Renal function in heart failure: a disparity between estimating function and predicting mortality risk. (July 2013)

• Record Type: Journal Article
• Authors: Plischke, Max; Neuhold, Stephanie; Kohl, Maria; Heinze, Georg; Sunder‐Plassmann, Gere; Pacher, Richard; Hülsmann, Martin
• Is Part Of: European journal of heart failure. Volume 15:Number 7(2013)
• Page Start: 763
• Page End: 770
• Publication Date: 2013-07
• Subjects: Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1093/eurjhf/hft022
• Languages: English
• ISSNs: 1388-9842

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ejhfhft022-sec-0001" sec-type="section"> <title>Aims</title> <p>To compare the predictive value of estimated renal function calculated by the Chronic Kidney Disease Epidemiology Collaboration (eGFR<sub>CKD‐EPI</sub>), four‐variable Modification of Diet in Renal Disease (eGFR<sub>MDRD‐4</sub>), and Cockcroft–Gault [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.</p> </sec> <sec id="ejhfhft022-sec-0002" sec-type="section"> <title>Methods and results</title> <p>A 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<sub>MDRD‐4</sub> [+12.33 points (mean), 95% limits of agreement –22.35 to 47.01; generalized kappa = 0.36]. eGFR<sub>MDRD‐4</sub> and eGFR<sub>CKD‐EPI</sub> were the most similar [–4.16 points (mean), 95% limits of agreement –11.56 to 3.25; generalized kappa = 0.74]. Up to 35.4% of patients were reclassified into different estimated glomerular filtration rate (eGFR) categories when comparing eGFR<sub>CKD‐EPI</sub> with eCcr and eGFR<sub>MDRD‐4</sub>. eGFR<sub>CKD‐EPI</sub> performed marginally better in terms of predicting all‐cause mortality than eGFR<sub>MDRD‐4</sub>, 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<sub>CKD‐EPI</sub> than for eGFR<sub>MDRD‐4</sub>.</p> </sec> <sec id="ejhfhft022-sec-0003" sec-type="section"> <title>Conclusion</title> <p>In this cohort of heart failure patients, eGFR<sub>CKD‐EPI</sub> was marginally better in predicting all‐cause mortality than eGFR<sub>MDRD‐4</sub>. Estimated function differed widely between equations and is likely to have an effect on therapy choice.</p> </sec> </abstract>