Creatinine Clearance Measurement with Bioelectrical Impedance Analysis in Heart Failure Patients: Comparison with
Pietro Scicchitano1, Massimo Iacoviello2, Piero Guida3
1Cardiology Section, F. Perinei Hospital, Altamura, Bari, Italy.
Insights
The Donadio equation estimates kidney function similarly to the MDRD-4 formula in heart failure (HF) patients. Bioimpedance vector analysis (BIVA) aids in managing HF and assessing renal function.
Area of Science:
- Nephrology
- Cardiology
- Medical Technology
Background:
- Kidney disease frequently co-occurs with heart failure (HF).
- Estimating kidney function in HF patients is crucial for management.
- The Donadio equation integrates plasma creatinine and bioimpedance vector analysis (BIVA) for creatinine clearance estimation.
Purpose of the Study:
- To compare the Donadio equation's performance against established formulas (Cockcroft-Gault, MDRD-4, CKD-EPI) for estimating glomerular filtration rate (eGFR) in HF patients.
- To evaluate the accuracy of the Donadio equation in identifying severe renal dysfunction in this population.
Main Methods:
- Analysis of data from 900 heart failure patients (mean age 76 ± 10 years).
- Inclusion of clinical, laboratory, BIVA, and echocardiographic evaluations.
- Comparison of eGFR estimations derived from Donadio, CG, MDRD-4, and CKD-EPI equations.
Main Results:
- The Donadio equation showed good agreement with CG and MDRD-4, and fair agreement with CKD-EPI.
- It demonstrated high accuracy (AUC > 0.9) in predicting severe renal dysfunction (eGFR < 30 mL/min/1.73 m2), comparable to the CG formula.
- Prevalence of renal insufficiency varied by formula: 24% (Donadio), 21% (CG), 13% (MDRD-4), and 23% (CKD-EPI).
Conclusions:
- The Donadio equation provides GFR estimations comparable to MDRD-4 in HF patients, regardless of HF acuity.
- BIVA integration offers a valuable tool for both HF management and kidney function assessment in these patients.
Background:
Kidney disease is common in patients with heart failure (HF). The Donadio equation combines plasma creatinine and bioimpedance vector analysis (BIVA) to estimate creatinine clearance. This study aimed to compare the Donadio formula to the Cockcroft-Gault (CG), Modification of Diet in Renal Disease Study (MDRD-4), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in patients with HF.
Methods:
We analysed data from 900 patients (mean age: 76 ± 10 years) with HF. All of them underwent clinical, laboratory, BIVA, and echocardiographic evaluations.
Results:
Donadio equation overestimated eGFR as compared to CG and CKD-EPI formulas (+6.8 and +12 mL/min/1.73 m2, respectively) while computing similar results to MDRD-4 (overestimation: +0.1 mL/min/1.73 m2). According to the different formulas, the prevalence of renal insufficiency (eGFR< 30 ml/min/1.73 m2) in relation to the different formulas was as follows: 24% with Donadio, 21% with CG, 13% with MDRD-4, and 23% with CKD-EPI formulas. All the equations demonstrated a high precision rate (r>0.8 for all). There was a "good" agreement between the Donadio and CG/MDRD-4 formulas and "fair" with the CDK-EPI formula. The Donadio equation showed a high accuracy in predicting severe renal dysfunction (eGFR< 30 mL/min/1.73 m2) in patients with HF (AUC > 0.9), showing comparable performances to CG.
Conclusion:
The Donadio formula provided an estimation of GFR comparable to MDRD-4 in HF patients, independently from acute or chronic HF conditions. The use of BIVA in HF patients may be adopted both for HF management and for evaluating kidney function.
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