Renal Dysfunction in Patients With Heart Failure With Preserved Versus Reduced Ejection Fraction
Year: 2012
Type: article
Abstract: BACKGROUND: Prior studies in heart failure (HF) have used the Modification of Diet in Renal Disease (MDRD) equation to calculate estimated glomerular filtration rate (eGFR). The Chronic Kidney Disease-Epidemiology Collaboration Group (CKD-EPI) equation provides a more-accurate eGFR 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 patients with HF by eGFR using the CKD-EPI and the MDRD equations and examined survival across eGFR strata. In 20 754 patients (15 962 with HF with reduced ejection fraction [HF-REF] and 4792 with HF with preserved ejection fraction [HF-PEF]; mean age, 68 years; deaths per 1000 patient-years, 151; 95% CI, 146-155), 10 589 (51%) and 11 422 (55%) had an eGFR <60 mL/min using the MDRD and CKD-EPI equations, respectively. Use of the CKD-EPI equation resulted in 3760 (18%) patients being reclassified 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%-5.9%). Reduced eGFR was a stronger predictor of all-cause mortality in HF-REF than in HF-PEF. CONCLUSIONS: Use of the CKD-EPI rather than the MDRD equation to calculate eGFR leads to higher estimates of renal dysfunction in HF and a more-accurate categorization of mortality risk. Renal function is more closely related to outcomes in HF-REF than in HF-PEF.
Source: Circulation Heart Failure
Authors: Finlay A. McAlister, Justin Ezekowitz, Luigi Tarantini, Iain Squire, Michel Komajda, Antoni Bayes-Genis, Israel Gotsman, Gillian Whalley, Nikki Earle, Katrina K. Poppe, Robert N. Doughty, Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) Investigators
Institutions: Universitat Autònoma de Barcelona, University of Leicester, University of Auckland, University of Alberta, Hadassah Medical Center, Glenfield Hospital, Pitié-Salpêtrière Hospital, Hospital Universitari Germans Trias i Pujol, NIHR Leicester Biomedical Research Centre, Unitec Institute of Technology
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2224608232