Abstract
Severe heart failure is highly associated with chronic kidney disease (CKD). Serum creatinine is a poor indicator of renal function and glomerular filtration rate (GFR) estimation is an accessible method for assessing renal function. The most popular formulas for GFR estimation are the Cockcroft-Gault (CG), the four-variable Simplified Modification of Diet in Renal Disease (sMDRD) and the recently introduced CKD-Epidemiology Collaboration (CKD-EPI). The objective of the study was to analyze the correlation between these three equations for estimating GFR in patients with severe heart failure. Cross-sectional observational study at a university reference center. GFR was estimated in patients with severe heart failure who were awaiting heart transplantation, using the CG, sMDRD and CKD-EPI formulas. These estimates were analyzed using Pearson's correlation and Bland-Altman analysis. This study included 157 patients, of whom 32 (20.3%) were female. Normal serum creatinine concentration was observed in 21.6%. The mean GFR according to CG, sMDRD and CKD-EPI was 70.1 ± 29.5, 70.7 ± 37.5 and 73.7 ± 30.1 ml/min/1.73 m²; P > 0.05. Pearson's coefficient demonstrated good correlations between all the formulas, as did Bland-Altman. However, the patients presented GFR < 60 ml/min more frequently with the sMDRD formula (54.1% versus 40.2% for CG and 43.2% for CKD-EPI; P = 0.02). Despite the good correlation and agreement between the three methods, the sMDRD formula classified more patients as presenting GFR less than 60 ml/min.
Highlights
Renal dysfunction is highly prevalent in patients with heart disease, mainly as a result of concomitant diabetes mellitus, hypertension or congestive heart failure.[1]
Serum creatinine is a poor indicator of renal function, and glomerular filtration rate (GFR) estimation is preferred in assessing renal function.[5]
The estimated GFR was obtained through three methods: (1) Simplified Modification of Diet in Renal Disease (sMDRD) equation: GFR = 186 x [cr] -1.154 x [age] -0.203 x [0.742 if patient was female]; (2) CG formula normalized to a body surface area of 1.73 m2, with creatinine clearance expressed in ml/min/1.73 m2: GFR = 1.23 x weight x [140-age]/plasma creatinine x 1.73/BSA; GFR = 1.03 x weight x [140age]/plasma creatinine x 1.73/BSA, where BSA (m2) = [weight x height/3600]; (3) chronic kidney disease (CKD)-EPI formula using the following equations: For women with creatinine < 0.7 mg/dl (62 mmol): GFR = 144 x-0.329 x (0.993) x age
Summary
Renal dysfunction is highly prevalent in patients with heart disease, mainly as a result of concomitant diabetes mellitus, hypertension or congestive heart failure.[1]. The most popular formulas include Cockcroft-Gault (CG) and the four-variable Simplified Modification of Diet in Renal Disease (sMDRD).[4,6,7] Over recent years, this simplified formula has been introduced into clinical practice, and it is currently considered to be the best available formula.[8] Generalization of these formulas to specific populations (e.g. heart failure or liver disease patients) is troublesome, mainly because of poor nutritional status, low muscle mass, edema and weight loss. There have been claims that it is as accurate as sMDRD for diagnosing cases of GFR less than 60 ml/min and that its performance among patients with GFR greater than 60 ml/min is better.[9] no study has compared the CKD-EPI, CG and sMDRD equations in a specific population with severe heart failure awaiting orthotopic heart transplantation
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Schedule a callMore From: Sao Paulo medical journal = Revista paulista de medicina
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