The Prognostic Impact of Estimated Creatinine Clearance by Bioelectrical Impedance Analysis in Heart Failure: Comparison of Different eGFR Formulas.

Pietro Scicchitano,Massimo Iacoviello,Andrea Passantino,Assunta Piscopo,Michele Gesualdo,Micaela De Palo,Pasquale Caldarola,Francesco Massari,Piero Guida

doi:10.3390/biomedicines9101307

Abstract

The estimation of glomerular filtration rate (eGFR) provides prognostic information in patients with heart failure (HF). Bioelectrical impedance analysis may calculate eGFR (Donadio formula). The aim of this study was to evaluate the impact of the Donadio formula in predicting all-cause mortality in patients with HF as compared to Cockroft-Gault, MDRD-4 (Modification of Diet in renal Disease Study), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. Four-hundred thirty-six subjects with HF (52% men; mean age 75 ± 11 years; 42% acute HF) were enrolled. Ninety-two patients (21%) died during the follow-up (median 463 days, IQR 287–669). The area under the receiver operator characteristic curve for eGFR, as estimated by Cockroft-Gault formula (AUC = 0.75), was significantly higher than those derived from Donadio (AUC = 0.72), MDRD-4 (AUC = 0.68), and CKD-EPI (AUC = 0.71) formulas. At multivariate analysis, all eGFR formulas were independent predictors of death; 1 mL/min/1.73 m2 increase in eGFR—as measured by Cockroft-Gault, Donadio, MDRD-4, and CKD-EPI formulas—provided a 2.6%, 1.5%, 1.2%, and 1.6% increase, respectively, in mortality rate. Conclusions. eGFR, as calculated with the Donadio formula, was an independent predictor of mortality in patients with HF as well as the measurements derived from MDRD4 and CKD-EPI formulas, but less accurate than Cockroft-Gault.

Highlights

The assessment of glomerular filtration rate (GFR) is mandatory in the management of patients with heart failure (HF)
The aims of this study were to evaluate the prognostic value of estimation of glomerular filtration rate (eGFR) as assessed by the Donadio formula, and to compare it to Cockroft-Gault, MDRD-4, and CKD-EPI
Our study mainly demonstrated that four formulas—namely Donadio formula, CG, MDRD-4, and CKD-EPI—were able to assess the risk of all-cause mortality in HF patients

Summary

Introduction

The assessment of glomerular filtration rate (GFR) is mandatory in the management of patients with heart failure (HF). About 23% of patients with HF show worsening renal function (WRF) as a consequence of the impairment in kidney perfusion, pharmacological treatments, and neuro-hormonal activation [1,2,3]. The literature has reported prevalence in WRF in acute decompensated HF patients ranging from 25% to 40% [4]. The worsening in kidney function in both acute (AHF) and chronic (CHF) patients is related to poor outcomes [1]. It is associated with a two-fold increase in all-cause mortality risk [1]. No matter the type of HF [5,6], WRF is related to a 2-3-fold increase in adverse in-hospital outcomes and 1.5-fold increase in 1-year mortality [5]

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