Article Text
Abstract
Background It is unknown how the creatinine-based renal function estimations differ for dose adjustment cut-offs and risk prediction in patients with heart failure.
Method and results The renal function was similar with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) (median 59 mL/min/1.73 m2, IQR 42 to 77) and Modification of Diet in Renal Disease Study (MDRD) (59 mL/min/1.73 m2, IQR 43 to 75) and slightly lower with the Cockcroft-Gault (CG) equation (57 mL/min, IQR 39 to 82). Across the commonly used renal function stages, the CKD-EPI and the MDRD classified patients into the same stage in 87.2% (kappa coefficient 0.83, p<0.001); the CKD-EPI and the CG equation agreed in 52.3% (kappa coefficient 0.39, p<0.001). Hence, a differing number of patients will receive dose adjustment depending on which formula is used as cut-off. The CG equation predicted worse prognosis better (c-statistics 0.740, 95% CI 0.734 to 0.746) than CKD-EPI (0.697, 95% CI 0.690 to 0.703, p<0.001) and MDRD (0.680, 95% CI 0.734 to 0.746). Using net reclassification improvement (NRI), the CG identified 12.8% more patients at higher risk of death as compared with the CKD-EPI equation.
Patients registered in the Swedish Heart Failure Registry (n= 40 736) with standardised creatinine values between 2000 and 2012 had their renal function estimated with the CKD-EPI, the MDRD and the CG. Agreement between the formulas was compared for categories. Prediction of death was assessed with c-statistics and with NRI.
Conclusion The choice of renal function estimation formula has clinical implications and differing results at various cut-off levels. For prognosis, the CG predicts mortality better than the CKD-EPI and MDRD.
- heart failure
- register
- creatinine
- renal function estimation
- application
- prognosis
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Footnotes
Contributors KS: statistical analysis; analysis and interpretation of data; critical revision manuscript. ME: study concept and design; interpretation of data; critical revision manuscript. LB: statistical anlalysis; analysis and interpretation of data. UD: founder of and registrar for the Swedish Heart Failure Registry; study concept and design; interpretation of data; critical revision manuscript; funding; administrative support; technical and material support. UA, JJC: study concept and design; interpretation of data; critical revision manuscript. LHL: study concept and design; acquisition of data; analysis and interpretation of data; drafting of manuscript; funding; administrative support; supervision.
Competing interests KS: lecture fee AstraZeneca and Aspen; ME: Lecture fee from Amgen; UD: Research grants to author’s institution, speaker’s/consulting fees: Astra-Zeneca, Novartis, Vifor Pharma; UA and LB: reports no conflict of interest; LHL: Research grants to author’s institution, speaker’s/consulting fees: Astra-Zeneca, Novartis, Vifor Pharma, Boston Scientific; JJC: No conflit of interest.
Ethics approval Ethics Committee in Stockholm.
Provenance and peer review Not commissioned; externally peer reviewed.