Overestimation of glomerular filtration rate by creatinine‐based equation in heart failure patients is predicted by a novel scoring system

Ishigo, Tomoyuki; Katano, Satoshi; Yano, Toshiyuki; Kouzu, Hidemichi; Ohori, Katsuhiko; Nakata, Hiromasa; Nonoyama, Masatoshi; Inoue, Takuya; Takamura, Yuhei; Nagaoka, Ryohei; Kondo, Fuki; Nakano, Kazushi; Takada, Ryo; Kitagawa, M.; Kimyo, Tomoko; Miura, Tetsuji

doi:10.1111/ggi.13959

Cited by 14 publications

(21 citation statements)

References 28 publications

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“…[ 25 , 26 ] However, eGFRcr has been shown to overestimate the GFR in heart failure when it is compared with the other 2 equations. [ 27 ] Therefore, changes in serum creatinine are more suitable for defining and staging AKI in AHF patients. Applying admission creatinine to estimate GFR in AHF could misinterpret the renal function and prognostic value.…”

Section: Discussionmentioning

confidence: 99%

Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality stratification in acute heart failure

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality stratification in acute heart failure

et al. 2020

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“…eGFR was calculated using equations developed for Japanese subjects as follows: eGFRcre (mL/min/1.73 m 2 ) = 194 × Scr −1.094 × age −0.287 (×0.739 if female). 21 CKD was defined as eGFRcre of less than 60 mL/min/1.73 m 2 .…”

Section: Methodsmentioning

confidence: 99%

Plasma amino acid profiling improves predictive accuracy of adverse events in patients with heart failure

et al. 2021

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AimsThe clinical outcome of heart failure (HF) is complicated by the presence of multiple comorbidities including malnutrition and cachexia, and prediction of the outcome is still difficult in each patient. Metabolomics including amino acid profiling enables detection of alterations in whole body metabolism. The aim of this study was to determine whether plasma amino acid profiling improves prediction of clinical outcomes in patients with HF. Methods and resultsWe retrospectively examined 301 HF patients (70 ± 15 years old; 59% male). Blood samples for measurements of amino acid concentrations were collected in a fasting state after stabilization of HF. Plasma amino acid concentrations were measured using ultraperformance liquid chromatography. Clinical endpoint of this study was adverse event defined as all-cause death and unscheduled readmission due to worsening HF or lethal arrhythmia. During a mean follow-up period of 380 ± 214 days, 40 patients (13%) had adverse events. Results of analyses of variable importance in projection score, a measure of a variable's importance in partial least squares-discriminant analysis (PLS-DA) showed that the top five amino acids being associated with adverse events were 3-methylhistidine (3-Me-His), β-alanine, valine, hydroxyproline, and tryptophan. Multivariate Cox-proportional hazard analyses indicated that a high 3-Me-His concentration and low β-alanine and valine concentrations were independently associated with adverse events. When HF patients were divided according to the cut-off values of amino acids calculated from receiver operating characteristic curves, Kaplan-Meier survival curves showed that event-free survival rates were lower in HF patients with high 3-Me-His than in HF patients with low 3-Me-His (68% vs. 91%, P < 0.01). In a subgroup with high 3-Me-His, HF patients with low β-alanine and those with low valine had significantly lower event-free survival rates than did HF patients with high β-alanine and those with high valine, respectively. On the other hand, Kaplan-Meier curves of event-free survival rates did not differ between HF patients with and those without low β-alanine and low valine in subgroups of patients with low 3-Me-His. Inclusion of both high 3-Me-His and low β-alanine or low valine into the adjustment model including N-terminal pro-brain natriuretic peptide improved the accuracy of prediction of adverse events after discharge. 3-Me-His concentration was associated with muscle mass and nutritional status. Conclusions Simple measurement of 3-Me-His with either β-alanine or valine improved the predictive ability for adverse events, indicating the utility of plasma amino acid profiling in risk stratification of hospitalized HF patients.

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“…The glomerular filtration rate (GFR), which is the rate of clearance of a substance from blood into urine, is the most acceptable indicator of the glomerular function ( 3 , 4 ). Serum creatinine (Scr), a product of creatine phosphate from muscle, and serum cystatin C, an endogenous protease inhibitor derived from all nucleated cells, are currently used for the GFR measurement, since both substances are considered good indicators of the GFR, as they are freely filtered at the glomerulus, and not reabsorbed by the renal tubule, although slight secretion of Scr by the renal tubule occurs ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…At present, the creatinine-based estimated glomerular filtration rate (eGFRcre) is the most widely used indicator for the estimation of the renal function in a daily clinical setting ( 3 , 4 ). However, the eGFRcre in elderly people and lean patients is frequently higher than the cystatin C-based estimated glomerular filtration rate (eGFRcys), since the plasma appearance of creatinine is reduced in people with a reduced muscle mass ( 3 - 8 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, the eGFRcre in elderly people and lean patients is frequently higher than the cystatin C-based estimated glomerular filtration rate (eGFRcys), since the plasma appearance of creatinine is reduced in people with a reduced muscle mass ( 3 - 8 ). Since the measurement of cystatin C is more costly than that of Scr, it is not commonly included in routine examinations ( 4 , 9 ). Therefore, a tool for identifying patients whose eGFR needs to be measured using cystatin C is likely to be useful in daily clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Utility of a Score for Predicting Glomerular Filtration Rate Overestimation in Patients with Cardiovascular and Renal Diseases and Their Risk Factors

et al. 2022

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Objective We recently reported a novel score for the detection of glomerular filtration rate (GFR) overestimation using a creatinine-based equation. We examined the utility of this score in patients with cardiovascular/renal diseases and diabetes mellitus. Methods We enrolled 1,425 patients (65±15 years old; 37% women) who were admitted to our hospital for the management of cardiovascular and renal diseases and their risk factors. Overestimation of the GFR (OE) was defined as a creatinine-based GFR (eGFRcre) ≥120% of the cystatin C-based estimated GFR. The OE score was calculated as the sum of the scores for the body weight, hemoglobin concentration, and blood urea nitrogen (BUN)/serum creatinine (Scr), totaling 1 point if the body weight was <63.0 kg in men or <42.0 kg in women, 1 point if the hemoglobin concentration was <12.4 g/dL in men or <11.0 g/dL in women, and 1 point if the BUN/Scr was >26.5. Results The proportion of patients with OE was 14.2%. The score predicted OE with a sensitivity of 70.8% and a specificity of 99.6%, and the sensitivity was increased in patients ≥75 years old (88.3%) and decreased in diabetics (58.6%). When patients were divided into subgroups by the total score, the frequencies of OE were 8% (59/754), 14% (72/502), 38% (58/151), and 72% (13/18) in patients with scores of 0, 1, 2, and 3, respectively. Conclusion The OE score is useful for detecting elderly cases of cardiovascular and renal diseases in which eGFRcre overestimates the GFR, although its utility is limited in diabetics.

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Overestimation of glomerular filtration rate by creatinine‐based equation in heart failure patients is predicted by a novel scoring system

Cited by 14 publications

References 28 publications

Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality stratification in acute heart failure

Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality stratification in acute heart failure

Plasma amino acid profiling improves predictive accuracy of adverse events in patients with heart failure

Utility of a Score for Predicting Glomerular Filtration Rate Overestimation in Patients with Cardiovascular and Renal Diseases and Their Risk Factors

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