmula puede hacer cambiar el número y tipo de derivaciones a nefrología

Background: The prevalence of chronic kidney disease (CKD) in Spain is higher than 7%. Its early diagnóstico can help to delay its progression. Glomerular filtration rate (GFR) based on serum creatinine (SC) is calculated in primary care (PC) to identify CKD. Objectives: To compare GFR by MDRD-4 and CKD-EPI equations obtained from clinical records(CR) and to compare the classification of CKD in a primary care population. Material and methods: A cross-sectional study was performed, including patients 20-99 years old, assigned to primary care centers of Barcelona, with a SC recorded between July 2008 and June 2010. Data were obtained from the CRs. GFR was calculated from MDRD-4 and CKD-EPI equations. Results: A total of 447,140 persons were studied (58.7% females, 56.6 [SD 18.8] years old).Of these 32.5% were diagnosed of hypertension, 11.0% diabetes and 9.3% had some associated cardiovascular disease. SC 0.89 (0.28) mg/dL (78.7 [SD 24.8] mol/L), GFR being 80.59(21.04) mL/min/1.73 m2by MDRD-4, and 85.03 (21.13) mL/min/1.73 m2by CKD-EPI. CKD-EPI compared to MDRD-4 classified 2.3% of patients in less advanced stages of CKD, 96.8% in the same stage and 0.9% in more advanced stages. Kappa coefficient: 0.87. In absolute numbers, CKD-EPI classified in 3b-4-5 stages (candidates for referral to nephrology) 958 patients more,691 of them being patients > 69 years old and stage 3b.Conclusions: Using one equation or another could vary the estimation of GFR. CKD-EPI tends to classify patients older than 69 into more advanced stages. Each equation can change the number and type of referral to nephrology (AU)

El filtrado glomerular reducido según las fórmulas de Cockcroft-Gault y MDRD no siempre predice la morbimortalidad cardiovascular en los pacientes hipertensos atendidos en atención primaria / Decreased glomerular filtration rate using the Cockgroft-Gaultand MDRD formulas does not always predict cardiovascular morbidity and mortality in hypertensive primary care patients

Antecedentes: El deterioro de la función renal se ha asociado con un incremento de la morbimortalidad cardiovascular. El objetivo del estudio fue analizar la asociación del filtrado glomerular (FG) basal, según las fórmulas de Cockcroft-Gault y MDRD, con la incidencia de eventos cardiovasculares (ECV) en una cohorte de personas hipertensas seguida durante 12 años. Métodos: Estudio prospectivo de una muestra aleatoria de 223 hipertensos libres de ECV atendidos en un centro de atención primaria urbano. Se estimó el FG mediante ambas fórmulas. Se consideró ECV la aparición de cardiopatía isquémica, insuficiencia cardíaca, accidente cerebrovascular, vasculopatía periférica o muerte por ECV. Se analizaron los datos mediante el método actuarial y modelos de regresión de Cox. Resultados: La mediana de tiempo de seguimiento fue de 10,7 años (rango intercuartílico,6,5-12,1). El seguimiento fue completo en 191 participantes (85,7%). La supervivencia acumulada fue del 64,7% (intervalo de confianza [IC] del 95%: 57,9-71,6%). La tasa media de incidencia de ECV durante todo el período de seguimiento fue de 3,6 (IC del 95%, 2,7-4,4%) por 100 personas hipertensas/año. El modelo multivariable final mostró que las variables con mayor poder predictivo de ECV en la población de estudio fueron la diabetes y la estimación del FG >60ml/min/1,73 m2mediante fórmula MDRD. Conclusiones: Se observó una relación entre la aparición de ECV y los valores de FG estimados por la fórmula MDRD al inicio del seguimiento superiores a 60 ml/min/1,73 m2, inversa a la eserada. La estimación del FG mediante fórmula de Cockcroft-Gault no se asoció con el riesgo cardiovascular (AU)

Background: Renal function decrease is associated with cardiovascular morbidity and mortality. The aim was to analyze the association of cardiovascular morbidity and mortality with baseline glomerular filtration rate (GFR), according Cockcroft-Gault and MDRD formulas, with incidence of major adverse cardiovascular events (MACEs) in a cohort of hypertensive individuals followed for 12 years. Methods: We performed a prospective study of a random sample of 223 hypertensive patients free of MACEs followed in an urban Primary Care Center. GFR was estimated using both formulas. MACEs were considered the onset of ischemic heart disease, heart failure, stroke, peripheral vascular disease or cardiovascular death. Data were analyzed using the life-table method and Cox regression modeling. Results: Follow-up median was 10.7 (interquartile range, 6.5-12.1) years. Follow-up was complete in 191 participants (85.7%). The cumulative survival was 64.7% (95%Confidence Interval (CI) 57.9%-71.6%). The incidence of MACEs during the follow-up period was 3.6 (95% CI, 2.7-4.4) per 100 subject-years. The final multivariable model showed that the most predictive variables of MACEs in the study population were the presence of diabetes and the estimation of GFR >60 ml/min/1.73 m2by MDRD equation. Conclusions: There was a relationship between the occurrence of MACEs and MDRD formula estimated GFR above60 ml/min/1.73 m2at study entry, inversely to what expected. C-G formula estimated GFR by was not associated with cardiovascular risk (AU)

[Decreased glomerular filtration rate using the Cockckroft-Gault and MDRD formulas does not always predict cardiovascular morbidity and mortality in hypertensive primary care patients]. / El filtrado glomerular reducido según las fórmulas de Cockcroft-Gault y MDRD no siempre predice la morbimortalidad cardiovascular en los pacientes hipertensos atendidos en atención primaria.

BACKGROUND: A decrease in renal function is associated with cardiovascular morbidity and mortality. The aim of this study was to analyse the association of cardiovascular morbidity and mortality with baseline glomerular filtration rate (GFR), calculated according to the Cockcroft-Gault and MDRD formulas, with the incidence of major adverse cardiovascular events (MACEs) in a cohort of hypertensive individuals followed for 12 years. METHOD: We performed a prospective study of a random sample of 223 hypertensive patients free of MACEs, who were followed in an urban Primary Care Centre. GFR was estimated using both formulas. MACEs were considered as the onset of ischaemic heart disease, heart failure, heart attacks, peripheral vascular disease or cardiovascular death. Data were analysed using the life-table method and Cox regression modeling. RESULTS: The median follow-up was 10.7 (interquartile range, 6.5-12.1) years. Follow-up was completed in 191 participants (85.7%). The cumulative survival was 64.7% (95% Confidence Interval (CI), 57.9-71.6). The incidence of MACEs during the follow-up period was 3.6 (95% CI, 2.7-4.4) per 100 subject-years. The final multivariable model showed that the most predictive variables of MACEs in the study population were the presence of diabetes mellitus and the estimation of GFR ≥60 ml/min/1.73 m2 by MDRD equation. CONCLUSIONS: There was a relationship between the occurrence of MACEs and an estimated GFR by MDRD above 60 ml/min/1.73 m2 at study entry, inversely to what was expected. GFR estimated by the C-G formula was not associated with cardiovascular risk.

[Diagnosis and monitoring of hypertension in Catalonia. The DISEHTAC study]. / Diagnóstico y seguimiento de la hipertensión arterial en Cataluña. Estudio DISEHTAC.

OBJECTIVES: To evaluate the diagnosis, monitoring and control of hypertension in reformed primary care centres in Catalonia, on the basis of the evaluation indicators proposed in the primary care hypertension guidelines. DESIGN: Multi-centre cross-sectional descriptive study.Setting. Primary care.Participants. 31 reformed PCC in Catalonia. Randomised sampling of centres and hypertense patients (n = 2240). External audit. MEASUREMENTS AND MAIN RESULTS: a) Diagnosis indicator: in 19.4% of cases a triple double-take of blood pressure showed an average of = 140/90 mmHg. b) Monitoring indicator: 77.9% of patients had been seen for blood pressure in the previous 6 months. c) Indicator of degree of control of blood pressure: 38.8% of patients had pressure below the figures then recommended ((3/4) 65 < 140/90 mmHg, and > 65, < 160/95 mmHg). 25.7% of cases were found to have blood pressure figures < 140/90 mmHg. CONCLUSIONS: There was high compliance on the monitoring indicator. The degree of control of hypertense patients treated at reformed PCCs is still low.