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Zhang B, Liang H, Yu Z, Wei FF, Wu Y. Clinical Implications of Estimating Glomerular Filtration Rate with Different Equations in Heart Failure Patients with Preserved Ejection Fraction. High Blood Press Cardiovasc Prev 2024; 31:205-213. [PMID: 38584212 DOI: 10.1007/s40292-024-00631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/03/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION The prognostic values of estimated glomerular filtration rate (eGFR) calculated by different formulas have not been adequately compared in patients with heart failure with preserved ejection fraction (HFpEF). AIM We compared the predictive values of serum creatinine-based eGFRs calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 equation, Modification of Diet in Renal Disease Study (MDRD) formula, and full-age-spectrum creatinine (FAS Cr) equation in 1751 HFpEF patients. METHODS The area under the receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were employed. RESULTS eGFR values were lowest calculated with FAS Cr equation (p < 0.001). When patients were classified into 4 subgroups (eGFR ≥ 90, 89-60, 59-30, and < 30 ml/min/1.73 m2) or only 2 subgroups (≥ 60 or < 60 ml/min/1.73 m2), the 3 formulas correlated significantly, with the best correlation found between the MDRD and CKD-EPI formulas (kappa = 0.871 and 0.963, respectively). The 3 formulas conveyed independent prognostic information. After adjusting for potential cofounders, risk prediction for all-cause mortality was more accurate (p = 0.001) using the CKD-EPI equation than MDRD formula as assessed by AUC. Compared with MDRD formula, CKD-EPI equation exhibited superior predictive ability assessed by IDI and NRI of 0.32% (p < 0.001)/10.4% (p = 0.010) for primary endpoint and 0.37% (p = 0.010)/10.8% (p = 0.010) for HF hospitalization. The risk prediction for deterioration of renal function was more accurate (p ≤ 0.040) using the CKD-EPI equation than FAS Cr equation as assessed by AUC, IDI, and NRI. CONCLUSION The CKD-EPI formula might be the preferred creatinine-based equation in clinical risk stratification in HFpEF patients.
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Affiliation(s)
- Baole Zhang
- Centre for Research and Development, Hybio Pharmaceutical Co., Ltd., Shenzhen, Guangdong, China
| | - Huiling Liang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhongping Yu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Fang-Fei Wei
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.
| | - Yuzhong Wu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.
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Scicchitano P, Iacoviello M, Passantino A, Guida P, De Palo M, Piscopo A, Gesualdo M, Caldarola P, Massari F. The Prognostic Impact of Estimated Creatinine Clearance by Bioelectrical Impedance Analysis in Heart Failure: Comparison of Different eGFR Formulas. Biomedicines 2021; 9:1307. [PMID: 34680423 PMCID: PMC8533548 DOI: 10.3390/biomedicines9101307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 01/11/2023] Open
Abstract
The estimation of glomerular filtration rate (eGFR) provides prognostic information in patients with heart failure (HF). Bioelectrical impedance analysis may calculate eGFR (Donadio formula). The aim of this study was to evaluate the impact of the Donadio formula in predicting all-cause mortality in patients with HF as compared to Cockroft-Gault, MDRD-4 (Modification of Diet in renal Disease Study), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. Four-hundred thirty-six subjects with HF (52% men; mean age 75 ± 11 years; 42% acute HF) were enrolled. Ninety-two patients (21%) died during the follow-up (median 463 days, IQR 287-669). The area under the receiver operator characteristic curve for eGFR, as estimated by Cockroft-Gault formula (AUC = 0.75), was significantly higher than those derived from Donadio (AUC = 0.72), MDRD-4 (AUC = 0.68), and CKD-EPI (AUC = 0.71) formulas. At multivariate analysis, all eGFR formulas were independent predictors of death; 1 mL/min/1.73 m2 increase in eGFR-as measured by Cockroft-Gault, Donadio, MDRD-4, and CKD-EPI formulas-provided a 2.6%, 1.5%, 1.2%, and 1.6% increase, respectively, in mortality rate. Conclusions. eGFR, as calculated with the Donadio formula, was an independent predictor of mortality in patients with HF as well as the measurements derived from MDRD4 and CKD-EPI formulas, but less accurate than Cockroft-Gault.
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Affiliation(s)
- Pietro Scicchitano
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, Italy; (A.P.); (M.G.); (F.M.)
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Science, University of Foggia, 71122 Foggia, Italy;
| | - Andrea Passantino
- Division of Cardiology and Cardiac Rehabilitation, Scientific Clinical Institutes Maugeri, IRCCS Institute of Bari, 70124 Bari, Italy;
| | - Piero Guida
- Regional General Hospital “F. Miulli”, 70021 Acquaviva delle Fonti, Italy;
| | - Micaela De Palo
- Cardiac Surgery Section, Policlinico University Hospital, 70124 Bari, Italy;
| | - Assunta Piscopo
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, Italy; (A.P.); (M.G.); (F.M.)
| | - Michele Gesualdo
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, Italy; (A.P.); (M.G.); (F.M.)
| | | | - Francesco Massari
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, Italy; (A.P.); (M.G.); (F.M.)
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Llauger L, Jacob J, Miró Ò. Renal function and acute heart failure outcome. Med Clin (Barc) 2018; 151:281-290. [PMID: 29884452 DOI: 10.1016/j.medcli.2018.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/28/2018] [Accepted: 05/01/2018] [Indexed: 12/18/2022]
Abstract
The interaction between acute heart failure (AHF) and renal dysfunction is complex. Several studies have evaluated the prognostic value of this syndrome. The aim of this systematic review, which includes non-selected samples, was to investigate the impact of different renal function variables on the AHF prognosis. The categories included in the studies reviewed included: creatinine, blood urea nitrogen (BUN), the BUN/creatinine quotient, chronic kidney disease, the formula to estimate the glomerular filtration rate, criteria of acute renal injury and new biomarkers of renal damage such as neutrophil gelatinase-associated lipocalin (NGAL and cystatin c). The basal alterations of the renal function, as well as the acute alterations, transient or not, are related to a worse prognosis in AHF, it is therefore necessary to always have baseline, acute and evolutive renal function parameters.
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Affiliation(s)
- Lluís Llauger
- Servicio de Urgencias, Hospital Universitari de Vic, Vic (Barcelona), España.
| | - Javier Jacob
- Servicio de Urgencias, Hospital Clínic de Barcelona, Barcelona, España
| | - Òscar Miró
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
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Josa-Laorden C, Sola A, Giménez-López I, Rubio-Gracia J, Garcés-Horna V, Pérez-Calvo J. Valor pronóstico de la ratio urea / creatinina en la insuficiencia cardiaca descompensada y su relación con el daño renal agudo. Rev Clin Esp 2018; 218:232-240. [DOI: 10.1016/j.rce.2018.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/01/2018] [Accepted: 03/14/2018] [Indexed: 12/28/2022]
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Josa-Laorden C, Sola A, Giménez-López I, Rubio-Gracia J, Garcés-Horna V, Pérez-Calvo J. Prognostic value of the urea:creatinine ratio in decompensated heart failure and its relationship with acute kidney damage. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.rceng.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Formiga F, Moreno-Gonzalez R, Chivite D, Casado J, Escrihuela-Vidal F, Corbella X. Clinical characteristics and one-year mortality according to admission renal function in patients with a first acute heart failure hospitalization. Rev Port Cardiol 2018; 37:159-165. [PMID: 29501214 DOI: 10.1016/j.repc.2017.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Chronic kidney disease is related to poor outcomes in patients with heart failure (HF). Few studies have assessed whether renal function influences one-year mortality risk in patients admitted for the first time for acute HF. METHODS We reviewed the medical records of all patients aged >50 years admitted within a two-year period for a first episode of decompensated HF. The sample was divided according to the patients' estimated glomerular filtration rate (eGFR) on admission into three groups (eGFR >60, 30-60 and <30 ml/min/1.73 m2). Index admission and one-year all-cause mortality rates were compared between groups using Cox regression analysis. RESULTS A total of 985 patients were included in the study, mean age 78.4±9 years, and with mean admission eGFR of 60.5±26 ml/min/1.73 m2. Of these, 516 (52.3%) patients had eGFR <60 ml/min/1.73 m2. One-year all-cause mortality was 25.4%, with a significant association between worse eGFR category and mortality (p<0.0001). Cox regression analysis assessing eGFR as a categorical variable confirmed this association (HR 1.378; p=0.030), together with older age (HR 1.066; p<0.001), previous diagnosis of hypertension (HR 0.527; p<0.001), and both lower systolic blood pressure (HR 0.993; p=0.009) and higher serum potassium on admission (HR 1.471; p <0.001). CONCLUSIONS Renal impairment is common in HF patients, even at the time of first admission. In this group of HF patients the presence of renal impairment was associated with higher mid-term (one-year) mortality risk.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital, Barcelona, Spain.
| | - Rafael Moreno-Gonzalez
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital, Barcelona, Spain
| | - David Chivite
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital, Barcelona, Spain
| | - Jesús Casado
- Internal Medicine Department, Getafe University Hospital, Madrid, Spain
| | | | - Xavier Corbella
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital, Barcelona, Spain; Hestia Chair in Integrated Health and Social Care, Faculty of Medicine and Health Sciences, Catalunya International University, Barcelona, Spain
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Clinical characteristics and one-year mortality according to admission renal function in patients with a first acute heart failure hospitalization. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Givens RC, Topkara VK. Renal risk stratification in left ventricular assist device therapy. Expert Rev Med Devices 2017; 15:27-33. [DOI: 10.1080/17434440.2018.1418663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Raymond C. Givens
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Veli K. Topkara
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
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Renal function assessment in heart failure. Rev Clin Esp 2017; 217:267-288. [PMID: 28258719 DOI: 10.1016/j.rce.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/17/2016] [Accepted: 01/14/2017] [Indexed: 11/23/2022]
Abstract
Renal function is one of the most consistent prognostic determinants in heart failure. The prognostic information it provides is independent of the ejection fraction and functional status. This article reviews the various renal function assessment measures, with special emphasis on the fact that the patient's clinical situation and response to the heart failure treatment should be considered for the correct interpretation of the results. Finally, we review the literature on the performance of tubular damage biomarkers.
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Farmakis D, Koeck T, Mullen W, Parissis J, Gogas BD, Nikolaou M, Lekakis J, Mischak H, Filippatos G. Urine proteome analysis in heart failure with reduced ejection fraction complicated by chronic kidney disease: feasibility, and clinical and pathogenetic correlates. Eur J Heart Fail 2016; 18:822-9. [DOI: 10.1002/ejhf.544] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/12/2016] [Accepted: 03/12/2016] [Indexed: 12/27/2022] Open
Affiliation(s)
- Dimitrios Farmakis
- Heart Failure Unit, Department of Cardiology; Athens University Hospital Attikon; Athens Greece
| | - Thomas Koeck
- Mosaiques Diagnostics and Therapeutics AG; Hanover Germany
| | - William Mullen
- BHF Glasgow Cardiovascular Research Centre; University of Glasgow; Glasgow UK
| | - John Parissis
- Heart Failure Unit, Department of Cardiology; Athens University Hospital Attikon; Athens Greece
| | - Bill D. Gogas
- Heart Failure Unit, Department of Cardiology; Athens University Hospital Attikon; Athens Greece
| | - Maria Nikolaou
- Heart Failure Unit, Department of Cardiology; Athens University Hospital Attikon; Athens Greece
| | - John Lekakis
- Heart Failure Unit, Department of Cardiology; Athens University Hospital Attikon; Athens Greece
| | - Harald Mischak
- Mosaiques Diagnostics and Therapeutics AG; Hanover Germany
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology; Athens University Hospital Attikon; Athens Greece
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