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

Abstract BACKGROUND Correct estimation of renal function is crucial in assessing prognosis of patients with heart failure (HF). Recently, two new equations have been proposed to calculate estimated glomerular filtration rate (eGFR) with cystatin C alone or both creatinine and cystatin C. We assessed the prognostic value of eGFR estimated by these new equations in outpatients with HF. METHODS The study included 879 patients with median age, 70.4 years; main etiology of HF ischemic heart disease, 52.7%; and median LVEF, 34%. RESULTS eGFR estimates by the new equations correlated significantly with eGFR estimates from previous equations, with the best correlation observed between the 2 equations containing cystatin C [intraclass correlation coefficient 0.95 (95% confidence interval 0.94–0.95)]. During a median follow-up of 3.94 years, 371 patients died. The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equations containing cystatin C were found to be best for predicting death [area under the ROC curve 0.685 for CKD-EPI-cystatin C and 0.672 for CKD-EPI-creatinine-cystatin C vs 0.632 for simplified Modification of Diet in Renal Disease Study traceable to isotope dilution mass spectrometry and 0.643 for CKD-EPI (all P < 0.001)]. The CKD-EPI-cystatin C equations also showed significantly better calibration and reclassification measurements for both integrated discrimination improvement and net reclassification improvement in predicting death (P < 0.001). Reclassification with these new equations was particularly better in the subgroup with intermediate eGFR [45–74 mL · min−1 · (1.73 m2)−1]. CONCLUSIONS The two new CKD-EPI equations containing cystatin C are useful for HF risk stratification and show better prognostic performance than creatinine-only based eGFR equations, mostly in patients with intermediate eGFR. These equations seem appropriate for assessing prognosis of HF patients with moderate renal insufficiency.

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Renal profiling based on estimated glomerular filtration rate and spot urine sodium identifies high‐risk acute heart failure patients

European Journal of Heart Failure ◽

10.1002/ejhf.2053 ◽

2020 ◽

Author(s):

Jan Biegus ◽

Robert Zymliński ◽

Jeffrey Testani ◽

Dominik Marciniak ◽

Agata Zdanowicz ◽

...

Keyword(s):

Heart Failure ◽

Glomerular Filtration Rate ◽

High Risk ◽

Glomerular Filtration ◽

Acute Heart Failure ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Urine Sodium ◽

Spot Urine ◽

Heart Failure Patients

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Comparison of seven estimated glomerular filtration rate equations in kidney patients

Orvosi Hetilap ◽

10.1556/oh.2013.29571 ◽

2013 ◽

Vol 154 (11) ◽

pp. 415-425

Author(s):

Ferenc Kovács ◽

Enikő Sárváry ◽

Ádám Remport

Keyword(s):

Chronic Kidney Disease ◽

Glomerular Filtration Rate ◽

Kidney Disease ◽

Glomerular Filtration ◽

Cystatin C ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Chronic Kidney Disease Stage ◽

Disease Stage ◽

Rate Equations

Introduction: The degree of glomerular filtration rate determines the stages of chronic renal disease and, therefore, knowledge on its estimation is essential. Aims: Two standardized creatinine based estimated glomerular filtration rate equations and five equations based on the immunoturbidimetric determination of cystatin C were compared. Methods: The distribution of the analytes and the equations, their relations, as well as the differences among the estimated glomerular filtration rates and their chronic kidney disease stages assignments were studied. Results: The equations based on cystatin C classified more patient into stage 1, while the creatinine based ones more into stages 2, 3 and 4. The equations published as Grubb1, Grubb2 and Larsson classified more patients while the equations created by Tan and Sjöström classified fewer into stage 5 compared to the creatinine based equations. The equations of Grubb1 and Grubb2 resulted in the most similar stage assignment. The occurence of stages between 3 and 5 was the lowest using the equation of Sjöström. Conclusions: The different equations for the estimation of glomerular filtration rate modify significantly the chronic kidney disease stage assignment which may have an influence on the treatment and outcome measures of the patients. Orv. Hetil., 2013, 154, 415–425.

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Elevated admission urinary N-acetyl-β-D-glucosamidase level is associated with worse long-term clinical outcomes in patients with acute heart failure

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620901986 ◽

2020 ◽

Vol 9 (5) ◽

pp. 429-436 ◽

Cited By ~ 1

Author(s):

Sayaka Funabashi ◽

Kazunori Omote ◽

Toshiyuki Nagai ◽

Yasuyuki Honda ◽

Hiroki Nakano ◽

...

Keyword(s):

Heart Failure ◽

Glomerular Filtration Rate ◽

Adverse Events ◽

Glomerular Filtration ◽

Clinical Outcomes ◽

Acute Heart Failure ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Prognostic Significance ◽

Heart Failure Patients

Background: The prognostic significance of urinary N-acetyl-β-D-glucosamidase in acute heart failure has not been fully elucidated. Accordingly, this study investigated whether urinary N-acetyl-β-D-glucosamidase could be associated with subsequent adverse events in acute heart failure patients. Methods: We studied 708 consecutive acute heart failure patients who had accessible N-acetyl-β-D-glucosamidase data on admission from the National Cerebral and Cardiovascular Center Acute Decompensated Heart Failure registry. We assessed the relationship between the admission N-acetyl-β-D-glucosamidase level and the combined endpoint of all-cause death and worsening heart failure. Worsening heart failure was defined as worsening symptoms and signs of heart failure requiring intensification of intravenous therapy such as diuretics, vasodilators and inotropes or initiation of mechanical support after stabilisation with initial treatment during hospitalisation, or readmission due to heart failure after discharge. Results: During a median follow-up period of 763 (interquartile range 431–1028) days, higher urinary N-acetyl-β-D-glucosamidase was significantly related to increased events of all-cause death and worsening heart failure. In addition, patients with higher urinary N-acetyl-β-D-glucosamidase and lower estimated glomerular filtration rate on admission had the worst clinical outcomes. In multivariable Cox regression, urinary N-acetyl-β-D-glucosamidase on admission was independently associated with adverse events (hazard ratio 1.19, 95% confidence interval 1.04–1.35) even after adjustment by covariates including the baseline estimated glomerular filtration rate. Conclusions: Higher urinary N-acetyl-β-D-glucosamidase level on admission was independently associated with worse clinical outcomes. Our findings indicate the potential value of assessing urinary N-acetyl-β-D-glucosamidase on admission for further risk stratification in patients with acute heart failure.

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