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Detection and prognostic impact of renal dysfunction in patients with chronic heart failure and normal serum

Domenico Scrutinio1, Andrea Passantino, Rocco Lagioia

  • 1Division of Cardiology and Cardiac Rehabilitation, S Maugeri Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy. domenico.scrutinio@fsm.it

International Journal of Cardiology
|September 15, 2009
PubMed

Insights

In chronic heart failure patients with normal serum creatinine, the Cockcroft-Gault formula normalized for body-surface area (eCrCl(BSA)) better predicts mortality risk than other formulas. This identifies a high-risk subgroup needing closer monitoring.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Risk Assessment

Background:

  • Accurate renal dysfunction (RD) identification is vital for chronic heart failure (CHF) risk stratification.
  • CHF patients are at increased risk of RD, even with normal serum creatinine (SCr), due to reduced creatinine generation.
  • Standard renal function equations are less accurate at low SCr levels.

Purpose of the Study:

  • To assess and compare the prognostic value of different renal function estimation formulas in CHF patients with normal SCr.
  • To identify the most accurate formula for predicting mortality in this specific patient group.

Main Methods:

  • Study included 462 patients with systolic CHF and normal SCr.
  • Estimated creatinine clearance using Cockcroft-Gault (eCrCl) and MDRD equation (eGFR).
  • Calculated eCrCl normalized for body-surface area (eCrCl(BSA)).
  • Primary outcome was 2-year all-cause mortality.

Main Results:

  • The eCrCl(BSA) was the only significant predictor of mortality (p = 0.006).
  • Patients in the lowest eCrCl(BSA) quartile had a 2.1-fold increased mortality risk.
  • Two-year survival was significantly lower in the lowest eCrCl(BSA) quartile (70.4%) compared to the referent quartile (89.7%).
  • Other mortality predictors included ischemic etiology, NYHA class, low LVEF, and anemia.

Conclusions:

  • A significant proportion of CHF patients with normal SCr have prognostically relevant RD.
  • The Cockcroft-Gault formula corrected for BSA (eCrCl(BSA)) more accurately identifies this high-risk subgroup than the MDRD equation.
  • These findings highlight the importance of using appropriate formulas for renal function assessment in CHF management.
Abstract

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