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Published on: May 10, 2013
Comparison of creatinine-based methods for estimating glomerular filtration rate in patients with heart failure
Anna Jonsson1, Ida Viklund2, Andreas Jonsson1
1Department of Public Health and Clinical Medicine, Umeå University, Umeå, S-901 87, Sweden.
Insights
Estimating glomerular filtration rate (eGFR) using creatinine-based equations is inaccurate in heart failure (HF) patients. New methods are needed for precise eGFR assessment in HF management.
Area of Science:
- Nephrology
- Cardiology
- Clinical Chemistry
Background:
- Glomerular filtration rate (GFR) is crucial for managing heart failure (HF).
- Creatinine-based equations are commonly used to estimate GFR (eGFR).
- The accuracy of these equations in HF populations requires validation.
Purpose of the Study:
- To validate eight creatinine-based eGFR equations in a heart failure patient cohort.
- To compare the performance of these equations against measured GFR (mGFR).
Main Methods:
- Retrospective study of 146 HF patients with measured GFR (51Cr-EDTA clearance).
- Evaluated eight eGFR equations: Cockcroft-Gault (ideal/actual weight), MDRD, simplified MDRD, CKD-EPI, Lund-Malmö, Full Age Spectrum, and BIS1.
- Analyzed accuracy using Pearson's correlation coefficient and mean difference.
Main Results:
- Mean measured GFR was 42 mL/min/1.73 m².
- MDRD equation showed the highest precision (r=0.9), followed by revised Lund-Malmö (r=0.88).
- All equations except MDRD overestimated renal function; accuracy was below 75% for all but MDRD.
Conclusions:
- Creatinine-based eGFR equations demonstrate poor accuracy in heart failure patients.
- Current methods are insufficient for reliable eGFR determination in this population.
- Development of more accurate eGFR assessment tools for HF patients is warranted.
Aims:
Glomerular filtration rate is an important factor in management of heart failure (HF). Our objective was to validate eight creatinine-based equations for estimating glomerular filtration rate (eGFR) in an HF population against measured glomerular filtration rate.
Methods And Results:
One hundred forty-six HF patients (mean age 68 ± 13 years, mean left ventricular ejection fraction 45% ± 15) within a single-centre hospital that underwent 51 Cr-EDTA clearance between 2010 and 2018 were included in this retrospective study. eGFR was estimated by means of Cockcroft-Gault ideal and actual weight, the Modification of Diet in Renal Disease Study (MDRD), simplified MDRD with isotope dilution mass spectroscopy traceable calibration, the Chronic Kidney Disease Epidemiology Collaboration, revised Lund-Malmö, full age spectrum, and the Berlin Initiative Study 1. Mean measured glomerular filtration rate was 42 mL/min/1.73 m2 . Pearson's correlation coefficient (r) had the highest precision for MDRD (r = 0.9), followed by revised Lund-Malmö (r = 0.88). All equations except MDRD (mean difference -4.8%) resulted in an overestimation of the renal function. The accuracy was below 75% for all equations except MDRD.
Conclusions:
None of the exclusively creatinine-based methods was accurate in predicting eGFR in HF patients. Our findings suggest that more accurate methods are needed for determining eGFR in patients with HF.
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