Clinical Implications of Estimating Glomerular Filtration Rate with Different Equations in Heart Failure Patients with Preserved Ejection Fraction.

IF 3.1 Q2 PERIPHERAL VASCULAR DISEASE

High Blood Pressure & Cardiovascular Prevention Pub Date : 2024-03-01 Epub Date: 2024-04-08 DOI:10.1007/s40292-024-00631-7

Baole Zhang, Huiling Liang, Zhongping Yu, Fang-Fei Wei, Yuzhong Wu

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引用次数: 0

Abstract

Introduction: The prognostic values of estimated glomerular filtration rate (eGFR) calculated by different formulas have not been adequately compared in patients with heart failure with preserved ejection fraction (HFpEF).

Aim: We compared the predictive values of serum creatinine-based eGFRs calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 equation, Modification of Diet in Renal Disease Study (MDRD) formula, and full-age-spectrum creatinine (FAS Cr) equation in 1751 HFpEF patients.

Methods: The area under the receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were employed.

Results: eGFR values were lowest calculated with FAS Cr equation (p < 0.001). When patients were classified into 4 subgroups (eGFR ≥ 90, 89-60, 59-30, and < 30 ml/min/1.73 m²) or only 2 subgroups (≥ 60 or < 60 ml/min/1.73 m²), the 3 formulas correlated significantly, with the best correlation found between the MDRD and CKD-EPI formulas (kappa = 0.871 and 0.963, respectively). The 3 formulas conveyed independent prognostic information. After adjusting for potential cofounders, risk prediction for all-cause mortality was more accurate (p = 0.001) using the CKD-EPI equation than MDRD formula as assessed by AUC. Compared with MDRD formula, CKD-EPI equation exhibited superior predictive ability assessed by IDI and NRI of 0.32% (p < 0.001)/10.4% (p = 0.010) for primary endpoint and 0.37% (p = 0.010)/10.8% (p = 0.010) for HF hospitalization. The risk prediction for deterioration of renal function was more accurate (p ≤ 0.040) using the CKD-EPI equation than FAS Cr equation as assessed by AUC, IDI, and NRI.

Conclusion: The CKD-EPI formula might be the preferred creatinine-based equation in clinical risk stratification in HFpEF patients.

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用不同公式估算射血分数保留的心衰患者肾小球滤过率的临床意义

导言：在射血分数保留型心力衰竭（HFpEF）患者中，不同公式计算的估计肾小球滤过率（eGFR）的预后价值尚未得到充分比较。目的：在 1751 例 HFpEF 患者中，我们比较了基于血清肌酐的 eGFR 的预测值，计算方法包括慢性肾脏病流行病学协作组织（CKD-EPI）2009 方程、肾病饮食改良研究（MDRD）公式和全年龄段肌酐（FAS Cr）公式：结果：用 FAS Cr 方程计算的 eGFR 值最低（p 2），或仅计算 2 个亚组（≥ 60 或 2），3 个公式有显著相关性，其中 MDRD 公式和 CKD-EPI 公式的相关性最好（kappa = 0.871 和 0.963）。这三个公式传达了独立的预后信息。根据 AUC 评估，在调整潜在的共因子后，使用 CKD-EPI 公式预测全因死亡率的风险比使用 MDRD 公式更准确（p = 0.001）。与 MDRD 公式相比，CKD-EPI 公式在 IDI 和 NRI 的评估中显示出更高的预测能力，达 0.32%（p 结论：CKD-EPI 公式的预测能力比 MDRD 公式高：CKD-EPI公式可能是基于肌酐的高危血友病患者临床风险分层公式的首选。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

High Blood Pressure & Cardiovascular Prevention PERIPHERAL VASCULAR DISEASE-

CiteScore

5.70

自引率

3.30%

发文量

期刊介绍： High Blood Pressure & Cardiovascular Prevention promotes knowledge, update and discussion in the field of hypertension and cardiovascular disease prevention, by providing a regular programme of independent review articles covering key aspects of the management of hypertension and cardiovascular diseases. The journal includes: Invited ''State of the Art'' reviews. Expert commentaries on guidelines, major trials, technical advances.Presentation of new intervention trials design.''Pros and Cons'' or round tables on controversial issues.Statements on guidelines from hypertension and cardiovascular scientific societies.Socio-economic issues.Cost/benefit in prevention of cardiovascular diseases.Monitoring of healthcare systems.News and views from the Italian Society of Hypertension (including abstracts).All manuscripts are subject to peer review by international experts. Letters to the editor are welcomed and will be considered for publication.