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Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality

Iokfai Cheang1, Shengen Liao, Wenming Yao

  • 1Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Medicine
|October 31, 2020
PubMed

Insights

Estimating kidney function using cystatin C-based equations improves mortality risk prediction in acute heart failure (AHF) patients compared to creatinine-based methods. This enhanced accuracy aids in better patient stratification and management.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Chemistry

Background:

  • Renal function is a critical risk marker for mortality in acute heart failure (AHF).
  • Routine estimation of glomerular filtration rate (eGFR) using serum creatinine is often imprecise.
  • Accurate assessment of renal function is vital for prognostic stratification in AHF.

Purpose of the Study:

  • To compare the prognostic impact of different CKD-EPI equations for eGFR estimation in AHF patients.
  • To evaluate the mortality stratification capabilities of creatinine-based (eGFRcr), cystatin C-based (eGFRcyst), and combined creatinine-cystatin C-based (eGFRcrcyst) equations.
  • To determine which eGFR equation provides superior prediction of all-cause mortality in AHF.

Main Methods:

  • Prospective inclusion of 354 AHF patients between January 2012 and June 2016.
  • Measurement of serum creatinine and cystatin C from the same blood sample on admission.
  • Quantification of eGFR using CKD-EPI creatinine (eGFRcr), cystatin C (eGFRcyst), and combined (eGFRcrcyst) equations.
  • Statistical analysis including continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) to compare prognostic value.

Main Results:

  • After a median follow-up of 35 months, 161 patients (45.5%) died.
  • Reduced eGFRcyst and eGFRcrcyst were significantly associated with increased mortality.
  • eGFRcyst demonstrated the best area under the curve (0.706) for predicting all-cause mortality.
  • eGFRcyst and eGFRcrcyst showed improved risk prediction compared to eGFRcr, with eGFRcyst providing further significant improvement over eGFRcrcyst.

Conclusions:

  • The CKD-EPI cystatin C-based equation (eGFRcyst) significantly improves mortality risk stratification in AHF patients.
  • eGFRcyst offers superior prognostic value compared to both creatinine-based (eGFRcr) and combined creatinine-cystatin C-based (eGFRcrcyst) equations.
  • Utilizing cystatin C-based eGFR estimation is recommended for enhanced risk assessment in acute heart failure management.

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