A sudden decrease in serum creatinine and estimated glomerular filtration rate: clinical implications of administrative gender assignment in transgender persons

Background The frequency of the initial short‐term decline in estimated glomerular filtration rate (eGFR), eGFR dip, following initiation of sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) and its clinical implications in real‐world practice are not clear. Methods and Results We built a cohort of 36 638 new users of SGLT2i and 209 025 new users of other antihyperglycemics. Inverse probability weighting was used to estimate the excess rate of eGFR dip, risk of the composite cardiovascular outcome of nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, or all‐cause mortality, and risk of the composite kidney outcome of eGFR decline >50%, end‐stage kidney disease, or all‐cause mortality. In the first 6 months of therapy, compared with other antihyperglycemics, excess rates of eGFR dip >10% and eGFR dip >30% were 9.86 (95% CI: 8.83–11.00) and 1.15 (0.70–1.62) per 100 SGLT2i users, respectively. In mediation analyses that accounted for eGFR dipping, SGLT2i use was associated with reduced risk of cardiovascular and kidney outcomes (hazard ratio, 0.92 [0.84–0.99] and 0.78 [0.71–0.87], respectively); the magnitude of the association reduced by eGFR dipping was small for both outcomes. SGLT2i was associated with reduced risk of both outcomes in those with higher than average probability of eGFR dip >10% or 30%. Compared with discontinuation, continued use of SGLT2i at 6 months was associated with reduced risk of cardiovascular and kidney outcomes in those with no eGFR dip or eGFR dip ≤10%, in those with eGFR dip >10%, and in those with eGFR dip >30%. Conclusions The salutary association of SGLT2i with cardiovascular and kidney outcomes was maintained regardless of eGFR dipping; concerns about eGFR dipping should not preclude use, and occurrence of eGFR dip after SGLT2i initiation may not warrant discontinuation.

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Cystatin C-based estimated glomerular filtration rate after percutaneous coronary intervention in the prediction of inhospital mortality in acute myocardial infarction

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4642 ◽

2021 ◽

Vol 26 (12) ◽

pp. 4642

Author(s):

K. V. Protasov ◽

O. S. Donirova ◽

E. V. Batunova

Keyword(s):

Myocardial Infarction ◽

Glomerular Filtration Rate ◽

Serum Creatinine ◽

Glomerular Filtration ◽

Cystatin C ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Coronary Intervention ◽

Inhospital Mortality ◽

Percutaneous Coronary

Aim. To assess the significance of changes cystatin C-based estimated glomerular filtration rate (eGFRcys) in predicting inhospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).Material and methods. In 133 patients with STEMI, serum creatinine and cystatin C were determined. Creatinine clearance (CrCl) was estimated according to Cockcroft-Gault equation. Creatinine-based estimated glomerular filtration rate (eGFRcr) was assessed using the MDRD (eGFRcr_MDRD) and CKD-EPI 2009 (eGFRcr_CKD-EPI). In addition, eGFRcys and a combination of serum creatinine and cystatin C (eGFRcr-cys) was assessed using the CKD-EPI 2012 equation at admission and 24-48 hours after PCI. In the groups of deceased patients and survivors, the studied parameters were compared. Their relationship with imhospital mortality was assessed by logistic regression adjusted for acute kidney injury (AKI) and GRACE risk. To assess the informativeness of identified independent predictors, an ROC analysis was performed.Results. After PCI, serum creatinine level increased by 9,8%, cystatin C — by 38,2%. CrCl decreased by 9,0%, eGFRcr_MDRD — by 10,2%, eGFRcr_CKD-EPI — by 5,2%, eGFRcys — by 29,5%, eGFRcr-cys — by 19,3%. AKI was diagnosed in 21 people (15,8%). Among the deceased patients (n=12), compared with the survivors, serum creatinine level was higher at baseline and after PCI, cystatin C — after PCI, eGFR of any calculation method was lower, while AKI developed more often. According to multivariate regression analysis, the eGFRcr-cys after PCI and the GRACE risk score were independent predictors of the endpoint. The area under the ROC curve for eGFRcr-cys after PCI was 0,835 [0,712-0,958], while the cut-off point was 38 ml/min/1,73 m2, below which the odds ratio of developing a fatal outcome was 22,2 with a 95% confidence interval of 5,7- 86,8.Conclusion. Estimated GFR determined 24-48 h after PCI based on the combination of serum creatinine and cystatin C using the CKD-EPI 2012 equation was an independent predictor of inhospital mortality in STEMI. The cut-off point of this parameter was 38 ml/min/1,73 m2, below which the death risk increases significantly. The results indicate the viability of introducing novel methods for assessing renal function based on cystatin C to improve the quality of prediction in STEMI.

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