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. 2020 Jun;7(3):1150-1160.
doi: 10.1002/ehf2.12643. Epub 2020 Feb 13.

Comparison of creatinine-based methods for estimating glomerular filtration rate in patients with heart failure

Anna Jonsson  1 , Ida Viklund  2 , Andreas Jonsson  1 , Fredrik Valham  1 , Ellinor Bergdahl  1 , Krister Lindmark  1 , Helena Norberg  1   3
Affiliations

Comparison of creatinine-based methods for estimating glomerular filtration rate in patients with heart failure

Anna Jonsson et al. ESC Heart Fail. 2020 Jun.

Abstract

Aims: Glomerular filtration rate is an important factor in management of heart failure (HF). Our objective was to validate eight creatinine-based equations for estimating glomerular filtration rate (eGFR) in an HF population against measured glomerular filtration rate.

Methods and results: One hundred forty-six HF patients (mean age 68 ± 13 years, mean left ventricular ejection fraction 45% ± 15) within a single-centre hospital that underwent 51 Cr-EDTA clearance between 2010 and 2018 were included in this retrospective study. eGFR was estimated by means of Cockcroft-Gault ideal and actual weight, the Modification of Diet in Renal Disease Study (MDRD), simplified MDRD with isotope dilution mass spectroscopy traceable calibration, the Chronic Kidney Disease Epidemiology Collaboration, revised Lund-Malmö, full age spectrum, and the Berlin Initiative Study 1. Mean measured glomerular filtration rate was 42 mL/min/1.73 m2 . Pearson's correlation coefficient (r) had the highest precision for MDRD (r = 0.9), followed by revised Lund-Malmö (r = 0.88). All equations except MDRD (mean difference -4.8%) resulted in an overestimation of the renal function. The accuracy was below 75% for all equations except MDRD.

Conclusions: None of the exclusively creatinine-based methods was accurate in predicting eGFR in HF patients. Our findings suggest that more accurate methods are needed for determining eGFR in patients with HF.

Keywords: Creatinine; Estimated glomerular filtration rate; Heart failure; Renal function.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Mean glomerular filtration rate (±1 SD) mL/min/1.73 m2. For details, see Supporting Information, Table S1 .
Figure 2
Figure 2
Pearson's correlation coefficient (r). For details, see Table 2. McNemar test with glomerular filtration rate 30 mL/min/1.73 m2 limits (green lines): P < 0.001 for all tests except MDRD (P = 0.727).
Figure 3
Figure 3
Bland–Altman scatterplots of the distribution of the true 51Cr‐EDTA–measured GFR (mGFR) and each creatinine‐based equation for estimated glomerular filtration rate. The y axis shows the mean differences in % and the x axis the average of the mGFR and estimated glomerular filtration rate. The lines represent the mean difference in % and the upper and lower limits of agreement. For details, see Table 2.
Figure 4
Figure 4
P30 for each creatinine‐based equation for estimated glomerular filtration rate. P30 = the percentage of patients with estimated glomerular filtration rate within +30% of measured glomerular filtration rate. The dotted line represents the 75% cut‐off for acceptable accuracy. For details, see Table 2.
See this image and copyright information in PMC

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