Drawbacks and Prognostic Value of Formulas Estimating Renal Function in Patients With Chronic Heart Failure and Systolic Dysfunction

Abstract

Background-Renal function is an important risk marker for morbidity and mortality in chronic heart failure (CHF) and is often estimated with the use of creatinine-based formulas. However, these formulas have never been validated in a wide range of CHF patients. We validated 3 commonly used formulas estimating glomerular filtration rate (GFR) with true GFR in CHF patients. Furthermore, we compared the prognostic value of these formulas for cardiovascular outcome with that of true GFR during 12 months of follow-up. Methods and Results-In 110 CHF patients (age, 57Ϯ11.7 years; left ventricular ejection fraction, 0.27Ϯ0.09; NYHA class, 2.5Ϯ0.9), we measured 125 I-iothalamate clearance. Cockcroft-Gault (GFR cg ), Modification of Diet in Renal Disease (MDRD), and simplified MDRD (sMDRD) equations were used as creatinine-based renal function estimations. Furthermore, 24-hour creatinine clearance (CrCl) was determined. CrCl and GFR cg were the most accurate. MDRD was most precise formula, although it was also highly biased. All formulas overestimated in the lower ranges and underestimated in the upper ranges of the GFR corrected for body surface area. The predictive performance of the formulas was best in severe CHF (NYHA classes III and IV). The prognostic value of CrCl and MDRD for cardiovascular outcome was comparable to that of GFR, the sMDRD was slightly less, and the GFR cg had a significantly worse prognostic value. Conclusions-In the more severe ranges of CHF, creatinine-based formulas and CrCl corrected for body surface area appeared to be more precise and accurate in estimating true GFR corrected for body surface area. The MDRD formula is the most precise and has a good prognostic value, whereas the sMDRD is slightly less accurate but uses fewer parameters, which makes this formula a practical alternative in clinical practice.

Prognostic impact of NT‐proBNP and renal function in comparison to contemporary multi‐marker risk scores in heart failure patients

“…However, serum creatinine only roughly reflects renal function [34]. We therefore analysed GFR estimated by the MDRD formula which has been shown to be the most precise estimation of GFR in heart failure patients and concurrently is clinically feasible [35]. In our population GFR was significantly predictive for event-free survival whereas serum creatinine showed only borderline significance (HR 1.2 95% CI 1.01-1.4 per increase of 1 SD of creatinine, p = 0.039).…”

Galectin-3 in Patients with Acute Heart Failure: Preliminary Report on First Polish Experience

“…LDL-cholesterol was estimated by the Friedewald formula unless triglyceride levels were > 300 mg/dL, in which case direct LDL-cholesterol determinations were performed. The estimated glomerular filtration rate (eGFR), as an indicator of renal function, was estimated from serum creatinine using a formula that accounts for the influence of age on creatinine production, which has been validated in patients with HF, and was described in detail elsewhere (MDRD) [17]. The concentrations of high sensitivity C-reactive protein (hsCRP) and N-terminal pro-brain natriuretic peptide (NT-proB -NP) in the serum were measured using a Flex ® Reagent Cartridge and Dimension ® EXL TM integrated chemistry system with a LOCI ® Module (Siemens HealthCare Diagnostics Ltd., Camberley, UK).…”

Natriuretic Peptides in Chronic Kidney Disease

“…Compared with other formulas, however, MDRD provides the most precise estimate of true renal function, especially in the lower GFR ranges, and is hence the most reliable in clinical practice (46). Indeed, a good correlation in patients with GFR Ͻ60 ml/min has been recently reported in a large, diverse population (47).…”