Renal Dysfunction in Heart Failure Patients with Preserved versus Reduced Ejection Fraction: Impact of the New CKD-EPI Formula.
Circ Heart Fail. 2012 Mar 22;
Authors: McAlister FA, Ezekowitz JA, Tarantini L, Squire I, Komajda M, Bayes-Genis A, Gotsman I, Whalley G, Earle N, Poppe KK, Doughty RN
Abstract
BACKGROUND: -Prior studies in heart failure have used the Modification of Diet in Renal Disease (MDRD) equation to estimate Glomerular Filtration Rate (eGFR). The Chronic Kidney Disease-Epidemiology Collaboration Group equation (CKD-EPI) more accurately estimates GFR than the MDRD when compared against the radionuclide gold standard. The prevalence and prognostic import of renal dysfunction in HF if the CKD-EPI equation is used rather than the MDRD is uncertain. METHODS AND RESULTS: -We used individual patient data from 25 prospective studies to stratify heart failure patients by eGFR using the CKD-EPI and the MDRD equations and examined survival across eGFR strata. In 20 754 patients (15 962 with reduced ejection fraction [HF-REF] and 4792 with preserved ejection fraction [HF-PEF], mean age 68 years, 151 [95%CI 146-155] deaths per 1000 patient-years), 10 589 (51%) had eGFR < 60 ml/min using the MDRD equation and 11 422 (55%) using the CKD-EPI equation. Using the CKD-EPI equation resulted in 3760 (18%) patients being re-classified into different eGFR risk strata; 3089 (82%) were placed in a lower eGFR category and exhibited higher all-cause mortality rates (net reclassification improvement with CKD-EPI 3.7%, 95% CI 1.5% to 5.9%). Reduced eGFR was a stronger predictor of all-cause mortality in HF-REF than HF-PEF. CONCLUSIONS: -Use of the CKD-EPI equation rather than the MDRD to calculate eGFR leads to higher estimates of renal dysfunction in heart failure and more accurate categorization of mortality risk. Renal function is more closely related to outcomes in HF-REF than in HF-PEF.
PMID: 22441773 [PubMed - as supplied by publisher]