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Published on: May 10, 2013
Mortality from renal dysfunction in heart transplant patients: creatinine versus glomerular filtration rate
J Navarro-Manchón1, L Almenar Bonet, L Martínez-Dolz
1Heart Failure and Transplant Unit, Department of Cardiology, La Fe University Hospital, Valencia, Spain. villacampus@hotmail.com
Insights
Serum creatinine and glomerular filtration rate (GFR) at one year post-heart transplant (HT) showed similar prognostic value for long-term mortality. Neither parameter offered additional benefit over the other in predicting patient survival after HT.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Renal dysfunction is a significant complication following heart transplantation (HT).
- Glomerular filtration rate (GFR) is increasingly used to assess renal function, often replacing serum creatinine.
- Predicting long-term mortality after HT is crucial for patient management.
Purpose of the Study:
- To compare the prognostic value of serum creatinine versus GFR at 1 year post-HT for predicting long-term mortality.
- To determine if GFR offers additional predictive information beyond creatinine in this patient cohort.
Main Methods:
- A cohort of 316 heart transplant recipients surviving at least 1 year post-transplant was analyzed.
- Serum creatinine and GFR (calculated using the MDRD4 equation) were measured at 1 year post-HT.
- Receiver operating characteristic (ROC) curves were used to compare the predictive accuracy of both parameters for mortality during follow-up.
Main Results:
- Over a mean follow-up of 6 years, 97 patients (30.7%) died.
- Patients who died had significantly higher creatinine levels and lower GFR at 1 year post-HT compared to survivors.
- Both creatinine and GFR demonstrated similar, statistically significant (P=.002) areas under the ROC curve (0.61), indicating comparable predictive ability.
Conclusions:
- Glomerular filtration rate calculated by the MDRD4 equation did not provide additional prognostic value over serum creatinine.
- Neither serum creatinine nor GFR at 1 year post-heart transplantation reliably predicts long-term mortality in this study population.
- Further research may be needed to identify more robust biomarkers for predicting outcomes after heart transplantation.
Introduction:
One of the most common, significant problems after heart transplantation (HT) is the development of renal dysfunction. In recent years, the glomerular filtration rate (GFR) has replaced the serum creatinine as the standard parameter for its determination. Our objective was to analyze which renal function parameter (creatinine or GFR) at 1 year after HT better classified patients who will die during follow-up.
Patients And Methods:
The study included 316 consecutive HT patients surviving at least 1 year after transplantation. Creatinine and GFR were determined by the Modification of Diet in Renal Disease Study (MDRD4) equation. Mortality during the follow-up was analyzed to compare both parameters using receiver operating characteristic curves.
Results:
Over a mean follow-up of 6±3 years, 97 patients died (30.7%). At 1 year after HT, the patients who succumbed displayed a significantly higher mean creatinine value (1.63±0.65 vs 1.41±0.64 mg/dL; P=.004) and a more decreased GFR (53.8 vs 60.8 mL/min/1.73 m2; P=.006). Both groups had the same area under the curve, 0.61 (95% confidence interval: 0.54-0.68; P=.002).
Conclusion:
Among our population, GFR calculated by the abbreviated MDRD4 equation did not provide any additional prognostic value to serum creatinine at 1 year after HT to predict long-term mortality.
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