Renal function in heart failure: a disparity between estimating function and predicting mortality risk

Abstract

AimsTo compare the predictive value of estimated renal function calculated by the Chronic Kidney Disease Epidemiology Collaboration (eGFR CKD-EPI ), four-variable Modification of Diet in Renal Disease (eGFR , and CockcroftGault [estimated creatinine clearance (eCcr)] equation in terms of all-cause mortality in heart failure. Renal function is an important prognostic factor in heart failure. Established methods of estimating renal function are known to under-/overestimate true function in certain settings. Methods and resultsA total of 800 systolic heart failure outpatients (mean age 57 + 11.5 years, 82% male) were studied over a median follow-up of 121 (Q1 -Q3: 110 -130) months. The highest systematic difference was seen between eCcr and eGFR [+12.33 points (mean), 95% limits of agreement -22.35 to 47.01; generalized kappa ¼ 0.36]. eGFR and eGFR CKD-EPI were the most similar [-4.16 points (mean), 95% limits of agreement -11.56 to 3.25; generalized kappa ¼ 0.74]. Up to 35.4% of patients were reclassified into different estimated glomerular filtration rate (eGFR) categories when comparing eGFR CKD-EPI with eCcr and eGFR . eGFR CKD-EPI performed marginally better in terms of predicting all-cause mortality than eGFR , as univariate areas under the time-dependent receiver operating characteristic curves (AUC), marginal and partial proportions of explained variation (PEV), net reclassification improvement (NRI), and the integrated discrimination improvement (IDI) for 5 years of follow-up were significantly higher for eGFR CKD-EPI than for eGFR . ConclusionIn this cohort of heart failure patients, eGFR CKD-EPI was marginally better in predicting all-cause mortality than eGFR . Estimated function differed widely between equations and is likely to have an effect on therapy choice.--

The renal arterial resistance index: a marker of renal function with an independent and incremental role in predicting heart failure progression

“…As a consequence, it is possible to hypothesize a clinical use for the RRI aimed at integrating with the information carried by the GFR. This is further supported by the fact that in our study we observed an incremental prognostic value of RRI independently from the formulas used for estimating GFR, that have recently been shown to have slight differences in predicting worse prognosis …”

Prognostic value of glomerular filtration rate estimation equations in acute heart failure with preserved versus reduced ejection fraction

“…Our findings are consistent with those of previous studies in outpatients with chronic heart failure . In contrast, other studies conducted in healthier and younger patient populations suggested a higher prevalence of RF using the MDRD‐4 formula compared with the CKD‐EPI formula . The influence of ageing on the prevalence of RF using different formulas of eGFR is reported in the ‘Nijmegen Biomedical Study’, which found that the CKD‐EPI formula provided lower values of eGFR than the MDRD formula in older subjects .…”

“…Earlier studies compared different formulas of eGFR as predictors of risk for adverse outcomes in stable chronic HF‐REF outpatients . Zamora et al.…”

Cardiac Mortality-Risk Assessment Improved by Evaluation of Hemoglobin Level in Combination with Kidney Function in the Patients with Systolic Heart Failure: A Cohort Study

“…The degree of agreement between the Cockcroft-Gault and MDRD equations for CRA syndrome was very good [24], most likely because the patients with CRA syndrome had substantially impaired renal function and both equations perform better at lower levels of kidney function [23].…”