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. 2010;116(3):206-12.
doi: 10.1159/000316038. Epub 2010 Aug 3.

Worsening renal function defined as an absolute increase in serum creatinine is a biased metric for the study of cardio-renal interactions

Jeffrey M Testani  1 , Brian D McCauley, Jennifer Chen, Michael Shumski, Richard P Shannon
Affiliations

Worsening renal function defined as an absolute increase in serum creatinine is a biased metric for the study of cardio-renal interactions

Jeffrey M Testani et al. Cardiology. 2010.

Abstract

Objectives: Worsening renal function (WRF) during the treatment of decompensated heart failure, frequently defined as an absolute increase in serum creatinine >or=0.3 mg/dl, has been reported as a strong adverse prognostic factor in several studies. We hypothesized that this definition of WRF is biased by baseline renal function secondary to the exponential relationship between creatinine and renal function.

Methods: We reviewed consecutive admissions with a discharge diagnosis of heart failure. An increase in creatinine >or=0.3 mg/dl (WRF(CREAT)) was compared to a decrease in GFR >or=20% (WRF(GFR)).

Results: Overall, 993 admissions met eligibility. WRF(CREAT) occurred in 31.5% and WRF(GFR) in 32.7%. WRF(CREAT) and WRF(GFR) had opposing relationships with baseline renal function (OR = 1.9 vs. OR = 0.51, respectively, p < 0.001). Both definitions had similar unadjusted associations with death at 30 days [WRF(GFR) OR = 2.3 (95% CI 1.1-4.8), p = 0.026; WRF(CREAT) OR = 2.1 (95% CI 1.0-4.4), p = 0.047]. Controlling for baseline renal insufficiency, WRF(GFR) added incrementally in the prediction of mortality (p = 0.009); however, WRF(CREAT) did not (p = 0.11).

Conclusions: WRF, defined as an absolute change in serum creatinine, is heavily biased by baseline renal function. An alternative definition of WRF should be considered for future studies of cardio-renal interactions.

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Figures

Fig. 1
Fig. 1
Relationship between serum creatinine and estimated GFR. The solid lines represent an increase in serum creatinine of 0.3 mg/dl from the 10% creatinine value (0.8 mg/dl) to 1.1 mg/dl and the corresponding change in estimated GFR. The dashed lines represent a 0.3-mg/dl increase in serum creatinine from the 90% percentile value (3.0 mg/dl) to 3.3 mg/dl and the corresponding decrease in estimated GFR.
Fig. 2
Fig. 2
Incidence of WRF in patients with baseline renal insufficiency defined by different serum creatinine levels. WRFCREAT = Worsening renal function defined as increase in serum creatinine by ≥0.3 mg/dl; WRFGFR = worsening renal function defined as a decrease in estimated GFR of ≥20%.
See this image and copyright information in PMC

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