Clinical Research
Renal Function in Acute Coronary Syndrome
Cockcroft-Gault Versus Modification of Diet in Renal Disease: Importance of Glomerular Filtration Rate Formula for Classification of Chronic Kidney Disease in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes

https://doi.org/10.1016/j.jacc.2007.11.045Get rights and content
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Objectives

Our purpose was to compare formulae for estimating glomerular filtration rate (GFR) in non–ST-segment elevation acute coronary syndromes (NSTE ACS) patients.

Background

Assessment of GFR is important for antithrombotic dose adjustment in NSTE ACS patients.

Methods

We assessed estimated glomerular filtration rate (eGFR) with Cockcroft-Gault (C-G) and Modification of Diet in Renal Disease (MDRD) formulae in 46,942 NSTE ACS patients from 408 CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines) hospitals. Formula agreement was shown continuously and by chronic kidney disease (CKD) stages. We determined in-hospital outcomes and the association between antithrombotic dose adjustment and bleeding for moderate CKD as determined by each formula.

Results

The median (interquartile range [IQR]) eGFR was 53.2 ml/min (34.7, 75.1 ml/min) by C-G and 65.8 ml/min (47.6, 83.5 ml/min) by MDRD. The mean eGFR was higher with MDRD (∼9.1 ml/min), but this difference was greater in age, weight, and gender subgroups. Chronic kidney disease classification differed in 20% of the population and altered when antithrombotic dose adjustment was required by C-G versus MDRD (eptifibatide: 45.7% vs. 27.3%; enoxaparin: 19.0% vs. 9.6%).

Conclusions

Important CKD disagreements occur in ∼20% of acute coronary syndrome patients, affecting dosing adjustments in those already susceptible to bleeding. Dosing based on C-G formula is preferable, particularly in the small, female, or elderly patient.

Abbreviations and Acronyms

ACC/AHA
American College of Cardiology/American Heart Association
BMI
body mass index
CI
confidence interval
CKD
chronic kidney disease
C-G
Cockcroft-Gault
eGFR
estimated glomerular filtration rate
GFR
glomerular filtration rate
GP
glycoprotein
MDRD
Modification of Diet in Renal Disease
NSTE ACS
non–ST-segment elevation acute coronary syndromes
OR
odds ratio

Cited by (0)

The CRUSADE initiative is a National Quality Improvement Initiative of the Duke Clinical Research Institute. The CRUSADE initiative is funded by the Schering-Plough Corporation. The Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership provides additional funding support. Millennium Pharmaceuticals, Inc., funded part of this work. This work is also supported, in part, by a grant from the National Institute on Aging (R01 AG025312-01A1, PI Peterson). More information on CRUSADE can be found at http://www.crusadeqi.com.