scholarly journals P0807THE IMPACT OF GLOMERULAR FILTRATION RATE IN HEART FAILURE PATIENTS WITH CARDIAC IMPLANTABLE DEVICES - MYTH OR FACT?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Natacha Rodrigues ◽  
Afonso N Ferreira ◽  
Pedro António ◽  
Mafalda Carrington ◽  
João De Sousa ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Clinical Characteristics ◽  
Filtration Rate ◽  
Independent Predictor ◽  
Implantable Devices ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
The Impact

Abstract Background and Aims Heart Failure (HF) and chronic kidney disease (CKD) are both epidemic, frequently simultaneous and sharing well knowned risk factors. Implantable devices can improve quality of life and reduce mortality in a selected population. Data derived from meta-analyses show both survival benefit in CKD patients receiving devices and increased risk of death in device patients with CKD. Little is Known about the impact of glomerular filtration rate (GFR) across the different stages of CKD in the vital prognoses of HF patients submitted to cardiac resynchronization therapy (CRT) or implantable cardiac defibrillator (ICD) implants. To evaluate the impact of CKD in all-cause mortality in HF patients who implanted a CRT or ICD. Method Prospective single-center study of patients who implanted CRT or ICD between 2015 and 2019. Clinical characteristics were evaluated at baseline and mortality was assessed using the national registry. CKD was evaluated according to the GFR by CKD-EPI equation according to the KDIGO guidelines. We performed univariate and multivariate analysis to compare clinical characteristics of patients who died and who survived using the Cox regression and Kaplan-Meier methods. For the predictor GFR levels, and according to the KDIGO classification, we assessed the best cut-off value for mortality using the area under the ROC curve (AUC) method. Results From 2015-2019, 974 devices were implanted, 414 ICDs and 560 CRTs (23.3% female, 67.6±12.1, follow-up duration 26.4±16.5 months). A total of 161 patients (16.5%) died during follow-up. GFR at the time of device implant was significantly lower in patients who died compared to those who survived (49.7 vs 67.3ml/min/1.73m2, p<0.001). When evaluating predictors for all-cause mortality by multivariate analysis, GFR at the time of device implant was an independent predictor of mortality, even when adjusted for age, gender, arterial hypertension and diabetes (HR 1.12; 95% CI 1.04-1.16, p<0.001). The best GFR cut-off value to predict mortality with a 69% sensitivity and 65% specificity was 75ml/min/1.73m2 (AUC 0.70). Patients with a GFR < 75ml/min/1.73m2 at the time of implant have a 2.5-fold higher risk of death (HR 2.5; 95% CI 1.6-3.9, p<0.001). Risk of death significantly increases along GFR decline, almost doubling each stage, with 2.7 for stage 3a (p=0.2), 5.5 for stage 3b, 9.5 for stage 4 and 14.7-fold higher risk of death for stage 5 (p<0.001). Conclusion In our cohort of HF patients who underwent CRT or ICD implant, glomerular filtration rate was an independent predictor for all-cause mortality. Additionally, GFR<75ml/min/1.73m2 at the time of device implant increased by 2.5-fold the risk of death, the risk doubles for each CKD stage increase, reaching a dramatic 14.7- fold higher risk of death for stage 5 patients. CKD should not postpone device implant, as its deterioration significantly increases the risk of death.

scholarly journals Association of Lipoprotein(a)-Associated Mortality and the Estimated Glomerular Filtration Rate Level in Patients Undergoing Coronary Angiography: A 51,500 Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhidong Huang ◽  
Yanfang Yang ◽  
Jin Lu ◽  
Jingjing Liang ◽  
Yibo He ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Coronary Angiography ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Lipoprotein A ◽  
Adjusted Risk ◽  
Risk Of Death ◽  
Increased Risk ◽  
All Cause Mortality

Background: High lipoprotein(a) is associated with poor prognosis in patients at high risk for cardiovascular disease. Renal function based on the estimated glomerular filtration rate (eGFR) is a potential risk factor for the change of lipoprotein(a). However, the regulatory effect of eGFR stratification on lipoprotein(a)-associated mortality has not been adequately addressed.Methods: 51,500 patients who underwent coronary angiography (CAG) or percutaneous coronary intervention (PCI) were included from the Cardiorenal ImprovemeNt (CIN) study (ClinicalTrials.gov NCT04407936). These patients were grouped according to lipoprotein(a) quartiles (Q1–Q4) stratified by eGFR categories (<60 and ≥60 mL/min/1.73m2). Cox regression models were used to estimate hazard ratios (HR) for mortality across combined eGFR and lipoprotein(a) categories.Results: The mean age of the study population was 62.3 ± 10.6 years, 31.3% were female (n = 16,112). During a median follow-up of 5.0 years (interquartile range: 3.0–7.6 years), 13.0% (n = 6,695) of patients died. Compared with lipoprotein(a) Q1, lipoprotein(a) Q2–Q4 was associated with 10% increased adjusted risk of death in all patients (HR: 1.10 [95% CI: 1.03–1.17]), and was strongly associated with about 23% increased adjusted risk of death in patients with eGFR <60 mL/min/1.73m2 (HR: 1.23 [95% CI: 1.08–1.39]), while such association was not significant in patients with eGFR ≥60 mL/min/1.73m2 (HR: 1.05 [95% CI: 0.97–1.13]). P for interaction between lipoprotein(a) (Q1 vs. Q2–Q4) and eGFR (≥60 vs. eGFR <60 mL/min/1.73m2) on all-cause mortality was 0.019.Conclusions: Elevated lipoprotein(a) was associated with increased risk of all-cause mortality and such an association was modified by the baseline eGFR in CAG patients. More attention should be paid to the patients with reduced eGFR and elevated lipoprotein(a), and the appropriate lipoprotein(a) intervention is required.

scholarly journals Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults

2016 ◽  
Vol 26 (2) ◽  
pp. 213 ◽  
Author(s):  
Naomi Anker ◽  
Rebecca Scherzer ◽  
Carmen Peralta ◽  
Neil Powe ◽  
Tanushree Banjeree ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Racial Differences ◽  
Kidney Function ◽  
Filtration Rate ◽  
Department Of Veterans Affairs ◽  
Black And White ◽  
Risk Of Death ◽  
Mdrd Formula ◽  
The Impact

<p><strong>Objective</strong>: The aim of our study was to investigate whether current eGFR equations in clinical use might systematically overestimate the kidney function, and thus misclassify CKD status, of Black Americans with HIV. Specifically, we evaluated the impact of removing the race coefficient from the MDRD and CKD-EPI equations on comparisons between Black and White HIV-infected veterans related to: 1) the prevalence of reduced eGFR; 2) the distribution of eGFR values; and 3) the relationship between eGFR and all-cause mortality.</p><p><strong>Design:</strong> Retrospective cohort study.</p><p><strong>Setting:</strong> The Department of Veterans Affairs (VA) HIV Clinical Case Registry (CCR), which actively monitors all HIV-infected persons receiving care in the VA nationally.</p><p><strong>Patients/Participants:</strong> 21,905 treatmentnaïve HIV-infected veterans.</p><p><strong>Main Outcome Measures:</strong> Estimated glomerular filtration rate (eGFR) using the abbreviated Modification of Diet in Renal Disease (MDRD) formula with and without (MDRD-RCR) the race coefficient and allcause mortality.</p><p><strong>Results:</strong> Persons with eGFR &lt;45 mL/ min/1.73m2 had a higher risk of death compared with those with eGFR &gt;80 mL/ min/1.73m2 among both Blacks (HR=2.8, 95%CI: 2.4-3.3) and Whites (HR=1.9, 95%CI: 1.4-2.6), but the association appeared to be stronger in Blacks (P=.038, test for interaction). Blacks with eGFR 45- 60 mL/min/1.73m2 also had a higher risk of death (HR=1.7, 95%CI: 1.4-2.1) but Whites did not (HR=0.86, 95%CI: .67- 1.10; test for interaction: P&lt;.0001). Racial differences were substantially attenuated when eGFR was re-calculated without the race coefficient.</p><p><strong>Conclusions:</strong> Our findings suggest that clinicians may want to consider estimating glomerular filtration rate without the race coefficient in Blacks with HIV. <em>Ethn Dis.</em> 2016;26(2):213-220; doi:10.18865/ ed.26.2.213</p>

Estimated Glomerular Filtration Rate as a Predictor of Restenosis After Carotid Stenting Using First-Generation Stents

Angiology ◽  
2021 ◽  
pp. 000331972110146
Author(s):  
Altuğ Ösken ◽  
Evliya Akdeniz ◽  
Muhammed Keskin ◽  
Ahmet Öz ◽  
Göktürk Ipek ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
First Generation ◽  
Estimated Glomerular Filtration Rate ◽  
Final Analysis ◽  
Carotid Stenting ◽  
Stent Restenosis ◽  
The Impact

This study evaluated the impact of the baseline estimated glomerular filtration rate (eGFR) on clinical and angiographic outcomes and long-term in-stent restenosis (ISR) rates in patients undergoing elective carotid artery stenting (CAS) procedures. Consecutive patients who underwent CAS were retrospectively enrolled (n = 456). At the end of 3 years of follow-up, patients who had died or were lost follow-up were excluded from the study and a final analysis was performed using data from the remaining 405 patients. The study population (n = 405) was divided into 3 tertiles based on the tertile values of the eGFR level (T1, T2, and T3); then, clinical and procedural characteristics and 3-year ISR rates were compared between the groups. An ISR of 50% was detected in 49 (12%) surviving patients. The 3-year ISR was higher among patients with the lowest eGFR values (T1) by 3.7 times (95% CI: 2.01-11.38) than that among patients with the highest eGFR values (T3). These significant relationships persisted following adjustment for confounders. A lower baseline eGFR level was significantly associated with an increased ISR rate. Decreased renal function may be a predictor of ISR after CAS using first-generation stents.

scholarly journals Organ-Specific Monitoring of Solitary Kidney after Living Donation by Using Markers of Glomerular Filtration Rate and Urinary Proteins

2021 ◽  
pp. 1-7
Author(s):  
Gerit Theil ◽  
Karl Weigand ◽  
Kersten Fischer ◽  
Joanna Bialek ◽  
Paolo Fornara
Keyword(s):  
Molecular Weight ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Donor Nephrectomy ◽  
Kidney Donation ◽  
Low Molecular Weight ◽  
Tubular Damage ◽  
Urinary Proteins

<b><i>Background:</i></b> Effective follow-up after living kidney donation is important for maintaining the renal function of the donor. We investigated whether the estimated glomerular filtration rate (eGFR) and urinary protein and enzyme levels can provide important information regarding the state of the remaining kidney after donor nephrectomy. <b><i>Methods:</i></b> Seventy-five living donations were included (prospective/retrospective) in the study. The following parameters were measured up to 1 year after donor nephrectomy: serum creatinine and cystatin C as markers of the GFR; the high-molecular-weight urinary proteins as markers of glomerular injury; and the low-molecular-weight urinary proteins and urinary enzymes as markers of tubular function. <b><i>Results:</i></b> One year after kidney donation, the creatinine and cystatin C values were 1.38-fold increased than their initial values, while the eGFR was 32% lower. At that time, 38% of donors had a moderate or high risk of CKD progression. The biochemical urinary glomerular and tubular kidney markers examined showed different behaviors. After a transient increase, the glomerular proteins normalized. Conversely, the detection of low-molecular-weight urinary proteins and enzymes reflected mild tubular damage at the end of the study period. <b><i>Conclusions:</i></b> Our findings suggest that for the evaluation of mild tubular damage, low-molecular-weight marker proteins should be included in the urine diagnostic of a personalized living kidney donor follow-up.

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