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Prognostic Comparison of the Estimations of Renal Function in Patients With Acute Heart Failure
Yu-Lun Cheng1,2,3, Shih-Hsien Sung1,2,3, Hao-Min Cheng4,5,2
1Department of Medicine, Taipei Veterans General Hospital.
Insights
The four-level Race Chronic Kidney Disease-Epidemiology Collaboration study equation (CKD-EPI4R) better predicts mortality in acute heart failure (AHF) patients than the Chinese-modified Modification of Diet in Renal Disease equation (cMDRD). CKD stages from CKD-EPI4R improve risk stratification for AHF survival.
Area of Science:
- Cardiology
- Nephrology
- Epidemiology
Background:
- The prognostic significance of estimated glomerular filtration rate (eGFR) equations in Asian patients with acute heart failure (AHF) remains underexplored.
- Comparison between the CKD-EPI4R and cMDRD equations for predicting outcomes in AHF populations is lacking.
Purpose of the Study:
- To compare the prognostic capabilities of eGFR calculated by CKD-EPI4R versus cMDRD in Asian patients with AHF.
- To evaluate the effectiveness of these eGFR equations in predicting long-term mortality and improving risk stratification.
Main Methods:
- A cohort of 3,044 hospitalized AHF patients was analyzed.
- Data linkage with the National Death Registry identified deaths within a 5-year follow-up period.
- Net reclassification improvement (NRI) was used to compare the prognostic value of eGFRcMDRD and eGFRCKD-EPI4R.
Main Results:
- Both eGFRcMDRD and eGFRCKD-EPI4R were independently associated with mortality in AHF patients (HR per 1-SD: 0.76 and 0.74, respectively).
- eGFRCKD-EPI4R demonstrated a 2.0% improvement in predicting death compared to eGFRcMDRD.
- CKD stages derived from eGFRCKD-EPI4R significantly outperformed eGFRcMDRD in risk stratification, with categorical NRI ranging from 8.3% to 11.5% across subgroups.
Conclusions:
- Both eGFR equations are significant independent predictors of long-term survival in AHF.
- The CKD stages determined by the eGFRCKD-EPI4R equation provide superior risk stratification for mortality compared to the eGFRcMDRD equation in AHF patients.
Background:
The prognostic significance of the eGFR calculated by either the four-level Race Chronic Kidney Disease-Epidemiology Collaboration study equation (CKD-EPI4R) or the Chinese-modified Modification of Diet in Renal Disease equation (cMDRD) has not been compared in Asian populations with acute heart failure (AHF).
Methods And Results:
A total of 3,044 patients hospitalized for AHF were enrolled. The National Death Registry was linked to identify deaths within a 5-year follow-up. Net reclassification improvement (NRI) was calculated to compare the prognostic value of either eGFR equation. During a median follow-up of 23.3 months, 1,424 (47%) patients died. Both eGFRcMDRDand eGFRCKD-EPI4Rwere independently predictive of death in the total study population (hazard ratio and 95% confidence intervals per 1-SD: 0.76, 0.71-0.81 and 0.74, 0.70-0.79, respectively), and in the subgroups of either reduced (HFrEF) or preserved (HFpEF) ejection fraction, after accounting for important confounders. With reference to eGFRcMDRD, eGFRCKD-EPI4Rmay improve the NRI by 2.0% (0.8-3.2%) for the prediction of death. The prognostic value of the CKD stages categorized by eGFRCKD-EPI4Rsignificantly outperformed eGFRcMDRDwith a categorical NRI of 9.5% (4.7-14.3%) in the total study population, 11.5% in HFrEF, and 8.3% in HFpEF.
Conclusions:
Both eGFRcMDRDand eGFRCKD-EPI4Rwere independently associated with long-term survival in patients with AHF. However, the CKD stages derived from eGFRCKD-EPI4Rimproved the risk stratification of death, compared with eGFRcMDRD.
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